Feigenbaum Dana F, Boscardin Christy K, Frieden Ilona J, Mathes Erin F D
Department of Dermatology, University of California, San Francisco, San Francisco, California.
Department of Medicine, University of California, San Francisco, San Francisco, California.
Pediatr Dermatol. 2017 Sep;34(5):566-571. doi: 10.1111/pde.13210. Epub 2017 Aug 2.
BACKGROUND/OBJECTIVES: Digital video is widely available and is used sporadically in clinical settings to evaluate patients, but whether it helps improve clinical management has not been determined. The aim of this study was to assess whether recorded video in addition to still images can improve residents' diagnostic and management accuracy and confidence with pediatric teledermatology cases.
Dermatology residents from three programs were assigned alternately to an online survey with 15 pediatric teledermatology cases presented with still images only (still) or still images plus recorded video (mixed). Participants provided free-text diagnoses and management recommendations and rated their confidence and image quality. Responses were scored using a modified script concordance grading key based on reference panelists' responses.
Thirty-one residents participated (response rate 57%). Participants in the mixed group scored significantly higher on management accuracy (87.6 ± 12.9 vs 71.7 ± 14.2; p = 0.003). Both groups performed better on more common conditions than less common conditions. The mixed group outperformed the still group on less common conditions with respect to management recommendations.
This novel study suggests that supplemental recorded video may improve the management accuracy of pediatric teledermatology consultations, particularly for complex cases. Residents may benefit from training in recording and interpreting video.
背景/目的：数字视频广泛可得，且在临床环境中偶尔用于评估患者，但它是否有助于改善临床管理尚未确定。本研究的目的是评估除静态图像外，录制的视频是否能提高住院医师对儿科远程皮肤病病例的诊断、管理准确性及信心。
来自三个项目的皮肤科住院医师被交替分配到一项在线调查中，该调查有15例儿科远程皮肤病病例，仅呈现静态图像（静态组）或静态图像加录制视频（混合组）。参与者提供自由文本诊断和管理建议，并对他们的信心和图像质量进行评分。根据参考专家小组成员的回答，使用修改后的脚本一致性评分标准对回答进行评分。
31名住院医师参与（回复率57%）。混合组在管理准确性方面得分显著更高（87.6±12.9对71.7±14.2；p=0.003）。两组在处理较常见病症时的表现均优于较不常见病症。在处理较不常见病症的管理建议方面，混合组的表现优于静态组。
这项新研究表明，补充录制的视频可能会提高儿科远程皮肤病会诊的管理准确性，尤其是对于复杂病例。住院医师可能会从视频录制和解读培训中受益。
