Pediatr Emerg Med J.  2025 Jan;12(1):20-29. 10.22470/pemj.2024.01151.

Characterizing pediatric dermatological presentations in an outer metropolitan emergency department: a single-center Western Australian study

• Ng TTW
• Low DZY
• Tang AYC
• Foo MZQ
• Edgar DW
• Hill PA

• KMID: 2563128
• DOI: http://doi.org/10.22470/pemj.2024.01151

Abstract

Purpose
To characterize the patterns of demographic data, dermatologic diagnosis, and disposition regarding pediatric dermatological presentations in an emergency department (ED) at Armadale Health Service, a secondary outer metropolitan hospital in Perth, Western Australia.
Methods
Retrospective cross-sectional study auditing pediatric dermatological presentations to the ED from December 2022 through November 2023. We analyzed the age group, sex, dermatologic diagnosis, Australasian Triage Scale, ED length of stay, and disposition. The age group comprised infants, preschoolers, schoolers, and adolescents. The diagnosis included anaphylaxis and angioneurotic edema (AAE), allergy-related and urticarial dermatitis (AUD), eczema and other dermatitis (EOD), infective dermatoses, and not elsewhere classified.
Results
Of the 540 pediatric patients who presented to the ED with a dermatological complaint, 44.4% were girls with a median age of 4.5 years (interquartile range, 1.5-9.3) and a hospitalization rate of 7.6%. The dermatologic diagnoses consisted of AUD (34.3%), infective dermatoses (29.3%), EOD (23.3%), AAE (8.5%), and not elsewhere classified (4.6%). Most patients were triaged as an Australasian Triage Scale category 3-4, with a median ED length of stay of 2.3 hours (1.5-3.5 hours). Pairwise comparisons showed differences in the diagnoses between infants and preschoolers and between schoolers and adolescents for EOD and infective dermatoses (P < 0.001). The hospitalized patients showed a higher proportion of AAE, EOD, and infective dermatoses than those discharged (P < 0.001). Patients with AUD were hospitalized less (odds ratio, 0.06; 95% confidence interval, 0.12-0.30; compared with AAE). No dermatological emergencies, such as Stevens-Johnson syndrome, were identified.
Conclusion
Our findings underscore regional differences and support global efforts to reduce non-life-threatening pediatric dermatological presentations to the ED. This study may contribute to the ongoing discourse on effectively managing such presentations in EDs.

Keyword

Dermatology; Emergency Service, Hospital; Pediatric Emergency Medicine; Retrospective Studies; Skin Diseases; Western Australia

Reference

References

1. Barry KK, Hawryluk EB. Access to pediatric dermatology. Curr Opin Pediatr. 2022; 34:359–66.

2. Rubegni P, Cevenini G, Lamberti A, Bruni F, Tiezzi R, Verzuri A, et al. Dermatological conditions presenting at the Emergency Department in Siena University Hospital from 2006 to 2011. J Eur Acad Dermatol Venereol. 2015; 29:164–8.

3. Ansorge C, Miocic JM, von Bubnoff D, Technau-Hafsi K. Dermatological conditions presenting to the emergency dermatological unit of a university hospital in Germany. J Dtsch Dermatol Ges. 2018; 16:1451–6.

4. Landolt B, Staubli G, Lips U, Weibel L. Skin disorders encountered in a Swiss pediatric emergency department. Swiss Med Wkly. 2013; 143:w13731.

5. Auvin S, Imiela A, Catteau B, Hueˆ ´ V, Martinot A. Paediatric skin disorders encountered in an emergency hospital facility: a prospective study. Acta Derm Venereol. 2004; 84:451–4.

6. Cortellazzo Wiel L, Cozzi G, Hazim MM, Barbi E, Calligaris L. Pediatric emergency department access related to skin disorders. Pediatr Emerg Care. 2020; 36:e178–9.

7. Techasatian L, Uppala R, Phungoen P. Paediatric dermatological conditions in an emergency department: a single-centre study in Thailand. BMJ Paediatr Open. 2021; 5:e001215.

8. Kramkimel N, Soussan V, Beauchet A, Duhamel A, Saiag P, Chevallier B, et al. High frequency, diversity and severity of skin diseases in a paediatric emergency department. J Eur Acad Dermatol Venereol. 2010; 24:1468–75.

9. Jack AR, Spence AA, Nichols BJ, Chong S, Williams DT, Swadron SP, et al. Cutaneous conditions leading to dermatology consultations in the emergency department. West J Emerg Med. 2011; 12:551–5.

10. Garg T, Ahmed R, Basu S, Chander R. Clinical spectrum of dermatological disorders in children referred from pediatrics department. Indian J Paediatr Dermatol. 2019; 20:212–8.

11. Borland M, Skarin D, Nagree Y. Comparison of methods used to quantify general practice-type patients in the emergency department: a tertiary paediatric perspective. Emerg Med Australas. 2017; 29:77–82.

12. Sun L, Alpalha˜o M, Filipe P. Analysis of dermatology emergency consultations in a pediatric population: one-year retrospective audit from the largest Portuguese tertiary teaching hospital. Pediatr Dermatol. 2023; 40:139–41.

13. Shao E, Judge C, McMeniman E, Bazianas T, Eley R. Presenting patterns of dermatology conditions to an Australian emergency department. World J Emerg Med. 2020; 11:74–8.

14. Lai-Kwon JE, Weiland TJ, Jelinek GA, Chong AH. Which patients with dermatological conditions are admitted via the emergency department? Australas J Dermatol. 2014; 55:255–9.

15. Australian Institute of Health and Welfare (AIHW), Australian Government. ArmadaleKelmscott Memorial Hospital [Internet]. AIHW; 2023 [cited 2024 Jul 11]. Available from: https://www.aihw.gov.au/reportsdata/myhospitals/hospital/h0635.

16. Australian Bureau of Statistics. Armadale. 2021 Census all persons QuickStats [Internet]. Australian Bureau of Statistics; 2021 [cited 2024 Aug 25]. Available from: https://www.abs.gov.au/census/findcensus-data/quickstats/2021/LGA50210.

17. Australasian College for Emergency Medicine (ACEM). Triage [Internet]. ACEM; c2024 [cited 2024 Jul 21]. Available from: https://acem.org.au/ContentSources/Advancing-Emergency-Medicine/BetterOutcomes-for-Patients/Triage.

18. Child and Adolescent Health Service (CAHS), Australian Government. REDCap resources [Internet]. CAHS; 2024 [cited 2024 Jul 21]. Available from: https://cahs.health.wa.gov.au/Research/Forresearchers/Research-Education-Program/REDCapresources.

19. AlKhater SA, Dibo R, Al-Awam B. Prevalence and pattern of dermatological disorders in the pediatric emergency service. J Dermatol Dermatol Surg. 2017; 21:7–13.

20. Mathias RC, Jayaseelan E, Augustine M. Spectrum of pediatric dermatological emergencies at a tertiary care hospital in India: a descriptive study. Int J Dermatol. 2013; 52:27–31.

21. Monir RL, Schoch JJ. Clinical relevance of the microbiome in pediatric skin disease: a review. Dermatol Clin. 2022; 40:117–26.

22. Manus MB, Kuthyar S, Perroni-Maran˜o´n AG, Nu´n˜ez-de la Mora A, Amato KR. Infant skin bacterial communities vary by skin site and infant age across populations in Mexico and the United States. mSystems. 2020; 5:e00834–20.

23. Pathak R, Shrestha S, Poudel P, Marahatta S, Khadka DK. Association of socio-demographic factors and personal hygiene with infectious childhood dermatoses. Skin Health Dis. 2023; 3:e219.

24. Schneider AM, Nelson AM. Skin microbiota: friend or foe in pediatric skin health and skin disease. Pediatr Dermatol. 2019; 36:815–22.

25. Chiu LS, Ho MS, Hsu LY, Tang MB. Prevalence and molecular characteristics of Staphylococcus aureus isolates colonizing patients with atopic dermatitis and their close contacts in Singapore. Br J Dermatol. 2009; 160:965–71.

26. Chow A, Teo SH, Kong JW, Lee SB, Heng YK, van Steensel MAM, et al. Teledermatology in primary care in Singapore: experiences of family doctors and specialists. Acta Derm Venereol. 2021; 101:adv00540.

27. Miller BJ, Finnane A, Vun Y, Halloran S, Stapelberg A, Soyer HP, et al. Real-time teledermatology clinics in a tertiary public hospital: a clinical audit. Australas J Dermatol. 2020; 61:e383–7.