Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA.
Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA.
World J Surg. 2022 Sep;46(9):2094-2101. doi: 10.1007/s00268-022-06597-8. Epub 2022 Jun 4.
In rural Africa where access to medical personnel is limited, telemedicine can be leveraged to empower community health workers (CHWs) to support effective postpartum home-based care after cesarean section (c-section). As a first step toward telemedicine, we assessed the sensitivity, specificity, and interrater reliability of image-based diagnosis of surgical site infections (SSIs) among women delivering via c-section at a rural Rwandan Hospital.
Women ≥18 years who underwent c-section from March to October 2017 at Kirehe District Hospital (KDH) were enrolled. On postoperative day 10 at KDH, participants underwent a physical examination by a general practitioner, who provided a diagnosis of SSI or no SSI. Trained CHWs photographed patients' incisions and the collected images were shown to six physicians, who upon review, assigned one of the following diagnoses to each image: definite SSI, suspected SSI, suspected no SSI, and definite no SSI, which were compared with the diagnoses based on physical exam. We report the sensitivity and specificity and assessed reviewer agreement using Gwet's AC1.
569 images were included, with 61 women (10.7%) diagnosed with an SSI. Of the 3414 image-reviews, 49 (1.4%) could not be assigned diagnoses due to image quality. The median sensitivity and specificity were 0.83 and 0.69, respectively. The Gwet's AC1 estimate for binary classification was 0.46.
We demonstrate decent accuracy but only moderate consistency for photograph-based SSI diagnosis. Strategies to improve overall agreement include providing clinical information to accompany photographs, providing a baseline photograph for comparison, and implementing photograph-taking processes aimed at improving image quality.
在农村非洲，由于医疗人员有限，远程医疗可以利用社区卫生工作者（CHW）的力量，在剖宫产（c-section）后为产妇提供有效的家庭产后护理。作为远程医疗的第一步，我们评估了在卢旺达农村一家医院接受剖宫产的女性中，基于图像的手术部位感染（SSI）诊断的敏感性、特异性和组内一致性。
2017 年 3 月至 10 月，在基雷哈区医院（KDH）接受剖宫产的≥18 岁女性被纳入研究。术后第 10 天，参与者由一名全科医生进行体格检查，该医生提供 SSI 或无 SSI 的诊断。经过培训的 CHW 拍摄了患者的切口照片，收集的照片展示给了六名医生，他们在查看后，根据照片对每个图像进行了以下诊断之一：明确的 SSI、疑似 SSI、疑似无 SSI 和明确的无 SSI，并与体格检查的诊断进行了比较。我们报告了敏感性和特异性，并使用 Gwet 的 AC1 评估了审稿人的一致性。
共纳入 569 张图像，61 名女性（10.7%）被诊断为 SSI。在 3414 次图像审查中，有 49 次（1.4%）因图像质量而无法给出诊断。中位敏感性和特异性分别为 0.83 和 0.69。二进制分类的 Gwet 的 AC1 估计值为 0.46。
我们证明了基于照片的 SSI 诊断具有相当的准确性，但一致性仅为中等。提高整体一致性的策略包括提供照片伴随的临床信息、提供基线照片进行比较以及实施旨在提高图像质量的照片拍摄流程。
