Department of Urology, School of Medicine, Marmara University, Istanbul, Turkey.
Department of Human Pathology, Section of Urology, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy.
Int J Med Inform. 2018 Mar;111:17-23. doi: 10.1016/j.ijmedinf.2017.12.011. Epub 2017 Dec 17.
The advancements in telemedicine provide the possibility to send photos of hematuria cases to professionals for further evaluation. We aimed to evaluate the inter-rater reliability of WhatsApp use in the evaluation of hematuria.
Between December 2014 and April 2016, 212 patients were evaluated prospectively for hematuria by 2 groups of urologists; Group A: in direct contact with patients for evaluation; Group B: "blind" urologist who had no access to the patients' data but received pictures via WhatsApp. Two photos of voided urine in a sterile container were taken and sent using WhatsApp. The opinions of Group A and B about the grade of hematuria were evaluated. Shapiro-Wilk test and Fleiss' kappa statistics were used for statistical analyses.
The median age of patients was 71 (min 22, max 96). The Group A urologists were in accordance in 96.22% of cases. Group B urologists had common opinions in 99.5% (n = 203) and there was almost perfect agreement between 2 groups (λ = 0.992). The number of common opinions among "blind" urologists is more than the number of common opinions among the consultants. When further classification is performed as serious and non-serious hematuria, the rate of misdiagnosing serious cases is approximately 6.5-7%. However, using WhatsApp, the urologists can differentiate normal urine and any form of hematuria with 100% accuracy.
It is possible to evaluate hematuria remotely and also reduce unnecessary costs of services for hematuria of mild clinical significance by using telemedicine. WhatsApp can provide valuable aid to tertiary hospitals where the urologist is not always present as well as in rural areas.
远程医疗的进步使得将血尿病例的照片发送给专业人员进行进一步评估成为可能。我们旨在评估 WhatsApp 在血尿评估中的应用的组内可靠性。
2014 年 12 月至 2016 年 4 月，两组泌尿科医生前瞻性地评估了 212 例血尿患者；A 组：直接与患者接触进行评估；B 组：“盲”泌尿科医生无法访问患者数据，但通过 WhatsApp 接收图片。拍摄并通过 WhatsApp 发送两个无菌容器中尿液的照片。评估 A 组和 B 组关于血尿程度的意见。使用 Shapiro-Wilk 检验和 Fleiss' kappa 统计进行统计分析。
患者的中位年龄为 71 岁（最小 22 岁，最大 96 岁）。A 组泌尿科医生在 96.22%的情况下意见一致。B 组泌尿科医生在 99.5%（n=203）的情况下有共同意见，两组之间存在几乎完美的一致性（λ=0.992）。“盲”泌尿科医生的共同意见数多于顾问的共同意见数。当进一步分为严重和非严重血尿时，误诊严重病例的发生率约为 6.5-7%。然而，使用 WhatsApp，泌尿科医生可以 100%准确地区分正常尿液和任何形式的血尿。
通过使用远程医疗，可以远程评估血尿，并为轻度临床意义的血尿减少不必要的服务费用。WhatsApp 可以为泌尿科医生不常出现的三级医院以及农村地区提供有价值的帮助。
