Referral Patterns and Diagnostic Concordance in Pediatric Skin Disorders

This study explores referral patterns in pediatric dermatology and assesses the diagnostic concordance between referring and dermatology providers. This retrospective cross-sectional study utilized referrals to an outpatient pediatric dermatology clinic. The review included patients referred between July 1, 2018 and June 30, 2019. Only patients who completed a clinic visit were included in the diagnostic concordance. Referral and first visit diagnoses were compared to determine concordance. A total of 8,682 charts were reviewed, and 3,738 completed a clinic visit. The most common referral diagnoses included atopic dermatitis, rash, lesion, melanocytic nevus, and warts. Physicians (78.5%) and APRNs (18.1%) most frequently referred patients. The diagnostic concordance of physicians was 67.1% vs 66.3% for APRNs. Physicians and APRNs showed similar rates of diagnostic concordance, yet a large proportion of diagnoses were discordant. Primary care providers may benefit from focused education around the most commonly referred and missed diagnoses.