Original article
Store-and-Forward Teledermatology: Assessment of Validity in a Series of 2000 Observations
Teledermatología diferida: análisis de validez en una serie de 2.000 observaciones
S. Vañó-Galvána,
, Á. Hidalgob, I. Aguayo-Leivaa, M. Gil-Mosquerac, L. Ríos-Bucetaa, M.N. Planad, J. Zamorad, A. Martorell-Calatayude, P. Jaéna
Autor para correspondencia
a Servicio de Dermatología, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
b Associate Professor in Fundamentals of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain
c Medicina de Familia, Hospital Ramón y Cajal, Madrid, Spain
d Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal. CIBER en Epidemiología y Salud Pública (CIBERESP), Instituto de Investigación Sanitaria (IRYCIS), Madrid, Spain
e Servicio de Dermatología, Hospital de Requena, Valencia, Spain
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CIBER en Epidemiología y Salud Pública (CIBERESP), Instituto de Investigación Sanitaria (IRYCIS), Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital de Requena, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Teledermatología diferida: análisis de validez en una serie de 2.000 observaciones" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-05-30" "fechaAceptado" => "2010-11-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec84898" "palabras" => array:6 [ 0 => "Teledermatology" 1 => "Telemedicine" 2 => "Store-and-forward" 3 => "Emergency services" 4 => "Validity" 5 => "Reliability" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec84899" "palabras" => array:6 [ 0 => "Teledermatología" 1 => "Telemedicina" 2 => "Almacenamiento" 3 => "Urgencias" 4 => "Validez" 5 => "Fiabilidad" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Background and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The percentage complete agreement was 69.05% (95% confidence interval [CI], 66.9%–71.0%). The aggregate agreement was 87.80% (95% CI, 86.1%–89.0%). When questioned about appropriate management of the patients, observers elected face-to-face consultation in 60% of patients (95% CI, 58%–61%) and teledermatology in 40% (95% CI, 38%–41%). 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) (<span class="elsevierStyleItalic">P</span><.001) and teledermatology was also chosen more often in patients from primary care compared with those from emergency services (42% vs 38%; <span class="elsevierStyleItalic">P<span class="elsevierStyleHsp" style=""></span></span>=.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) (<span class="elsevierStyleItalic">P</span><.001). Teledermatology was also chosen more often in patients with infectious diseases (52%) than in those with inflammatory disease (40%) or tumors (28%) (<span class="elsevierStyleItalic">P</span><.001).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">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%.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción y objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Objetivo: evaluar la validez de la teledermatología diferida y su aplicación como herramienta de apoyo a Atención Primaria y servicios de Urgencias hospitalarias (consultas presenciales evitadas). Comparar validez y manejo del paciente (presencial vs teledermatología) según el origen del paciente y el grupo diagnóstico.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se compararon los diagnósticos emitidos sobre 100 pacientes por 20 dermatólogos observadores con el emitido en la consulta presencial (patrón oro) y se comparó el manejo entre los grupos de pacientes.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Porcentaje de acuerdo completo (AC): 69,05 (IC 95%: 66,9–71,0). Porcentaje de acuerdo agregado (AG): 87,80 (IC 95%: 86,1–89,0). Pacientes manejados de manera presencial: 60% (58–61). Pacientes manejados por teledermatología: 40% (38–41). Los pacientes provenientes de Atención Primaria y el grupo de patología infecciosa presentó mayor validez diagnóstica (76,1 AC y 91,8 AG; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001 para Atención Primaria y 73,3 AC y 91,3 AG; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001 para patología infecciosa) y fueron manejados vía teledermatológica (42%; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,003 para Atención Primaria y 52%; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001 para patología infecciosa) en mayor medida que los provenientes de Urgencias (61,8 AC y 83,4 AG; 38% manejo teledermatológico) y aquellos con patología inflamatoria (70,8 AC y 86,4 AG; 40% manejo teledermatológico) o tumoral (63,0 AC y 87,2 AG; 28% manejo teledermatológico).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La teledermatología diferida presenta una elevada validez diagnóstica, especialmente en casos remitidos de Atención Primaria y para patología infecciosa, y es útil en el manejo y diagnóstico a distancia de pacientes, ya que evitaría el 40% de las consultas presenciales.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| año/Mes | Html | Total | |
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| 2020 Agosto | 27 | 15 | 42 |
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| 2020 Marzo | 45 | 15 | 60 |
| 2020 Febrero | 3 | 3 | 6 |
| 2020 Enero | 0 | 8 | 8 |
| 2019 Diciembre | 0 | 10 | 10 |
| 2019 Octubre | 0 | 2 | 2 |
| 2019 Septiembre | 0 | 2 | 2 |
| 2019 Julio | 0 | 4 | 4 |
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| 2019 Mayo | 0 | 41 | 41 |
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| 2018 Enero | 17 | 5 | 22 |
| 2017 Diciembre | 21 | 9 | 30 |
| 2017 Noviembre | 16 | 5 | 21 |
| 2017 Octubre | 15 | 6 | 21 |
| 2017 Septiembre | 15 | 3 | 18 |
| 2017 Agosto | 26 | 6 | 32 |
| 2017 Julio | 12 | 4 | 16 |
| 2017 Junio | 17 | 5 | 22 |
| 2017 Mayo | 16 | 5 | 21 |
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| 2017 Marzo | 16 | 79 | 95 |
| 2017 Febrero | 18 | 8 | 26 |
| 2017 Enero | 12 | 8 | 20 |
| 2016 Diciembre | 25 | 4 | 29 |
| 2016 Noviembre | 27 | 4 | 31 |
| 2016 Octubre | 34 | 19 | 53 |
| 2016 Septiembre | 37 | 3 | 40 |
| 2016 Agosto | 28 | 3 | 31 |
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| 2016 Junio | 7 | 5 | 12 |
| 2016 Mayo | 6 | 0 | 6 |
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| 2016 Marzo | 2 | 0 | 2 |
| 2016 Febrero | 6 | 2 | 8 |
| 2016 Enero | 4 | 1 | 5 |
| 2015 Diciembre | 6 | 0 | 6 |
| 2015 Noviembre | 8 | 0 | 8 |
| 2015 Octubre | 6 | 1 | 7 |
| 2015 Septiembre | 4 | 4 | 8 |
| 2015 Agosto | 8 | 3 | 11 |
| 2015 Julio | 28 | 10 | 38 |
| 2015 Junio | 44 | 3 | 47 |
| 2015 Mayo | 68 | 12 | 80 |
| 2015 Abril | 26 | 7 | 33 |
| 2015 Marzo | 26 | 6 | 32 |
| 2015 Febrero | 24 | 7 | 31 |
| 2015 Enero | 31 | 8 | 39 |
| 2014 Diciembre | 45 | 16 | 61 |
| 2014 Noviembre | 26 | 18 | 44 |
| 2014 Octubre | 30 | 18 | 48 |
| 2014 Septiembre | 33 | 11 | 44 |
| 2014 Agosto | 29 | 13 | 42 |
| 2014 Julio | 39 | 27 | 66 |
| 2014 Junio | 41 | 13 | 54 |
| 2014 Mayo | 44 | 24 | 68 |
| 2014 Abril | 51 | 14 | 65 |
| 2014 Marzo | 48 | 24 | 72 |
| 2014 Febrero | 28 | 14 | 42 |
| 2014 Enero | 40 | 14 | 54 |
| 2013 Diciembre | 63 | 21 | 84 |
| 2013 Noviembre | 27 | 14 | 41 |
| 2013 Octubre | 23 | 13 | 36 |
| 2013 Septiembre | 28 | 18 | 46 |
| 2013 Agosto | 24 | 17 | 41 |
| 2013 Julio | 29 | 27 | 56 |
| 2013 Junio | 15 | 27 | 42 |
| 2013 Mayo | 19 | 28 | 47 |
| 2013 Abril | 7 | 6 | 13 |
| 2013 Marzo | 5 | 9 | 14 |
| 2013 Febrero | 6 | 5 | 11 |
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