Paediatric dermatological conditions in an emergency department: a single-centre study in Thailand

BACKGROUND: Few studies have evaluated paediatric dermatological conditions and their associated factors that warrant admission at the emergency department. OBJECTIVES: The main objective of this study was to present the demographic information of paediatric dermatological conditions encountered in the emergency department and identify possible associated factors for hospital admission. METHODS: This retrospective cross-sectional study included paediatric patients who visited the emergency department between 1 January 2016 and 31 December 2019. Data collection was performed using an authorised electronic medical records programme at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. RESULTS: A total of 40 683 paediatric patients visited the emergency department during the study period, with 1701 cases presenting dermatological conditions. Infections were the most frequent conditions encountered in the emergency department (647, 38.0%), followed by urticaria/anaphylaxis (478, 28.1%), eczematous diseases (463, 27.2%), cutaneous drug eruptions (64, 3.7%) and miscellaneous (49, 2.9%). Among 1701 paediatric cases with dermatological conditions, only 182 cases (10.7%) were admitted to the hospital and required further management. Cases presenting cutaneous drug eruptions had the highest proportion of hospital admissions (60.9%) and were significantly different from cases in other dermatologic categories (p<0.001). The association of admission found an OR of 0.96 for every year of increase in age (95% CI 0.93 to 0.99, p=0.003). CONCLUSION: The present study found that the majority of patients with cutaneous conditions visiting the emergency department were non-urgent; however, dermatological emergencies exist and should not be underestimated. Younger paediatric patients presenting with dermatological condition is a population with a high risk for hospital admission. Cutaneous drug eruptions showed the highest proportion of hospital admissions compared with other dermatological categories. Therefore, physicians in the emergency department should always look for specific cutaneous signs of drug eruptions, such as target-like lesions and mucosal involvement in Steven-Johnsons syndrome/toxic epidermal necrolysis to prevent misdiagnosis of this dermatological condition.