Emergency department visits for DEB more common during summer
Children with DEB also more likely to require hospitalization, study finds
Children with dystrophic epidermolysis bullosa (DEB) in the U.S. are more likely to have visits to the emergency department during summertime compared with kids who don’t have the rare disease, according to a new study.
Conversely, that dynamic was found to be reversed in the autumn months, with fewer visits seen for children with DEB versus those without the genetic condition.
Overall, the study found that pediatric patients with DEB are more likely to require hospitalization than their counterparts without the disease. In fact, more than 50% of children with DEB were admitted to the hospital versus fewer than 5% of other patients.
“Understanding the features of [emergency department] visits due to DEB can better prepare healthcare teams and improve patient outcomes,” the researchers wrote.
The study, “Increased healthcare burden and comorbidity risks of pediatric patients with dystrophic epidermolysis bullosa: Analysis of Nationwide Emergency Department Sample 2015-2019,” was published in the journal Pediatric Dermatology.
More emergency department visits for DEB patients seen from June to August
In DEB, mutations in a gene responsible for producing part of collagen — a protein that helps maintain the skin’s strength and structure — cause the skin to become fragile and prone to blistering. DEB can affect several parts of the body, including the mouth and the eyes, leading to complications that may require emergency care.
To understand how often these emergency visits occur, the costs involved, and whether any related health issues are present, researchers from Northwestern University in Chicago drew on data from the Nationwide Emergency Department Sample (NEDS) covering the years from 2015 to 2019. Information from pediatric patients, here those younger than 18, was analyzed.
Among more than 27 million pediatric emergency department visits, there were 53 recorded cases of DEB. Seven children had a primary diagnosis of DEB, while 46 had a secondary diagnosis of DEB, meaning they visited the emergency department for a reason other than the skin disease.
Children with DEB were more likely than those without the disease — 35.7% versus 21.4% — to visit the emergency department during the summer months from June to August. They were less likely to do so during the fall months of September through November, according to the study, which showed more emergency department visits for children without DEB than for those with the condition (30.2% vs. 13.1%).
“The explanation is unclear, although it may be due to aggravation of symptoms, such as blistering and dehydration, and increased risk of skin infection during the hotter months,” the researchers wrote.
In all, 56.2% of the children with DEB were admitted to the hospital after their emergency department visits, compared with 3.4% of the children without DEB. This high rate of admission likely reflects the serious nature of complications related to DEB, which may require more intensive medical care, according to the researchers.
The explanation [for more hospital visits in summertime] is unclear, although it may be due to aggravation of symptoms, such as blistering and dehydration, and increased risk of skin infection during the hotter months.
For visits with a secondary diagnosis of DEB, the most common reasons for seeking emergency treatment were fever, constipation, and care following a bone marrow transplant. It was about twice as common for children with DEB to have fever and constipation compared with children without DEB (16.9% vs. 7.8% in those without the disease).
Children with DEB also were more likely to have other health issues, such as high blood pressure, cellulitis, which is a bacterial infection of the skin, and sepsis, or a heightened response to an infection. Kidney, digestive or heart problems, and anxiety also were more common among the children with DEB.
The average cost for an emergency visit was more than twice as high for children with DEB than for those without the disease ($5,028.74 vs. $2,143.37), reflecting the high economic burden of epidermolysis bullosa in general, the study found.
According to the team, the findings of this study add to previous research that resulted in management guidelines for emergency department visits for patients with all types of epidermolysis bullosa.
“Through better understanding the characteristics and medical emergencies of patients with DEB in the [emergency department] setting, healthcare providers can improve management and mitigate the high admission rates,” the researchers concluded.
About the Author
