• 作者：S. Vañ ; ó ; -Galv&#225 ; n^a ; ^{sergiovano@yahoo.es} ; Á ; . Hidalgo^b ; I. Aguayo-Leiva^a ; M. Gil-Mosquera^c ; L. Rí ; os-Buceta^a ; M.N. Plana^d ; J. Zamora^d ; A. Martorell-Calatayud^e ; P. Jaé ; n^a
• 关键词：Teledermatologí ; a ; Telemedicina ; Almacenamiento ; Urgencias ; Validez ; Fiabilidad
• 刊名：Actas Dermo-Sifiliogr谩ficas
• 出版年：2011
• 期刊代码：pca35_00017310
• 类别：med
• 出版时间：May 2011
• 卷：102
• 期：4
• 页码：277-283
• 文件大小：267 K

lass="h4">Background and objectives

The aim of this study was to assess the validity of store-and-forward teledermatology as a tool to support physicians in primary care and hospital emergency services and reduce the requirement for face-to-face appointments. Diagnostic validity and the approach chosen for patient management (face-to-face vs teledermatology) were compared according to patient origin and diagnostic group.

lass="h4">Material and methods

Digital images from 100 patients were assessed by 20 different dermatologists and the diagnoses offered were compared with those provided in face-to-face appointments (gold standard). The proposed management of the different groups of patients was also compared.

lass="h4">Results

The percentage complete agreement was 69.05%(95%confidence interval [CI], 66.9%鈥?1.0%). The aggregate agreement was 87.80%(95%CI, 86.1%鈥?9.0%). When questioned about appropriate management of the patients, observers elected face-to-face consultation in 60%of patients (95%CI, 58%鈥?1%) and teledermatology in 40%(95%CI, 38%鈥?1%).聽Diagnostic validity was higher in patients from primary care (76.1%complete agreement and 91.8%aggregate agreement) than those from hospital emergency services (61.8%complete agreement, 83.4%aggregate agreement) (p < 0.001) and teledermatology was also chosen more often in patients from primary care compared with those from emergency services (42%vs 38%; p = 0.003). In terms of diagnostic group, higher validity was observed for patients with infectious diseases (73.3%complete agreement and 91.3%aggregate agreement) compared to those with inflammatory disease (70.8%complete agreement and 86.4%aggregate agreement) or tumors (63.0%complete agreement and 87.2%aggregate agreement) (p <0.001). Teledermatology was also chosen more often in patients with infectious diseases (52%) than in those with inflammatory disease (40%) or tumors (28%) (p <0.001).

lass="h4">Conclusions

Store-and-forward teledermatology has a high level of diagnostic validity, particularly in those cases referred from primary care and in infectious diseases. It can be considered useful for the diagnosis and management of patients at a distance and would reduce the requirement for face-to-face consultation by 40%.