Trends in dermatological presentations at the emergency department of a tertiary hospital in Singapore: a 4-year analysis pre- and during COVID-19.

Abstract

Background: Skin disorders comprise a significant portion of emergency department (ED) visits. Limited dermatology training among junior ED doctors poses challenges, especially during crises like COVID-19, which introduced resource constraints and new viral rash morphologies. This study examines dermatological ED presentations at Singapore General Hospital, comparing pre-pandemic (2018-2019) and pandemic (2020-2021) trends in diagnosis and disposition patterns.

Materials & methods: A retrospective analysis of de-identified electronic health records (2018-2021) was conducted. Data included patient demographics, diagnosis, and disposition (admission, referral, discharge). Diagnoses were classified into major categories, and statistical analyses were performed using Python 3.12 and chi-squared tests.

Results: Among 28,621 cases, dermatological presentations declined by 15.6% during COVID-19. Infective conditions remained the most common, with bacterial cellulitis and herpes zoster leading. Inflammatory dermatoses, especially urticaria, atopic, and contact dermatitis, increased during the pandemic. Allergy cases surged in 2021, largely linked to COVID-19 vaccinations. Admissions peaked in 2020, and referrals to dermatologists increased in 2021, while GP referrals declined.

Conclusion: Major shifts in dermatological ED trends highlight the impact of PPE usage, vaccinations, and pandemic psychological stressors. Increased admissions and specialist referrals emphasize the need for enhanced dermatology training and resource allocation in emergency medicine for future pandemic preparedness.