Study Identifies Predictors of Hospital Admission for Those with Dermatological Conditions

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Predictive factors such as age ≥ 45 years, length of emergency department stay, male sex, high body mass index, and type of dermatological diagnoses are significantly associated with increased rates of hospital admission for dermatological emergencies, according to new findings.¹

These findings represented the conclusion of new research conducted in Switzerland to evaluate determinants and variables which are related to the disposal of patients and hospitalization of those in emergency departments for a dermatological condition. This research was led by S. Cazzaniga of the department of dermatology at Bern University Hospital in Switzerland.

The investigators noted that specialists given adequate training for dermatological conditions are necessary, so the identification of predictors for patients’ clinical pathways was determined to be an invaluable way to improve patient disposition following emergency department triage.²

“Therefore, our study had two objectives: first, to explore in patients with a (dermatological emergencies) the predictive factors and determinants leading to hospital admission with an analysis of the hospitalization rate; second, to gain insight into the trajectories of these hospitalized patients within the various departments after their initial evaluation in the (emergency department),” Cazzaniga and colleagues wrote.¹

Background and Design

The investigators conducted their single-center research at the University Hospital of Bern in the timeframe between February 2016 - September 2020, utilizing a retrospective trial design and assessing all consecutive patients who were admitted to the emergency department for dermatological emergencies. These individuals were noted by the investigators as having skin conditions which were deemed serious by either the patients themselves or referring clinicians, thereby necessitating a visit.

A discharge diagnosis along with a Diagnosis-Related Group (DRG) code for a skin issue was provided by the research team to individuals who had been admitted to the hospital. This would then help determine their payment based upon the Swiss Diagnosis Related Group (SwissDRG) system.

The team implemented the International Classification of Diseases, Tenth Revision (ICD-10) codes for the purposes of selecting dermatological patients to use as subjects for their research. Provided that multiple ICD-10 codes were observed, they would only involve subjects that had a primary dermatological diagnosis code.
When there was no code, subjects were determined by the investigators based on a set of keywords which matched ICD-10 definitions for dermatological conditions observed in the the diagnosis of a clinician. Following their first emergency department interaction, hospitalization and transference to a medical department for additional attention or a discharge occurred.

The choices of the emergency department related to disposition of these subjects involved a consultation with other specialists when it was deemed important. There were on-call dermatologists who were available for consultation within a half hour if needed.

The de-identified data of patients were extracted by the research team from the hospital's system of electronic medical records. Some of these data included triage scores, demographics, number of visits, and other related elements.

Findings

Overall, there had been 5,096 patients who went to the hospital’s emergency department due to a primary dermatological condition. The investigators reported that 79% had been admitted to the hospital following an earlier assessment.

The research team’s multivariable analyses pointed to several different factors which were found to be associated with higher rates of hospital admission. Some of the major examples the team found included being 45 years or older, extended stays in the department, male sex, low oxygen levels, abnormal vital signs, elevated body mass index (BMI), timing of admission to the department, and the number and types of dermatological issues.

While there were dermatological conditions which the investigators noted had been critical to diagnostic related group (DRG) payments, they found that only 2.2% of such individuals who had been hospitalized were sent to a dermatology ward. The team added that a substantial decline in numbers of subjects who had been treated by dermatologists over the course of their stay had been identified.

“Dermatology is increasingly marginalized in the management of inpatients in Switzerland,” they wrote. “The impact of this trend on patients' outcome is however unclear and needs further investigations. The best interest of patients, state-of-the-art medical management and cost-effectiveness should be taken into account for an adequate patients' disposal at an ED and organization of healthcare structures.”

References

1. ^{Cazzaniga S, Heidemeyer K, Zahn CA, Seyed Jafari SM, Sauter TC, Naldi L, et al. Dermatological emergencies and determinants of hospitalization in Switzerland: A retrospective study. J Eur Acad Dermatol Venereol. 2024; 00: 1–10. https://doi.org/10.1111/jdv.20176.}
2. ^{Lotti T, Handog EB, Hercogova J, Ramos ESM. International dermatology: the many faces and challenges of the specialty in the global village. Dermatol Clin. 2008; 26(2): 183–190, v.}
3. ^{Lim HW, Edison KE, Kauper KD, Hall MT, Lundberg M, Domanowski K. A 10-point plan to demonstrate the value of dermatology in the health care system. J Am Acad Dermatol. 2018; 79(2): 342–344.}