Kvedar J C, Edwards R A, Menn E R, Mofid M, Gonzalez E, Dover J, Parrish J A
Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, USA.
Arch Dermatol. 1997 Feb;133(2):161-7.
To investigate the diagnostic accuracy of clinicians viewing a patient's history and static digital image set compared with clinicians who conducted office-based physical examinations of the same patients.
Observational study.
One hundred sixteen adult patients presenting with dermatologic symptoms in a university-based practice who consented to have their skin conditions documented with a still digital camera according to a standardized protocol.
Concordance between office-based dermatologists' diagnoses and 2 remote clinicians' diagnoses using still digital images (resolution, 92 dots per inch) and identical medical history data to render diagnoses.
When photographic quality was high and office-based clinician certainty was high, remote clinicians were in agreement more than 75% of the time. Office-based and remote clinicians were in agreement 61% to 64% of the time for all cases. No specific disease category appeared to be more or less amenable to diagnosis based on still digital imagery. The diagnostic certainty of the office-based clinician (reported from 0-10) had the most impact on agreement. When cases with office-based clinician certainty of no more than 7 were compared with cases with certainty of at least 9, agreement increased 54% for remote clinician 1 and 111% for remote clinician 2. As an isolated variable, photographic quality had a modest impact on agreement.
Still digital images can substitute for the dermatologic physical examination in up to 83% of cases. This study provides validation of the store-and-forward concept of telemedicine as applied to dermatology. These results serve as the foundation for field testing of the concept in primary care settings.
调查临床医生查看患者病史和静态数字图像集时的诊断准确性，并与对同一患者进行门诊体格检查的临床医生进行比较。
观察性研究。
116名在大学门诊出现皮肤症状的成年患者，他们同意按照标准化方案用数码相机记录其皮肤状况。
门诊皮肤科医生的诊断与两名远程临床医生的诊断之间的一致性，这两名远程临床医生使用静态数字图像（分辨率为每英寸92点）和相同的病史数据进行诊断。
当照片质量高且门诊临床医生的确定性高时，远程临床医生在超过75%的时间内意见一致。在所有病例中，门诊和远程临床医生在61%至64%的时间内意见一致。基于静态数字图像，似乎没有特定的疾病类别更易于或更难诊断。门诊临床医生的诊断确定性（报告范围为0至10）对一致性影响最大。将门诊临床医生确定性不超过7的病例与确定性至少为9的病例进行比较时，远程临床医生1的一致性提高了54%，远程临床医生2的一致性提高了111%。作为一个独立变量，照片质量对一致性有适度影响。
在高达83%的病例中，静态数字图像可替代皮肤科体格检查。本研究验证了远程医疗应用于皮肤科的存储转发概念。这些结果为在初级保健环境中对该概念进行现场测试奠定了基础。
