Diagnostic accuracy and precision in assessing dermatologic disease. Problem or promise?

Whited, J. D.

doi:10.1001/archderm.133.11.1409

Cited by 6 publications

(6 citation statements)

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“…Teledermatology is becoming an important tool for providing specialty care to patients who would otherwise not have access to dermatologists. Our finding that 75% of cases were able to be diagnosed regardless of the historical data provided is in accordance with previously published data in adults suggesting that store‐and‐forward teledermatology consults can decrease the need for an in‐person dermatology consultation in the majority of cases . The impact of this in pediatric dermatology care is emphasized by a previous study at UCSF in patients seen via store‐and‐forward consultation between 2002 and 2006 .…”

Section: Discussionsupporting

confidence: 92%

Pediatric Teledermatology Consultations: Relationship Between Provided Data and Diagnosis

Philp

Frieden

Cordoro

2013

Pediatric Dermatology

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There is a shortage of pediatric dermatologists. Teledermatology has emerged as a tool to facilitate access to dermatologists. Many questions remain regarding how to optimize consultations in order to provide the best diagnosis and management recommendations. The aim of this retrospective cohort study was to categorize the historical data and judge the adequacy of photographs sent by referring providers to our academic pediatric teledermatology practice at the University of California, San Francisco, and to evaluate the relationship of these data to our ability to render a diagnosis. A diagnosis was rendered in 75% of cases. The only historical data associated with receiving a diagnosis was prior treatment (OR 2.01, CI 1.01, 4, p < 0.05). Appropriate image distance from the target was associated with receiving a diagnosis for rashes (OR 2.69, CI 1.07, 6.8, p = 0.04) and growths (OR 4.16, CI 1.04, 16.6, p = 0.04). A lack of diagnosis was significantly associated with a recommendation for referral for biopsy (OR 0.03, CI 0.01, 0.10, p < 0.0001) or for in-person consultation (OR 0.19, CI 0.05, 0.66, p < 0.001). In conclusion, pediatric teledermatologists are able to make a diagnosis most of the time, regardless of historical information provided or image quality. The rate of diagnosis may be improved with the use of standardized templates for historical information. Similarly, photography training could minimize the need for in-person consultation. Specific information regarding prior treatments could also help in providing useful management recommendations.

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Section: Discussionsupporting

confidence: 92%

Pediatric Teledermatology Consultations: Relationship Between Provided Data and Diagnosis

Philp

Frieden

Cordoro

2013

Pediatric Dermatology

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“…It is possible that some of the dermatologists' clinical assessment was inaccurate and that a TBSE was not performed. However, previous research 27 has shown that dermatologists are highly accurate in their clinical assessment of cutaneous malignant lesions. Nondermatologists might have assumed that the dermatologist would perform a TBSE at the consultation visit and therefore did not perform a thorough skin examination.…”

Section: Commentmentioning

confidence: 97%

Outcomes of Referral to Dermatology for Suspicious Lesions

Viola¹,

Tolpinrud²,

Gross³

et al. 2011

Arch Dermatol

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“…Not surprisingly, dermatologists performed better (faster and with greater accuracy) than nondermatologists at diagnosing skin disease . A visual diagnosis has been shown to be possible in as short a time as 200 ms .…”

Section: Dermatology and Its Heuristicsmentioning

confidence: 99%

“…Other frequently misdiagnosed diseases include tinea barbae; Spitz naevi; keratoacanthomas; Lyme disease in nonendemic areas; Kaposi sarcoma in dark skin; and scabies . A review of several studies found, using pathology records, a positive predictive value for dermatologists’ examination for melanoma ranging from 17% to 86% . Histological diagnoses can be subjective and result in significant interobserver variation as, for example, in the diagnosis of melanoma, where an 18% discordance rate is cited in one study .…”

mentioning

confidence: 99%

Cognitive and visual diagnostic errors in dermatology: part 1

Lowenstein

Sidlow

2018

Br J Dermatol

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Sir William Osler famously, and ironically, stated that 'Medicine is a science of uncertainty and an art of probability'. The processes by which each physician metes out diagnostic uncertainty and navigates probabilities in dermatology is far from uniform. While certain ubiquitous cognitive and visual heuristics can enhance diagnostic speed, they also create pitfalls and thinking traps that introduce significant variation in the diagnostic process. Discussed in this part of a two-part article are various cognitive and visual heuristics as they pertain to skin disease, with an introduction and special attention paid to the heuristic methods classically applied by dermatologists. How to best address error and improve our thought processes will be addressed in part 2.

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Diagnostic accuracy and precision in assessing dermatologic disease. Problem or promise?

Cited by 6 publications

References 0 publications

Pediatric Teledermatology Consultations: Relationship Between Provided Data and Diagnosis

Pediatric Teledermatology Consultations: Relationship Between Provided Data and Diagnosis

Outcomes of Referral to Dermatology for Suspicious Lesions

Cognitive and visual diagnostic errors in dermatology: part 1

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