de Almeida Geraldino Rogério, Rezende Liliana Vicente Melo de Lucas, da-Silva Cibele Queiroz, Almeida Júlio César Franco
Health Sciences Faculty, University of Brasília, Brasília, Brazil.
CABI Odontologia, Brasília, Brazil.
Dent Traumatol. 2017 Oct;33(5):350-357. doi: 10.1111/edt.12347. Epub 2017 Jul 7.
Intra-oral photographs have been aided diagnosis of several pathologies in teledentistry. Mobile phone cameras may produce high-quality photographs, presenting itself as a viable tool for remote diagnosis of traumatic dental injuries.
To evaluate the levels of interexaminer agreement in cases of traumatic dental injuries when comparing diagnoses conducted in person and remotely.
The sample included 40 patients with 73 traumatized teeth, and a total of 90 diagnoses, who had presented to two dental clinics, one private, and the other public, in Brazil's Federal District. The dental history and clinical examination data were registered in electronic forms, and digital photographs were captured with a mobile phone camera and uploaded to a cloud drive. Six remote examiners formulated their diagnoses based solely on photographic analysis. Thereafter, they were provided with additional clinical data and asked to provide a second round of diagnoses. These diagnoses were compared to those conducted in person, which were considered the gold standard. The data were analyzed with Gwet's AC1 interexaminers' measure to evaluate the agreement between the in-surgery and remote diagnoses.
The levels of interexaminer agreement between the in-surgery and remote diagnoses formulated exclusively with images were 0.83 or higher (95% confidence interval: 0.73-0.91), and 0.93 or higher (95% confidence interval: 0.88-0.97), when clinical information was available.
The precision of the remote diagnoses was comparable to the diagnoses conducted in person. The levels of interexaminer agreement were higher when clinical data were included with the images. Mobile phones may be an effective tool for capturing images that assist in the remote diagnosis of traumatic dental injuries.
口腔内照片有助于远程牙科诊断多种病症。手机摄像头可拍摄高质量照片，是远程诊断牙外伤的可行工具。
比较现场诊断和远程诊断牙外伤病例时，评估检查者间的一致性水平。
样本包括巴西联邦区两家牙科诊所（一家私立，一家公立）的40例患者，共73颗外伤牙，总计90次诊断。牙科病史和临床检查数据以电子表格记录，用手机摄像头拍摄数码照片并上传至云盘。六名远程检查者仅根据照片分析做出诊断。之后，向他们提供额外临床数据并要求进行第二轮诊断。将这些诊断与被视为金标准的现场诊断进行比较。采用格韦特AC1检查者间测量法分析数据，以评估手术诊断与远程诊断之间的一致性。
仅根据图像做出的手术诊断与远程诊断之间，检查者间一致性水平为0.83或更高（95%置信区间：0.73 - 0.91）；当有临床信息时，一致性水平为0.93或更高（95%置信区间：0.88 - 0.97）。
远程诊断的准确性与现场诊断相当。当图像包含临床数据时，检查者间一致性水平更高。手机可能是一种有效的工具，用于拍摄有助于远程诊断牙外伤的图像。
