Atypical ulcers in the inpatient setting evaluated by special consult services

OBJECTIVE: The majority of ulcers in the inpatient setting are pressure-induced or diabetic. As such, research on inpatient ulcers often focuses on these aetiologies. In this study, the authors aim to present the characteristics of patients with atypical cutaneous ulcers (such as, inflammatory, neoplastic, vascular, infectious, drug induced or multifactorial) in the inpatient setting, or non-diabetic, non-pressure ulcers, that require consultation by a specialty service. METHOD: This is a retrospective review of patients at Oregon Health & Science University who underwent formal consultation for a cutaneous ulcer between October 2015 and November 2020. Patients were identified from vascular surgery, plastic surgery, infectious disease and dermatology consultation databases. RESULTS: Of the 322 identified patients, 120 were included in the review. The mean patient age at the time of specialty service consultation was 52.46±14.29 years; 54.2% were female (n=65), 8.3% were homeless (n=10) and the majority of patients (n=114, 95.0%) had at least one comorbidity. The most common final diagnoses of ulcer aetiology were: multifactorial (n=36; 30.0%); infectious (n=28, 23.3%); and inflammatory (n=21; 17.5%). Of the patients, 22 (18.3%) were deceased by the time of this retrospective review. CONCLUSION: Patients with atypical ulcers often have comorbid conditions and increased risk of mortality, and may require complex, multispecialty care. Further prospective research evaluating factors that predispose patients to increased morbidity and mortality for these ulcers is indicated.