Lewis Fiona M, McSweeney Sheila M, Wendling Jeanne, Moyal-Barracco Micheline
St John's Institute of Dermatology Guy's & St Thomas' Hospital London UK.
149 bis rue Biomet Paris France.
Skin Health Dis. 2022 Oct 10;3(1):e178. doi: 10.1002/ski2.178. eCollection 2023 Feb.
During the COVID-19 pandemic, virtual consultation (VC) was used to replace in-person consultations. This raises specific questions when dealing with vulval conditions.
To assess the feasibility and the efficiency of VC with and without supplementary imaging, in patients with vulval conditions, and to evaluate the images provided as an aid to diagnosis.
This prospective multicentre audit took place in three specialized vulval clinics in London and Paris. Anonymized data on patients' clinical characteristics, consultation characteristics (including the number and quality of any supplementary images provided) and consultation outcomes (diagnostic certainty and physician satisfaction) were collected. Characteristics and outcomes in those with or without supplementary imaging were compared amongst both new and follow-up consultations.
A total of 316 VCs were included. In total, 18.7% ( = 59) were new patient consultations and 81.3% ( = 257) were follow-up. Supplementary imaging (photographs and/or video recordings) were provided by 28.5% ( = 90) of the total cohort. Median photographic quality was significantly higher on a five-point Likert-type scale when photographs were taken by a third party as opposed to the patient themselves (4 vs. 3, Mann-Whitney -test, < 0.0001). There was no association between the provision of supplementary imaging and diagnostic certainty amongst new patient consultations. However, a higher proportion of follow-up patients who provided supplementary imaging received definitive management decisions ( test, < 0.001) and physician satisfaction with these consultations, as measured on a five-point Likert-type scale, was significantly higher (Mann-Whitney -test, < 0.0001). Furthermore, median physician satisfaction scores ≥4 were observed in follow-up consultations for candidiasis, lichen simplex/eczema and vulvodynia.
Although in-person consultation remains the gold standard of care, VC may have a role in the management of selected patients with vulval disease. It is possible to provide good-quality photographs for clinical assessment, particularly with the help of a third party and follow-up patients with an established, cancer-unrelated diagnosis may be best suited for this consultation modality.
在新冠疫情期间，虚拟会诊（VC）被用于取代面对面会诊。在处理外阴疾病时，这引发了一些特定问题。
评估在有外阴疾病的患者中，有或没有辅助成像的虚拟会诊的可行性和效率，并评估提供的用于辅助诊断的图像。
这项前瞻性多中心审计在伦敦和巴黎的三家专业外阴诊所进行。收集了关于患者临床特征、会诊特征（包括提供的任何辅助图像的数量和质量）以及会诊结果（诊断确定性和医生满意度）的匿名数据。在新患者会诊和随访会诊中，比较了有或没有辅助成像的患者的特征和结果。
共纳入316次虚拟会诊。其中，18.7%（n = 59）为新患者会诊，81.3%（n = 257）为随访会诊。28.5%（n = 90）的总队列提供了辅助成像（照片和/或视频记录）。当照片由第三方拍摄而非患者自己拍摄时，在五点李克特量表上，照片的中位质量显著更高（4分对3分，曼-惠特尼U检验，P < 0.0001）。在新患者会诊中，提供辅助成像与诊断确定性之间没有关联。然而，提供辅助成像的随访患者中，有更高比例获得了明确的治疗决策（卡方检验，P < 0.001），并且以五点李克特量表衡量，医生对这些会诊的满意度显著更高（曼-惠特尼U检验，P < 0.0001）。此外，在念珠菌病、单纯性苔藓/湿疹和外阴痛的随访会诊中，观察到医生中位满意度得分≥4分。
虽然面对面会诊仍然是护理的金标准，但虚拟会诊可能在选定外阴疾病患者的管理中发挥作用。可以提供高质量的照片用于临床评估，特别是在第三方的帮助下，并且患有已确诊的、与癌症无关诊断的随访患者可能最适合这种会诊方式。
