Preclaro Ivan Arni Caballero, Gulmatico-Flores Zharlah, Tianco Elizabeth Amelia Velasco
Department of Dermatology, Jose R Reyes Memorial Medical Center, Manila, Philippines.
Department of Dermatology and Venereology, Tondo Medical Center, Manila, Philippines.
JMIR Dermatol. 2022 Oct 31;5(4):e32546. doi: 10.2196/32546.
Dermatologists rely on visual findings; thus, teledermatology is uniquely compatible to providing dermatologic care. The use of mobile phones in a store-and-forward approach, where gathered data are sent to a distant health provider for later review, may be a potential bridge in seeking dermatologic care.
This study aimed to determine the agreement between face-to-face consultations and teledermatologic consultations through the store-and-forward approach using mobile phones and its accuracy compared to a histopathologic diagnosis.
The study design was a cross-sectional study of participants consecutively recruited from dermatology patients who presented with skin or mucosal complaint and without prior dermatologist consultation. Photographs were taken using a standard smartphone (iPhone 6s Plus), and a 4-mm skin punch biopsy was taken on each patient-the gold standard to which the study result was compared to. The photographs were sent to 3 consultant dermatologists using a store-and-forward approach, for independent diagnosis and treatment plan.
A total of 60 patients were included, with a median age of 41 years. There was moderate-to-almost perfect agreement in terms of final diagnosis between the face-to-face dermatologic diagnosis and teledermatologic diagnoses. The third teledermatologist had the highest agreement with the clinical dermatologist in terms of final diagnosis (κ=0.84; P<.001). Among the 3 dermatologists, there was moderate-to-almost perfect agreement as well. Agreement between pairs of teledermatologists ranged from 0.45 to 0.84. The 3 teledermatologists had moderate-to-substantial agreement with the biopsy results, with the third teledermatologist having the highest accuracy (κ=0.77; P<.001). Overall, there was a moderate agreement in the diagnosis of patients across raters.
Teledermatology is a viable alternative to face-to-face consultations. Our results show moderate-to-substantial agreement in diagnoses from a face-to-face consultation and store-and-forward teledermatology.
皮肤科医生依赖视觉检查结果；因此，远程皮肤病学在提供皮肤科护理方面具有独特的适应性。以存储转发方式使用手机，即将收集到的数据发送给远程医疗服务提供者以供日后查看，这可能是寻求皮肤科护理的潜在桥梁。
本研究旨在确定通过使用手机的存储转发方式进行的面对面会诊与远程皮肤病学会诊之间的一致性，以及与组织病理学诊断相比的准确性。
本研究设计为一项横断面研究，研究对象为连续招募的皮肤科患者，这些患者有皮肤或黏膜问题且此前未咨询过皮肤科医生。使用标准智能手机（iPhone 6s Plus）拍照，并对每位患者进行4毫米皮肤打孔活检——这是与研究结果进行比较的金标准。照片通过存储转发方式发送给3位皮肤科顾问医生，以进行独立诊断和制定治疗方案。
共纳入60例患者，中位年龄为41岁。面对面皮肤科诊断与远程皮肤病学诊断在最终诊断方面存在中度至几乎完美的一致性。第三位远程皮肤科医生在最终诊断方面与临床皮肤科医生的一致性最高（κ=0.84；P<0.001）。在这3位皮肤科医生之间也存在中度至几乎完美的一致性。远程皮肤科医生之间的一致性范围为0.45至0.84。这3位远程皮肤科医生与活检结果存在中度至高度一致性，第三位远程皮肤科医生的准确性最高（κ=0.77；P<0.001）。总体而言，不同评估者对患者的诊断存在中度一致性。
远程皮肤病学是面对面会诊的可行替代方案。我们的结果表明，面对面会诊和存储转发式远程皮肤病学在诊断方面存在中度至高度一致性。
