Exanthems in Hospitalized Pediatric Patients: Concordance between Pediatric and Dermatological Diagnoses

BACKGROUND: Exanthems in children often represent a diagnostic challenge. PURPOSE: To determine the concordance between pediatric and dermatological diagnoses of exanthems. DESIGN: Prospective study. PROCEDURE: Exanthems that appeared in hospitalized pediatric patients were diagnosed by pediatricians. Pediatric dermatologists, by consensus, either confirmed or modified the diagnoses. Whenever possible, laboratory tests were used to confirm the final clinical diagnoses. Age and evolution were compared with the Kruskal-Wallis test; the kappa coefficient was used to determine concordance. SETTING: Institutional tertiary referral pediatric care center. RESULTS: Concordance between pediatric and dermatological diagnoses was found in only 44 patients. When pediatric and dermatological diagnoses of exanthems were classified, the concordance between both diagnoses was very low (kappa = 0.165). CONCLUSIONS: Pediatric specialists, other than dermatologists, failed to diagnose common skin diseases. This may be a consequence of insufficient training in dermatology by medical schools and pediatric residency.