Tayfun ÖZTÜRK, ÖMER LEVENT AVŞAROĞULLARI, MURAT BORLU, BAHADIR TAŞLIDERE

ACİL SERVİSE DERMATOLOJİK YAKINMALAR İLE BAŞVURAN HASTALARIN ANALİZİ

Amaç:Çalışmanın amacı Acil Servise dermatolojik yakınmalarla başvuran hastaların demografik ve klinik özellikleri, konsültasyon, taburculuk ve hastaneye yatış oranları ile hayati tehlike arz edebilecek klinik tabloları hakkında bilgi vermektir. Materyal ve Metot:Erciyes Üniversitesi Tıp Fakültesi Acil Servisi’ne dermatolojik şikâyetlerle başvuran hastalardan 16 yaş ve üzeri olanlar dâhil edilerek prospektif olarak yapılmıştır. Değerlendirmede yaş, cinsiyet, özgeçmiş, başvuru yakınması ve ortaya çıkış zamanı, hastaneye başvurana kadar geçen süre, lezyonun tipi, tanısı, konsültasyonlar, hastaneye yatış ve taburculuk durumunu içeren parametreler yer almıştır. Bulgular:Çalışmaya toplam 400 hasta dâhil edilmiştir. Acil Servise başvuran hastaların % 0,70’ini dermatolojik yakınmalar ile gelenler oluşturuyordu. Hastaların 221’i (%55) kadın olup yaş ortalaması 38,6 yıldı.. Ciltte kızarıklık % 29,8 oranı ile en sık başvuru nedeni veürtikerençoktespitedilentanıdır(%54,3).Hastaların %48,3’ünün yakınmalar başladıktan en az 24 saat sonra Acil Servise başvurmuştur. %31’i konsülte edilmiş olup en sık nedenler; selülit ve anjioödemdir. ‘Gerçek dermatolojik acil’ olarak nitelendirilen nekrotizan fasiit, toksik epidermal nekroliz, eritema multiformebirerhastadagörülmüştür(%0.75).Hastaların %19’unun hastaneye yatırılmıştır ve en sık tanı selülittir (%30.8). Lezyon vücut yüzey alanının tek başına hastaneye yatış oranını etkilemediği görülmüştür. Sonuç:Dermatolojik yakınmalar ile başvuran hasta sayısının, tüm Acil Servis başvuruları içindeki oranı az olsa da özellikle yaşamı tehdit edebilecek sistemik organ etkilenmesi olan hastaların hastaneye yatırılarak tedavi edilmesi daha uygundur.

Evaluation of Patients Who Referred to Emergency Department with Dermatologic Complaints

Aim:The aim of this study was to give information about demographic and clinical characteristics, consultation, discharge, hospitalization rates and life-threatening clinical presentations of patients presenting to the Emergency Department with dermatological complaints. Materials and Methods:The study prospectively included patients older than 16 who were admitted to Erciyes University Hospital Emergency Department with dermatological complaints between. The evaluated parameters were age, gender, patients history, complaint, complaint onset, the period spent until admission, type of lesion, diagnosis, consultations, hospitalization, and discharge status. Results:A total of 400 patients were included in the study. Patients who presented with dermatological complaints represented %0.70 of all patients admitted to the Emergency Department. 221 (55%) of the patients were female with a mean age of 38.6 years. Skin redness was the most common cause of admission (29.8%) and urticaria was the most common diagnosis (54.3%). 48.3% of the patients applied to the emergency department at least 24 hours after the onset of symptoms. 31% of the patients were consulted. ‘True dermatological emergencies’ such as necrotizing fasciitis, toxic epidermal necrolysis, and erythema multiforme, were diagnosed in only three patients (0.75%). 19% of the patients were hospitalized and the most common diagnosis was cellulitis (30.8%). The body surface area of the lesion alone did not affect the rate ofhospitalization. Conclusion:The proportion of patients presenting with dermatological complaints to the Emergency Department is limited. Especially, patients with accompanying life-threatening systemic organ involvement should be hospitalized.

PDF

___

1. Peart JM, Sharma P, Kovarik CL, Carr BG, Rosenbach M, Lipoff JB. Prevalence of dermatologic disease in an urban emergency department: a cross-sectional study. J Am Acad Dermatol.2015;72(5):920-1.
2. Erdoğan HK, Altunay İK, Köşlü A. Evaluation of Dermatologic Emergency Patients: An Unicentral Prospective Clinical Study. Turkderm.2009;43:144-8.
3. Martínez-García E. Skin Diseases in the Emergency Department: Impact on Patient Quality of Life. Actas Dermosifiliogr.2017;108(10):892.
4. Grillo E, Vaoo-Galvan S, Jimenez-Gomez N, Ballester A,Ballester A,Muñoz-Zato E,Jaén P. Dermatologic emergencies: descriptive analysis of 861 patients in a tertiary care teaching hospital. Actas Dermo- Sifiliograficas.2013;104(4):316-24.
5. Baibergenova A, Shear NH. Skin conditions that bring patients to emergency departments Arch Dermatol. 2011;147(1):118-20.
6. Thomas JJ, Perron AD, Brady WJ. Approach to Skin Disorders in the Emergency Department. In Tintinalli JE, Stapczynski JS, Cline DM, Ma OJ, Cydulka RK, Meckler GD, editors. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York: McGraw- Hill,2011;1599-611.
7. Browne BJ, Edwards B, Rogers RL. Dermatologic Emergencies. Prim Care.2006;33(3):685-95.
8. Hassan I, Rather PA. Emergency dermatology and need of dermatological intensive care unit. Pak J Med. 2013;1:71-82.
9. Wang E, Lim BL, Than KY. Dermatological conditions presenting at an emergency department in Singapore. Singapore Med J.2009;50(9):881-4.
10. 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(4):551-5.
11. Dertlioğlu SB, Çiçek D, Bozdemir MN, Kandi B. Fırat Üniversitesi Tıp Fakültesi acil servisine başvuran dermatoloji hastalarının değerlendirilmesi. J Kartal. 2010;21(2):84-8.
12. Kılıçaslan İ, Bozan H, Oktay C. Demographic properties of patients presenting to the emergency department in Turkey. Turk J Emerg Med. 2005;5:5- 13.
13. Martinez ML, Escario-Travesedo E, Rodriguez-Vaquez MAzaña-Defez JM,Martín de Hijas-Santos MC,Juan-Pérez-García L.Dermatology consultations in an emergency department prior to establishment of emergency dermatology cover. Actas Dermo- Sifiliograficas.2011;102(1):39-47.
14. Kaptanoğlu AF, Ozgol Y, Tınazlı M. Dermatological Applications to the Emergency Department of an University Hospital in Northern Cyprus. J Emerg Med Case Rep.2012;11:137-40.
15. Arakaki RY, Strazzula L, Woo E. The Impact of Dermatology Consultation on Diagnostic Accuracy and Antibiotic Use Among Patients With Suspected Cellulitis Seen at Outpatient Internal Medicine OfficesA Randomized Clinical Trial. JAMA Dermatol. 2014;150(10):1056-61.
16. Karadağ AS, Bilgili SG, Çalka Ö, Akdeniz N, Özkol HU, Aktar S. Akut Ürtikerli Yatan Hastaların Klinik Olarak Değerlendirilmesi. Turkderm. 2011;45(4):179- 83.
17. Diepgen TL. Occupational skin diseases. J Dtsch Dermatol Ges.2012;10(5):297-315.
18. Cherrez Ojeda I, Vanegas E, Felix M, Mata V, Cherrez S, Simancas-Racines D. Etiology of chronic urticaria: the Ecuadorian experience. World Allergy Organ J. 2018;11(1):1.
19. Symvoulakis EK, Krasagakis K, Komninos ID,Kastrinakis I,Lyronis I,Philalithis Aet al. Primary care and pattern of skin diseases in a Mediterranean island. BMC Fam Pract.2006;7:6.
20. Scichilone N, Callari A, Augugliaro G,MarcheseM,Togias A,Bellia V.The impact of age on prevalence of positive skin prick tests and specific IgE tests. Respir Med.2011;10(5):651-8.
21. Baş Y, Kalkan G, Seçkin HY, Takcı Z, Şahin S, Demir AK. Geriatrik Hastalarda Dermatolojik Sorunların Analizi. Turk J Dermatol.2014;2:95-100.
22. Demirseren DD, Emre S,Ateskan U, Metin A. Geriatri poliklinik hastalarında saptanan deri bulgularının prospektif analizi. Turk Geriatri Derg.2010;13:87-91.
23. Polat, M, İlhan, MN. Dermatological complaints of the elderly attending a dermatology outpatient clinic in Turkey: a prospective study over a one-year period. Acta Dermatovenerol Croat.2015;23(4):277-81.
24. Baibergenova A, Shear NH. Skin conditions that bring patients to emergency departments. Arch Dermatol.2011;147(1):118-20.
25. Hess MR, Hess SP. Skin Disorders Common On The Trunk, Drug Reactions. In: Tintinalli, editors. J. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7 th ed. New York: McGraw-Hill ;2010; 1663.
26. Bigby M. Rates of cutaneous reactions to drugs. Arc Dermatol.2001;137:765-70.
27. Adışen E, Karaca F, Gürer AM. Dermatolojide ilaç reaksiyonları. Turk J Dermatol.2008;2:1-5.