Rita Buckley

NEW YORK (Reuters Health) - Inpatient dermatology consultations for skin disorders are associated with improved diagnostic accuracy and faster intervention, researchers have

found.

Information about the impact of hospitalist dermatology consultative services is limited, Dr. Daniela Kroshinsky from Massachusetts General Hospital in Boston and colleagues note in JAMA  Dermatology, online January 13.

To learn more, the team conducted a cross-sectional study of data from dermatology consult teams at four academic medical centers in the U.S. Full-time inpatient dermatologists with resident teams performed a total of 1,661 inpatient dermatology consultations within 24 to 48 hours of request over 12 months from 2008 to 2009.

All final diagnoses were based on clinical history, examination findings, and laboratory testing. Each service (primary team) that asked for a dermatology consult provided its presumptive diagnosis at the time of its request.

The most common primary teams were Medicine (47%), followed by Surgery (15%), Intensive Care Units (12%), and Hematology-Oncology (9%). The most commonly undiagnosed or misdiagnosed conditions by the primary teams were cellulitis, leg ulcerations, and viral infections. The majority of primary team preliminary diagnoses included rash/unknown (n=814), followed by cellulitis/abscess (n=115), and drug rash (n=111). The majority of primary diagnoses by dermatologists included drug rash (n=292; 18%), psoriasis/eczema (n=170; 10%), and benign neoplasm (n=168; 10%).

The dermatologists identified additional cutaneous issues in 298 (18%) of consults; diagnosis was confirmed by biopsy in 667 (40%) patients. Overall, dermatology consultation changed the final diagnosis in 71% of consultation requests.

Just under a third of the patients were admitted to the hospitals because of their skin conditions. In the remaining cases, the dermatologic issues were found incidentally or developed during hospitalization.

In 40% of cases, dermatology-specific evaluation and treatment recommendations were carried out in a single visit; 29% required one follow-up evaluation and 16% required two.

"This is the first multicenter national study to define the nature of dermatologic issues presenting to academic medical centers and to demonstrate the impact dermatologists have on improving the correct diagnosis of patients with skin issues,"Dr. Kroshinsky told Reuters Health by email.

Hospitalist dermatology is an important and effective subset of dermatology and hospital medicine, she said.

"Ideally," Dr. Kroshinsky added, "hospitals would have access to a dermatologist in real-time or via teledermatology."

NEW YORK (Reuters Health) - Inpatient dermatology consultations for skin disorders are associated with improved diagnostic accuracy and faster intervention, researchers have

found.

Information about the impact of hospitalist dermatology consultative services is limited, Dr. Daniela Kroshinsky from Massachusetts General Hospital in Boston and colleagues note in JAMA  Dermatology, online January 13.

To learn more, the team conducted a cross-sectional study of data from dermatology consult teams at four academic medical centers in the U.S. Full-time inpatient dermatologists with resident teams performed a total of 1,661 inpatient dermatology consultations within 24 to 48 hours of request over 12 months from 2008 to 2009.

All final diagnoses were based on clinical history, examination findings, and laboratory testing. Each service (primary team) that asked for a dermatology consult provided its presumptive diagnosis at the time of its request.

The most common primary teams were Medicine (47%), followed by Surgery (15%), Intensive Care Units (12%), and Hematology-Oncology (9%). The most commonly undiagnosed or misdiagnosed conditions by the primary teams were cellulitis, leg ulcerations, and viral infections. The majority of primary team preliminary diagnoses included rash/unknown (n=814), followed by cellulitis/abscess (n=115), and drug rash (n=111). The majority of primary diagnoses by dermatologists included drug rash (n=292; 18%), psoriasis/eczema (n=170; 10%), and benign neoplasm (n=168; 10%).

The dermatologists identified additional cutaneous issues in 298 (18%) of consults; diagnosis was confirmed by biopsy in 667 (40%) patients. Overall, dermatology consultation changed the final diagnosis in 71% of consultation requests.

Just under a third of the patients were admitted to the hospitals because of their skin conditions. In the remaining cases, the dermatologic issues were found incidentally or developed during hospitalization.

In 40% of cases, dermatology-specific evaluation and treatment recommendations were carried out in a single visit; 29% required one follow-up evaluation and 16% required two.

"This is the first multicenter national study to define the nature of dermatologic issues presenting to academic medical centers and to demonstrate the impact dermatologists have on improving the correct diagnosis of patients with skin issues,"Dr. Kroshinsky told Reuters Health by email.

Hospitalist dermatology is an important and effective subset of dermatology and hospital medicine, she said.

"Ideally," Dr. Kroshinsky added, "hospitals would have access to a dermatologist in real-time or via teledermatology."

NEW YORK (Reuters Health) - Inpatient dermatology consultations for skin disorders are associated with improved diagnostic accuracy and faster intervention, researchers have

found.

Information about the impact of hospitalist dermatology consultative services is limited, Dr. Daniela Kroshinsky from Massachusetts General Hospital in Boston and colleagues note in JAMA  Dermatology, online January 13.

To learn more, the team conducted a cross-sectional study of data from dermatology consult teams at four academic medical centers in the U.S. Full-time inpatient dermatologists with resident teams performed a total of 1,661 inpatient dermatology consultations within 24 to 48 hours of request over 12 months from 2008 to 2009.

All final diagnoses were based on clinical history, examination findings, and laboratory testing. Each service (primary team) that asked for a dermatology consult provided its presumptive diagnosis at the time of its request.

The most common primary teams were Medicine (47%), followed by Surgery (15%), Intensive Care Units (12%), and Hematology-Oncology (9%). The most commonly undiagnosed or misdiagnosed conditions by the primary teams were cellulitis, leg ulcerations, and viral infections. The majority of primary team preliminary diagnoses included rash/unknown (n=814), followed by cellulitis/abscess (n=115), and drug rash (n=111). The majority of primary diagnoses by dermatologists included drug rash (n=292; 18%), psoriasis/eczema (n=170; 10%), and benign neoplasm (n=168; 10%).

The dermatologists identified additional cutaneous issues in 298 (18%) of consults; diagnosis was confirmed by biopsy in 667 (40%) patients. Overall, dermatology consultation changed the final diagnosis in 71% of consultation requests.

Just under a third of the patients were admitted to the hospitals because of their skin conditions. In the remaining cases, the dermatologic issues were found incidentally or developed during hospitalization.

In 40% of cases, dermatology-specific evaluation and treatment recommendations were carried out in a single visit; 29% required one follow-up evaluation and 16% required two.

"This is the first multicenter national study to define the nature of dermatologic issues presenting to academic medical centers and to demonstrate the impact dermatologists have on improving the correct diagnosis of patients with skin issues,"Dr. Kroshinsky told Reuters Health by email.

Hospitalist dermatology is an important and effective subset of dermatology and hospital medicine, she said.

"Ideally," Dr. Kroshinsky added, "hospitals would have access to a dermatologist in real-time or via teledermatology."

Young adult cancer survivors will continue to have high hospitalization rates over time, a Canadian study shows.

In five-year cancer survivors diagnosed between ages 20 and 44, hospitalization rates were elevated for at least 20 years, compared to rates in age- and sex-matched controls, according to Dr. Nancy N. Baxter at St. Michael's Hospital in Toronto and colleagues.

For all malignancies except melanoma and testicular cancer, the adjusted relative rate (ARR) of hospitalizations was significantly higher among survivors than controls.

"Late effects and complications of cancer treatments are experienced by many survivors for the rest of their lives," Dr. Baxter told Reuters Health via e-mail. The patients in this population-based study were treated from 1992-1999. "Therapies have changed, she said. "In some cases there may be fewer late effects, but in others, they may be worse."

The study cohort included 20,275 survivors of young adult cancers who were recurrence-free for at least five years, and 101,344 controls. The authors observed survivors for a median of 9.93 years (range 0-16 years), according to their report online July 13 in the Journal of Clinical Oncology. During this period, 34.3% had at least one hospitalization,

vs. 27.3% for controls. The rate per 100 person-years was similar between male and female survivors.

Overall, the ARR of hospitalization in survivors compared with controls was 1.51. At all-time periods, survivors were more likely to be hospitalized than controls. The rate of hospitalization (per 100-person years) among survivors was 0.22 during years 5 to 8, 9 to11, and 12 to14. It decreased significantly during years 15 to 17 and 18 to 20, falling to 0.17 and 0.15, respectively (P<0.0001). Among controls, the hospitalization rate was relatively constant during all time periods, ranging from 0.13 at 5 to 8 years to 0.12 at years 18 to 20.

The ARR of hospitalizations in survivors compared with controls was also relatively constant during for the first three3 time periods: 1.67, 1.55, and 1.57 at years 5 to 8, 9 to

11, and 12 to 14, respectively. It decreased to 1.36 at 15 to 17 years and 1.22 at years 18 to 20. Those who survived gastrointestinal, urologic, colorectal, or brain cancers, or leukemia or lymphoma, had an ARR of hospitalization at least twice that of controls.

"We only looked at hospital admissions, not visits to the family doctor or medical conditions and disabilities that didn't require inpatient care," Dr. Baxter said, explaining that this likely underestimated the long-term impact of intense treatments that include surgery, chemotherapy, radiation, and hormonal therapy.

"Understanding the late effects of cancer treatment will help us design better treatments, counsel patients, and improve symptom management."

Young adult cancer survivors will continue to have high hospitalization rates over time, a Canadian study shows.

In five-year cancer survivors diagnosed between ages 20 and 44, hospitalization rates were elevated for at least 20 years, compared to rates in age- and sex-matched controls, according to Dr. Nancy N. Baxter at St. Michael's Hospital in Toronto and colleagues.

For all malignancies except melanoma and testicular cancer, the adjusted relative rate (ARR) of hospitalizations was significantly higher among survivors than controls.

"Late effects and complications of cancer treatments are experienced by many survivors for the rest of their lives," Dr. Baxter told Reuters Health via e-mail. The patients in this population-based study were treated from 1992-1999. "Therapies have changed, she said. "In some cases there may be fewer late effects, but in others, they may be worse."

The study cohort included 20,275 survivors of young adult cancers who were recurrence-free for at least five years, and 101,344 controls. The authors observed survivors for a median of 9.93 years (range 0-16 years), according to their report online July 13 in the Journal of Clinical Oncology. During this period, 34.3% had at least one hospitalization,

vs. 27.3% for controls. The rate per 100 person-years was similar between male and female survivors.

Overall, the ARR of hospitalization in survivors compared with controls was 1.51. At all-time periods, survivors were more likely to be hospitalized than controls. The rate of hospitalization (per 100-person years) among survivors was 0.22 during years 5 to 8, 9 to11, and 12 to14. It decreased significantly during years 15 to 17 and 18 to 20, falling to 0.17 and 0.15, respectively (P<0.0001). Among controls, the hospitalization rate was relatively constant during all time periods, ranging from 0.13 at 5 to 8 years to 0.12 at years 18 to 20.

The ARR of hospitalizations in survivors compared with controls was also relatively constant during for the first three3 time periods: 1.67, 1.55, and 1.57 at years 5 to 8, 9 to

11, and 12 to 14, respectively. It decreased to 1.36 at 15 to 17 years and 1.22 at years 18 to 20. Those who survived gastrointestinal, urologic, colorectal, or brain cancers, or leukemia or lymphoma, had an ARR of hospitalization at least twice that of controls.

"We only looked at hospital admissions, not visits to the family doctor or medical conditions and disabilities that didn't require inpatient care," Dr. Baxter said, explaining that this likely underestimated the long-term impact of intense treatments that include surgery, chemotherapy, radiation, and hormonal therapy.

"Understanding the late effects of cancer treatment will help us design better treatments, counsel patients, and improve symptom management."

Young adult cancer survivors will continue to have high hospitalization rates over time, a Canadian study shows.

In five-year cancer survivors diagnosed between ages 20 and 44, hospitalization rates were elevated for at least 20 years, compared to rates in age- and sex-matched controls, according to Dr. Nancy N. Baxter at St. Michael's Hospital in Toronto and colleagues.

For all malignancies except melanoma and testicular cancer, the adjusted relative rate (ARR) of hospitalizations was significantly higher among survivors than controls.

"Late effects and complications of cancer treatments are experienced by many survivors for the rest of their lives," Dr. Baxter told Reuters Health via e-mail. The patients in this population-based study were treated from 1992-1999. "Therapies have changed, she said. "In some cases there may be fewer late effects, but in others, they may be worse."

The study cohort included 20,275 survivors of young adult cancers who were recurrence-free for at least five years, and 101,344 controls. The authors observed survivors for a median of 9.93 years (range 0-16 years), according to their report online July 13 in the Journal of Clinical Oncology. During this period, 34.3% had at least one hospitalization,

vs. 27.3% for controls. The rate per 100 person-years was similar between male and female survivors.

Overall, the ARR of hospitalization in survivors compared with controls was 1.51. At all-time periods, survivors were more likely to be hospitalized than controls. The rate of hospitalization (per 100-person years) among survivors was 0.22 during years 5 to 8, 9 to11, and 12 to14. It decreased significantly during years 15 to 17 and 18 to 20, falling to 0.17 and 0.15, respectively (P<0.0001). Among controls, the hospitalization rate was relatively constant during all time periods, ranging from 0.13 at 5 to 8 years to 0.12 at years 18 to 20.

The ARR of hospitalizations in survivors compared with controls was also relatively constant during for the first three3 time periods: 1.67, 1.55, and 1.57 at years 5 to 8, 9 to

11, and 12 to 14, respectively. It decreased to 1.36 at 15 to 17 years and 1.22 at years 18 to 20. Those who survived gastrointestinal, urologic, colorectal, or brain cancers, or leukemia or lymphoma, had an ARR of hospitalization at least twice that of controls.

"We only looked at hospital admissions, not visits to the family doctor or medical conditions and disabilities that didn't require inpatient care," Dr. Baxter said, explaining that this likely underestimated the long-term impact of intense treatments that include surgery, chemotherapy, radiation, and hormonal therapy.

"Understanding the late effects of cancer treatment will help us design better treatments, counsel patients, and improve symptom management."