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Introduction
Patients in intensive care units (ICU) represent a proportion of patients with most complex medical issues. Counselling of other specialities is a common procedure to avoid delay of diagnosis and specific treatment. Surprisingly not much has been published on interaction with and the role of dermatology in such a setting although skin diseases are quite common in the general population [1]. Data from burn centres suggest that an intense teamwork with dermatologists seem to be favourable for patients [2].
Skin diseases itself may lead to ICU admission in case of emergencies like severe adverse drug reactions including Stevens-Johnson syndrome [3], drug reactions with eosinophilia and systemic symptoms (DRESS) [4], toxic epidermal necrosis [5], serum sickness-like syndrome [6]. The incidence of Stevens-Johnson syndrome and toxic epidermal necrolysis has been calculated as high as 1.89 per million inhabitants per year in western Germany and Berlin [7]. A survey from Britain identified the following big three dermatological admissions: infectious diseases, cutaneous malignancies and acute skin failure. The mortality rate for patients with dermatologic diseases in ICU was estimated as high as 27.5%, with 39.6% who died before ultimate discharge from the hospital [8].
In this study we would like to analyze skin problems in ICU patients in an Academic Teaching Hospital in the south-east of Germany. We will focus on those skin problems that need a dermatological counselling during the patient’s stay in the ICU. We hope that such an analysis will better define the necessary for an optimal patient care and also that we appreciate the importance of team work which is vital in such an environment to avoid unnecessary misdiagnosis and treatments.
Material and Methods
Patients: We analyzed patients in the Intensive Care Unit (ICU) of our hospital treated from January to October 2010 including dermatological counselling. The average annual number of dermatologic consultations in the whole Academic Teaching Hospital is 2,000 to 2,500. The patients were analyzed for diagnosis, treatment and diagnostics resulting from the dermatologic consultations.
Results
The total number of patients of the ICU was 1,208 with a median stay of 4.1 days. The Department of Anaesthesiology & Intensive Medicine, Emergency Medicine and Pain Management runs a specialized high care unit (HCU) with 16 places for assisted ventilation among other facilities. Table...