Minneapolis Veterans Affairs Medical Center, Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota 55417, USA.
J Am Acad Dermatol. 2011 Apr;64(4):759-72. doi: 10.1016/j.jaad.2010.08.026. Epub 2010 Oct 30.
We performed a systematic review of the literature addressing teledermatology: (1) diagnostic accuracy/concordance; (2) management accuracy/concordance; (3) clinical outcomes; and (4) costs.
Peer-reviewed controlled trials published in English between 1990 and 2009 were identified through MEDLINE and PubMed searches.
Of 78 included studies, approximately two-thirds comparing teledermatology and clinic dermatology found better diagnostic accuracy with clinic dermatology. Diagnostic concordance of store and forward with clinic dermatology was good; concordance rates for live interactive and clinic dermatology were higher, but based on fewer patients. Overall rates of management accuracy were equivalent, but teledermatology and teledermatoscopy were inferior to clinic dermatology for malignant lesions. Management concordance was fair to excellent. There was insufficient evidence to evaluate clinical course outcomes. Patient satisfaction and preferences were comparable. Teledermatology reduced time to treatment and clinic visits and was cost-effective if certain assumptions were met.
Heterogeneity in studies (design, skin conditions, outcomes) limited the ability to pool data.
The benefits of teledermatology need to be evaluated in the context of potential limitations.
我们对涉及远程皮肤病学的文献进行了系统评价：（1）诊断准确性/一致性；（2）管理准确性/一致性；（3）临床结果；和（4）成本。
通过 MEDLINE 和 PubMed 搜索，确定了 1990 年至 2009 年期间以英文发表的同行评审对照试验。
在纳入的 78 项研究中，约三分之二的研究比较了远程皮肤病学和诊所皮肤病学，发现远程皮肤病学的诊断准确性优于诊所皮肤病学。存储和转发与诊所皮肤病学的诊断一致性良好；实时交互和诊所皮肤病学的一致性率更高，但基于更少的患者。总体管理准确性相当，但远程皮肤病学和远程皮肤镜检查对恶性病变的准确性低于诊所皮肤病学。管理一致性为良好至优秀。由于某些假设，缺乏评估临床病程结果的证据。患者满意度和偏好相当。如果满足某些假设，远程皮肤病学可以缩短治疗和就诊时间，并且具有成本效益。
研究之间的异质性（设计、皮肤状况、结果）限制了数据汇总的能力。
需要根据潜在限制来评估远程皮肤病学的益处。
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