Profile of patients and characteristics of admissions to a tertiary dermatology ward in Sao Paulo, Brazil

Abstract

Dermatology is primarily an outpatient clinical and surgical specialty, but it also plays important roles in the care of inpatients who are admitted to dermatology beds. The aim of this study was to assess the epidemiologic, clinical, and laboratory data of patients admitted to the Dermatology Division of Hospital das Cl ınicas da Faculdade de Medicina da Universidade de São Paulo. We performed a retrospective study of patients admitted to dermatology beds between September 1, 2002, and September 30, 2010. The following variables were analyzed: age, gender, ethnicity, length of stay, dermatologic disease, comorbidities, hospital infection, transfer to the intensive care unit (ICU), and mortality. During this 8-year period, 3308 admissions were analyzed. The most frequent admissions were for infections and infestation (18.0%) andeczema/dermatitis (17.8%). The median length of stay was 13.0 days(SD ± 13). We observed longer admissions for immunobullous disorders (mean, 21.8 days) and chronic ulcers (mean, 20.6 days). Admissions were shorter for benign (mean, 4.0 days) and malignant cutaneous neoplasms (mean, 4.4 days). The mean number of comorbidities per patient was 1.0 (SD ± 1.2) and among the most frequent were hypertension and diabetes mellitus. The rate of hospital infection was 6.2% with the blood stream infection regarded as the most common, and Staphylococcus aureu s as the most infectious agent found in culture. Of the admitted patients, 3.7% were transferred to ICU and 2.5% passed away. In these groups, the most common dermatological diagnosis was immunobullous diseases, and the mean of hospital length stay and hospital infection rate were higher in comparison with the total group of patients. A ward organized and specially intended for the care of patients with dermatologic disease and cutaneous/mucosal manifestations of systemic diseases often provide better medical and nursing care in addition to cost effectiveness. Higher valuation of dermatology inpatient services should be necessary in order to attempt to expand the availability of dermatology beds, mainly in tertiary hospitals, taking into consideration the higher potential of severity of the dermatologic diseases found in many patients referred to this kind of service.