The reliability of diagnosis using store-and-forward teledermatology

Abstract

We compared diagnoses made by a teledermatologist from digital photographs and patient histories sent from general practitioners using a store-and-forward technique and those made by another dermatologist in a face-to-face consultation with the same patients. A total of 117 patients (mean age 47 years) were referred by 18 general practitioners for diagnosis of a skin condition. Between one and seven digital images were transmitted per case. In 31% of the cases, three images were transmitted. There was full concordance between store-and-forward and face-to-face diagnoses in 57 of 106 cases (54%); in 10 cases (9%) there was overlap between the differential diagnoses provided by the teledermatologist and the face-to-face consultant. Diagnostic categories with relatively high concordances were eczema and follicular eruptions. General practitioners need to be trained in the making of digital images and in giving a good patient history.

Teledermatology for diagnosis and management of skin conditions: A systematic review

“…All studies used a repeated measures study design with the exception of one randomized controlled trial. 11 Based on location, most of the studies were conducted in the United States (n = 14), [3][4][5][6]22,24,25,33,35,37,[41][42][43]45 followed by the United Kingdom (n = 9), 11,12,15,18,29,30,32,38,44 Italy (n = 6), 7,8,20,21,36,39 Spain (n = 4), 9,10,13,17 Australia/New Zealand (n = 3), 14,31,40 Turkey (n = 2), 16,19 and one study each from Germany, 23 Netherlands, 24 Pakistan, 27 Brazil, 28 and Switzerland. 34 Patient and skin condition characteristics.…”

“…6,11,16,19,[24][25][26][27]31,32,35,37,41,44,45 Twenty-two studies evaluated only patients with circumscribed lesions; of these, 12 studies exclusively evaluated subjects with pigmented skin lesions 4,8,13,17,20,21,23,29,30,34,36,39 and two studies enrolled only subjects with nonpigmented skin lesions. 5,7 The remaining 8 studies only included subjects with circumscribed lesions but did not specify pigmentation status.…”

“…Twenty studies involving a range of dermatologic conditions (lesions and rashes) evaluated diagnostic concordance (Table IV [available online at http://www.eblue.org] and Fig 5). 3,6,11,16,18,19,24,[26][27][28]31,32,35,37,38,40,41,[43][44][45] Aggregated diagnostic agreement was assessed in 10 of these studies and ranged from 60% to 100%. 18,24,26,27,31,32,35,40,41,43 The 3 highest rates were from studies in which the same dermatologist served as both clinic dermatologist and teledermatologist and did not appear to be blinded (91%, 26 96%, 31 and 100% 40 ).…”

Mobile teledermatology coming of age

“…store-and-forward communication is independent from time-zones. The technical equipment, including digital camera and a fix built-in light-source (flash) is less expensive and provides higher quality images than a cam-camera as used in the full-motion video-transmission (Hockey, 2004;DuMoulin, 2003). Moreover, images can be corrected electronically before transmission and can be labelled with annotations.…”

Teledermatology: Outcomes and Economic Considerations

“…71-.76 .90-.97 (Bowns et al, 2006) .55 - (Oakley et al, 2006) .53 .64 (Tucker & Lewis, 2005) .56 .68 (Baba et al, 2005) .75 - (Mahendran et al, 2005) .44-.48 .64-.65 (Du Moulin et al, 2003) .54 .63 (Eminovic et al, 2003) .41 .51 (Lim et al, 2001) .73-.85 .83-.89 (Taylor et al, 2001) .44-.51 .57-.61 (High et al, 2000) .64-.77 .81-.89 (Whited et al, 1999) .41-.55 .79-.95 (Lyon & Harrison, 1997) .89 - (Zelickson & Homan, 1997) .88 - (Kvedar et al, 1997) .61-.64 .67-.70 Table 2. Interobserver Reliability for S&F Teledermatology and Conventional Care…”