Use of teledermatology by dermatology hospitalists is effective in the diagnosis and management of inpatient disease. J Am Acad Dermatol 2021 Jun;84(6):1547-1553
Date
05/12/2020Pubmed ID
32389716Pubmed Central ID
PMC7204758DOI
10.1016/j.jaad.2020.04.171Scopus ID
2-s2.0-85096405967 (requires institutional sign-in at Scopus site) 20 CitationsAbstract
BACKGROUND: Patient outcomes are improved when dermatologists provide inpatient consultations. Inpatient access to dermatologists is limited, illustrating an opportunity to use teledermatology. Little is known about the ability of dermatologists to accurately diagnose disease and manage inpatients with teledermatology, particularly when using nondermatologist-generated clinical data.
METHODS: This prospective study assessed the ability of teledermatology to diagnose disease and manage 41 dermatology consultations from a large urban tertiary care center, using internal medicine referral documentation and photographs. Twenty-seven dermatology hospitalists were surveyed. Interrater agreement was assessed by the κ statistic.
RESULTS: There was substantial agreement between in-person and teledermatology assessment of the diagnosis with differential diagnosis (median κ = 0.83), substantial agreement in laboratory evaluation decisions (median κ = 0.67), almost perfect agreement in imaging decisions (median κ = 1.0), and moderate agreement in biopsy decisions (median κ = 0.43). There was almost perfect agreement in treatment (median κ = 1.0), but no agreement in follow-up planning (median κ = 0.0). There was no association between raw photograph quality and the primary plus differential diagnosis or primary diagnosis alone.
LIMITATIONS: Selection bias and single-center nature.
CONCLUSIONS: Teledermatology may be effective in the inpatient setting, with concordant diagnosis, evaluation, and management decisions.
Author List
Gabel CK, Nguyen E, Karmouta R, Liu KJ, Zhou G, Alloo A, Arakaki R, Balagula Y, Bridges AG, Cowen EW, Davis MDP, Femia A, Harp J, Kaffenberger B, Keller JJ, Kwong BY, Markova A, Mauskar M, Micheletti R, Mostaghimi A, Pierson J, Rosenbach M, Schwager Z, Seminario-Vidal L, Sharon VR, Song PI, Strowd LC, Walls AC, Wanat KA, Wetter DA, Worswick S, Ziemer C, Kvedar J, Mikailov A, Kroshinsky DAuthor
Karolyn A. Wanat MD Vice Chair, Professor in the Dermatology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Dermatology
Feasibility Studies
Female
Hospitalists
Hospitalization
Humans
Male
Middle Aged
Observer Variation
Photography
Prospective Studies
Remote Consultation
Skin
Skin Diseases
Surveys and Questionnaires
Tertiary Care Centers
