Patient outcomes are improved when dermatologists provide inpatient consults. Inpatient access to dermatologists is limited, illustrating an opportunity to utilize teledermatology. Little is known about the ability of dermatologists to accurately diagnose and manage inpatients using teledermatology, particularly utilizing non-dermatologist generated clinical data.
This prospective study assessed the ability of teledermatology to diagnose and manage 41 dermatology consults from a large urban tertiary care center utilizing internal medicine referral documentation and photos. Twenty-seven dermatology hospitalists were surveyed. Interrater agreement was assessed by the kappa statistic.
There was substantial agreement between in-person and teledermatology assessment of the diagnosis with differential diagnosis (median kappa = 0.83), substantial agreement in laboratory work-up decisions (median kappa = 0.67), almost perfect agreement in imaging decisions (median kappa = 1.0), and moderate agreement in biopsy decisions (median kappa = 0.43). There was almost perfect agreement in treatment (median kappa = 1.0), but no agreement in follow-up planning (median kappa = 0.0). There was no association between raw photo quality and the primary plus differential diagnosis or primary diagnosis alone.
Selection bias and single-center nature.
Teledermatology may be effective in the inpatient setting, with concordant diagnosis, evaluation, and management decisions.
Copyright © 2020. Published by Elsevier Inc.
About The Expert
Colleen K Gabel
Emily Nguyen
Ryan Karmouta
Kristina Jing Liu
Guohai Zhou
Allireza Alloo
Ryan Arakaki
Yevgeniy Balagula
Alina G Bridges
Edward W Cowen
Mark Denis P Davis
Alisa Femia
Joanna Harp
Benjamin Kaffenberger
Jesse J Keller
Bernice Y Kwong
Alina Markova
Melissa Mauskar
Robert Micheletti
Arash Mostaghimi
Joseph Pierson
Misha Rosenbach
Zachary Schwager
Lucia Seminario-Vidal
Victoria R Sharon
Philip I Song
Lindsay C Strowd
Andrew C Walls
Karolyn A Wanat
David A Wetter
Scott Worswick
Carolyn Ziemer
Joseph Kvedar
Anar Mikailov
Daniela Kroshinsky
References
PubMed