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Di Xia F, Fuhlbrigge M, Waul M, Joyce C, Mostaghimi A. Characteristics of Patients Presenting to the Emergency Department and Urgent Care for Treatment of Sunburn. JAMA Dermatol. 2017;153(9):934–935. doi:10.1001/jamadermatol.2017.1874
Sunburn led to an estimated 33 826 visits to US emergency departments (EDs) in 2013, resulting in a cost of $11.2 million.1 Despite this burden, little is known about the features of patients utilizing the ED or urgent care clinic (UCC) for treatment of sunburn. Characterizing this patient population may help guide efforts of prevention, utilization reduction, and transition of care to lower cost settings. In this study we examined the demographics and characteristics of patients seen at the ED or UCC for sunburn treatment at 2 major hospitals over a 15-year period.
We searched the Partners Healthcare Research Patient Data Repository for sunburn visits to the EDs of Brigham & Women’s Hospital, Massachusetts General Hospital, and associated UCC between January 1, 2000, through December 31, 2015, using the International Classification of Diseases, Ninth Revision, Clinical Modification, codes for sunburn (692.71, 692.76, and 692.77). Each identified medical record was individually reviewed to confirm the diagnosis of sunburn and for data extraction. Reason for sunburn and patient characteristics were recorded. Records without adequate documentation or a primary diagnosis of sunburn were excluded (n = 59). The study was approved by the Partners institutional review board. Written informed consent was not required because this was a retrospective study.
We identified 200 patients with a total of 204 visits for sunburn to the ED (n = 180) or UCC (n = 24) (Table 1). We found that psychiatric illness (19 patients [9.3%]), alcohol use (13 patients [6.4%]), and homelessness (13 patients [6.4%]) were associated patient characteristics (Table 2). Indoor tanning accounted for 4 patients (2.0%) of the presenting sunburns.
Blistering (76 patients [37.3%]), constitutional symptoms (38 patients [18.6%]), and secondary infection (2 patients [1.0%]) were the most common complications (Table 2). The most common treatment provided was nonsteroidal anti-inflammatory drugs, acetaminophen with or without opioid (119 patients [58.3%]), and aloe and/or moisturizers (61 patients [29.9%]). Documentation of sun protection counseling occurred in less than half of the cases (68 cases [33.3%]).
Our study provides insight into patient factors resulting in ED and UCC visits for sunburn. Lack of insurance does not seem to have significant impact on use because 149 (74.5%) of patients in our cohort were insured. While some patients had constitutional symptoms, blistering, or secondary infection, only a minority required IV fluids (18 [8.8%]) or admission (4 [2.0%]), suggesting that the most treatment could have been given in other care settings or through over-the-counter medications.
The association of psychiatric illness, alcohol use, and homelessness with sunburn visits highlights a vulnerable population that should be targeted through public health initiatives. Homeless shelters, for example, are often closed during the day, and additional measures such as broadening of shelter hours, free sunscreen dispensers, designated shade structures, and improved awareness for sunburn risk in these vulnerable populations may help reduce risks and utilization.
Our data show that sun protection counseling was performed during only one-third of ED or UCC visits. Research has shown that significant behavioral intervention at the time of medical illness leading to hospitalization or ED visits is more likely to be successful than random intervention.2 Similarly, education around sun protection may be more effective at the time of ED or UCC presentation or treatment for severe sunburn. This is particularly important for patients with sunburns from indoor tanning whose reliance on tanning often mirrors other addictive behaviors.3
Although our data are derived from 2 large hospitals and affiliated UCCs over a 15-year period, our study is limited by its retrospective nature and common geography in Massachusetts. Future studies should assess patient characteristics for utilization of EDs and UCCs for sunburn treatment on a national scale.
Despite these limits, it is clear that ED and UCC utilization for sunburn treatment is a largely avoidable phenomenon that leads to considerable costs. Our study demonstrates possible areas for interventions to reduce disease burden and streamline care.
Corresponding Author: Arash Mostaghimi, MD, MPA, MPH, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, PBB-B 421, Boston, MA 02115 (firstname.lastname@example.org).
Accepted for Publication: April 25, 2017.
Published Online: July 12, 2017. doi:10.1001/jamadermatol.2017.1874
Author Contributions: Drs Xia and Mostaghimi had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Ms Xia and Ms Fuhlbrigge contributed equally to this work.
Study concept and design: Xia, Fuhlbrigge, Mostaghimi.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Xia, Fuhlbrigge, Mostaghimi.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Joyce.
Administrative, technical, or material support: Mostaghimi.
Study supervision: Mostaghimi.
Conflict of Interest Disclosures: None reported.