Dermatology Research Centre, The University of Queensland, School of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Emerg Med Australas. 2011 Oct;23(5):562-8. doi: 10.1111/j.1742-6723.2011.01443.x. Epub 2011 Jun 29.
The aim of the present study was to investigate the feasibility of using a store-and-forward Skin Emergency Telemedicine Service (SETS) to provide rapid specialist diagnostic and management advice for dermatological cases in an ED.
This pilot study was conducted at the Princess Alexandra Hospital between August 2008 and August 2009. Study subjects were consenting patients over 18 years of age who presented with a dermatological condition to the ED. The ED doctor sent the patient's history, examination findings and the digital images of the skin conditions to a secure email address, which automatically forwarded this to the teledermatologist. The teledermatologist reviewed the cases and sent advice on diagnosis and management to the referring ED doctor via email and/or telephone. Face-to-face follow-up consultations with the patients were conducted within 2 weeks. The diagnostic and management concordance between ED doctors, teledermatologists and reviewing dermatologists were analysed.
A total of 60 patients participated in the present study. SETS provided a rapid response with 56 (93%) of ED consultations receiving a dermatology opinion within 2 h. Face-to-face follow up occurred in 50 patients (83%). Statistical analysis showed significant levels of agreement between tele-diagnosis and ED diagnosis of 71.2% (Kappa 0.42) and tele-diagnosis and final clinical diagnosis of 98% (Kappa: 0.93). The clinical management concordance was 96% in complete agreement and 4% in relative agreement between the teledermatologists and reviewing dermatologists, based on chart review.
The present study has shown that SETS can provide rapid and accurate diagnostic and treatment advice from a specialist for dermatological presentations to the ED.
本研究旨在探讨存储转发皮肤急诊远程医疗服务（SETS）在急诊科为皮肤科病例提供快速专科诊断和管理建议的可行性。
本试点研究于 2008 年 8 月至 2009 年 8 月在亚历山德拉公主医院进行。研究对象为年龄在 18 岁以上、因皮肤科疾病到急诊科就诊的同意患者。急诊科医生将患者的病史、检查结果和皮肤状况的数字图像发送到安全的电子邮件地址，该地址自动将其转发给远程皮肤科医生。远程皮肤科医生查看病例，并通过电子邮件和/或电话向转诊急诊科医生发送诊断和管理建议。在 2 周内对患者进行面对面的随访咨询。分析急诊科医生、远程皮肤科医生和审查皮肤科医生之间的诊断和管理一致性。
共有 60 名患者参加了本研究。SETS 提供了快速响应，56 例（93%）ED 咨询在 2 小时内收到皮肤科意见。对 50 例患者（83%）进行了面对面随访。统计分析显示，远程诊断与急诊科诊断的一致性显著，为 71.2%（Kappa 0.42），远程诊断与最终临床诊断的一致性为 98%（Kappa：0.93）。根据图表回顾，远程皮肤科医生和审查皮肤科医生之间的临床管理一致性为 96%完全一致和 4%相对一致。
本研究表明，SETS 可以为急诊科的皮肤科就诊提供快速准确的专科诊断和治疗建议。
