Üçüncü Basamak Bir Hastanede Dermatolojik Acil Durumlar: Tanımlayıcı Bir Çalışma

Yıl 2022, Cilt: 2 Sayı: 3, 42 - 45, 22.12.2022

Dilber Üçöz Kocaşaban , Mehmet Serkan Yurdakul , Figen Coşkun

https://doi.org/10.58252/artukluder.1175138

Öz

Amaç: Bu çalışmada, acil servise deri lezyonları ile gelen erişkin hastaların başvuru sıklıkları ve acil serviste konulan ana tanıların belirlenmesi amaçlanmıştır. Acil olmayan durumlarda hastaların dermatoloji polikliniği yerine acil servisi tercih etme nedenlerini araştırmayı amaçladık.
Gereç ve Yöntem: : Bu çalışma, üçüncü basamak bir hastanenin acil servisinde prospektif olarak yapıldı. Altı aylık bir süre içinde dermatolojik şikayetleri olan hastalar çalışmaya alındı. Temel epidemiyolojik ve klinik veriler ile hastaların ve klinisyenlerin bakış açısından durumun "gerçek bir acil durum" olup olmadığı kaydedilmiştir.
Bulgular: Çalışmaya 262 hasta dahil edildi. Acil serviste en sık görülen üç tanı akut ürtiker (%41.6), makülopapüler ilaç döküntüleri (%17.2) ve kaşıntı (%7.6) idi. Tüm hastaların 26'sına (%9,9) dermatoloji konsültasyonu istendi. Acil servis muayenesinin hasta ve hekim açısından gerekliliği değerlendirildiğinde ve durumun gerçekten acil olup olmadığı sorulduğunda 262 hastanın %74.0'ü durumunun acil olduğunu bildirdi, ancak hekimler sadece %40.0 hastanın acil müdahale ihtiyacı olduğunu değerlendirdi. Acil olmayan hastalarda acil servis seçiminde en önemli faktör sağlık güvencesinin olmamasıdır (%20,6).
Sonuç: Acil servise dermatolojik şikayetlerle başvuran hastalar her zaman "gerçek acil durumlar" değildir ve hastaların dermatoloji polikliniği yerine acil servis tercihinde çeşitli faktörler rol oynayabilir. Çalışmamızın sonucuna göre en sık acil servise başvuru nedeni sağlık sigortası sorunlarıydı.

Anahtar Kelimeler

Dermatolojik aciller, acil servis, üçüncü basamak hastane, cilt hastalıkları

Dermatological Emergencies in a Tertiary Hospital: A Descriptive Study

Öz

Objective: This study aims to determine the frequency of adult patients presenting to the emergency department with skin lesions, and the main diagnoses made in the ED. We aimed to investigate the reasons of patients choose the emergency department rather than dermatology outpatient clinics in non-emergency situations.
Material and Method: This is a prospective study conducted on patients with dermatological conditions diagnosed in the emergency department of a tertiary hospital during a 6-month period. Basic epidemiological and clinical characteristics, and whether the situation is a "real emergency" from the perspectives of the patients and clinicians were recorded.
Results: A total of 262 patients were included. The three most common diagnoses in the ED were acute urticaria (41.6%), maculopapular drug eruptions (17.2%) and pruritus (7.6%). Dermatology consultation was requested for 26 (9.9%) of all patients. When evaluating the necessity of emergency ED examination from the point of view of the patient and the physician, and asked whether the situation was emergent, 74.0% of 262 patients reported that their condition was emergent, but the physicians evaluated only 40.0% of patients has a truly emergent situation. The most important factor in the choice of ED in non-emergent patients was the lack of medical insurance (20.6%).
Conclusion: Patients who presented to the ED with dermatological complaints were not always "true emergencies" and several factors may play a role preference of patients’ for the ED instead of the outpatient dermatology clinic. The most common cause was medical insurance problems according to our results.

Anahtar Kelimeler

Dermatological emergencies, emergency department, tertiary hospital, skin disease

Kaynakça

• EMTALA Fact Sheet. Available from: https://www.acep.org/life-as-a-physician/ethics--legal/emtala/emtala-fact-sheet/Accessed Date: 22.01.2022.
• Alpalhão M, Uva L, Soromenho G, Filipe P. Dermatological emergencies: one-year data analysis of 8,620 patients from the largest Portuguese tertiary teaching hospital. Eur J Dermatol. 2016;26(5):460-464.
• Hernando I, González-López MA, Fernández-Llaca JH, Loricera J. Urgenciasdermatológicas: Estudiodescriptivoen un hospital terciario [Dermatological emergencies: A descriptive study in a tertiary hospital]. Semergen. 2019;45(3):156-163.
• Feldman SR, Fleischer AB Jr, McConnell RC. Most common dermatologic problems identified by internists, 1990-1994. Arch Intern Med. 1998;158(7):726-30.
• Kilic D, Yigit O, Kilic T, Buyurgan CS, Dicle O. Epidemiologic characteristics of patients admitted to emergency department with dermatological complaints; a retrospective cross-sectional study. Arch Acad Emerg Med. 2019;7(1):e47.
• Lai-Kwon JE, Weiland TJ, Jelinek GA, Chong AH. Which patients with dermatological conditions are admitted via the emergency department? Australas J Dermatol. 2014;55(4):255-9.
• Freiman A, Borsuk D, Sasseville D. Dermatologic emergencies. CMAJ. 2005;173(11):1317-9.
• Lowell BA, Froelich CW, Federman DG, Kirsner RS. Dermatology in primary care: Prevalence and patient disposition. J Am Acad Dermatol. 2001;45(2):250-5.
• Chan CY, Kam KL, Graham CA, Rainer TH, Luk NM. Clinical profile of skin diseases in accident and emergency department attenders. Hong Kong J Dermatol Venereol. 2007;15(1):4-9.
• Erdoğan HK, Altunay İK, Köşlü A. Evaluation of dermatologic emergency patients: An unicentral prospective clinical study. Türkderm. 2009;43:144-8.
• Legoupil D, Davaine AC, Karam A, PeuDuvallon P, et al. Evaluation d'une consultation d'urgencesendermatologie [Assessment of dermatological emergencies in a French university hospital]. Ann Dermatol Venereol 2005;132(11):857-9.
• Murr D, Bocquet H, Bachot N, Bagot M, Revuz J, Roujeau JC. Medical activity in a emergency outpatient dermatology department. Ann Dermatol Venereol. 2003;130:167-70.
• Penso-Assathiany D, Bourdon-Lanoy E, Derancourt C, Roujeau JC, Bastuji-Garin S. Demandes de rendez-vousenurgenceendermatologielibérale: ETudeUrgencesenDErmatologielibérale (ET.U.DE) [Requests for emergency appointments with dermatologists in private practice in France: The ETudeUrgencesenDErmatologielibérale (ET.U.DE) study]. Ann Dermatol Venereol. 2007;134(1):23-9.
• Son BS, Sihn MS, Kwon HJ, Kim BC, Lee KS, Song JY. A Statistical analysis of dermatologic emergency patients visiting the emergency room over 10 years (1986-1995). Korean J Dermatol. 1997;35:223-7.
• Grillo E, Vañó-Galván S, Jiménez-Gómez N, Ballester A, Muñoz-Zato E, Jaén P. Dermatologic emergencies: Descriptive analysis of 861 patients in a tertiary care teaching hospital. Actas Dermosifiliogr. 2013;104(4):316-24.
• Gupta S, Sandhu K, Kumar B. Evaluation of emergency dermatological consultations in a tertiary care centre in North India. J Eur Acad Dermatol Venereol. 2003;17(3):303-5.
• Republic of Turkey Social Security Institution. Available from: http://www.sgk.gov.tr/wps/portal/sgk/en/home-page/mainpage Date: 23.01.2022.