Diagnostic accuracy ratings in dermatological outpatient department in a tertiary care centre in Kathmandu, Nepal

Abstract

Background Diagnostic accuracy ratings of different dermatological disorders are helpful in critical evaluation of correct diagnosis and hence timely management of condition to reduce morbidity and mortality. The objective of this study was to assess diagnostic accuracy in dermatological outpatient department in a tertiary care hospital in Kathmandu, Nepal.   Methods Patients whose clinical diagnosis was not clear or needed further confirmation were subjected to biopsies and were included in the study after history and clinical examination. The clinician was asked to rank three clinical diagnoses in order priority. The first three clinical diagnoses were compared with the final histopathological diagnosis and diagnostic accuracy was calculated in terms of percentage. A comparison of diagnostic accuracy was done between different skin lesions and rashes.   Results Thirty-eight patients (76%) presented with rash and 12 (24%) patients presented with lesions. It was seen that 34 clinical diagnoses (68%) correlated well with final diagnoses. Alopecia, papulo squamous diseases, panniculitis, disorder of pigmentation and urticaria had the highest accurate diagnostic ratings (100% each) followed by eczemas (87.5%), immunobullous diseases (75%), connective tissue diseases (75%), infections (60%), and tumors (57.1%). Vasculitis (0%) and melanocytic disorders (33.3%) had the least diagnostic ratings.  The difference between correct and incorrect diagnoses between lesions and rashes was not significant (P >0.05).   Conclusion The diagnostic accuracy of skin lesions in this study is 68%, with the highest accuracy seen with alopecia, papulosquamous diseases, panniculitis, disorder of pigmentation and urticaria. There is no difference in the diagnostic accuracy between lesion and rashes.