Background/Purpose: Among pediatric patients with scleroderma, there is a significant delay between onset of symptoms and diagnosis ranging from 1.2-1.6 years for Localized Scleroderma (LS) to 1.9-2.8 years for Systemic Sclerosis (SSc). Stubbs et al explored caregivers’ perceptions of navigating their child’s diagnosis with LS and SSc: their work identified that the number one barrier parents identified was lack of provider knowledge(1). Our aim is to create an intervention for front-line providers to improve the recognition of rashes associated with rheumatologic disease with the ultimate goal to improve referral patterns and decrease time to diagnosis.

Methods: Using Kern’s Model of curriculum development, we created a needs assessment to evaluate competency among a range of pediatric providers by querying their skills, knowledge, and attitudes surrounding rash identification. We also obtained qualitative data which was coded and used to generate themes to inform the quantitative results.

Results: We received 39 responses (53% resident, 28% attending, 18% APP). Approximately a third were currently practicing or planning to become primary care providers, another third planned to go into subspecialties other than rheumatology, and the remaining third were planning to continue or pursue hospitalist or ED positions. The majority of respondents (61.5%) did not feel they received adequate training in rheumatology during their pre-clinical years. On recall, most reported 5-10 hours of pre-clinical education spent on rheumatology. Regarding skill identifying rashes, the majority of respondents (64%) rated themselves as only slightly knowledgeable, 25.6% as moderate and 10% having no knowledge/skill identifying rheumatic skin disease. Reassuringly, 100% of participants responded that identification of rashes was somewhat important or very important. Additionally, we queried respondents for qualitative responses. Themes that emerged included that rheumatology was frequently taught as an “afterthought”, with inadequate content, and without pediatric-specific examples. Many also identified that their skills identifying rashes were poor because they had little experience.

Conclusion: A needs assessment of front-line pediatricians revealed that there is a lack of knowledge and skill surrounding rheumatic diseases and the common rashes that can provide clues to their diagnosis. More education is needed to ensure that providers are familiar with these rare diagnoses to facilitate early and appropriate rheumatology referral to prevent accumulation of damage with delayed diagnosis. Our group is creating a 45min didactic intervention dedicated to recognizing skin manifestations of key pediatric rheumatic conditions to further address these needs. We will assess efficacy via pre- and post-testing as well as qualitative responses.(1) Stubbs LA, Ferry AM, Guffey D, et al. Barriers to care in juvenile localized and systemic scleroderma: an exploratory survey study of caregivers’ perspectives. Pediatr Rheumatol Online J 2023;21(1):39. DOI: 10.1186/s12969-023-00819-6.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/skin-manifestations-of-rheumatic-diseases-educating-providers-to-improve-diagnostic-skills/