Emergency Department Diagnosis and Management of Skin Diseases With Real-Time Teledermatologic Expertise

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Abstract

IMPORTANCE

Skin conditions are a common reason for patients to consult emergency department (ED) physicians.

OBJECTIVE

To evaluate real-time teledermatologic expertise with the use of mobile telephones for the diagnosis and management of skin conditions in patients seen in the ED.

DESIGN, SETTING, AND PARTICIPANTS

This observational study of adults who consecutively consulted in the ED for a dermatologic condition was conducted under routine conditions in the ED from May 1, 2008, through June 30, 2010.

MAIN OUTCOMES AND MEASURES

Diagnosis agreement and management concordance.

RESULTS

One hundred eleven patients were enrolled in the study. Eighty-three patients (74.8%) were evaluated using videoconferencing. Dermatologic remote expertise invalidated, enlarged, or clarified ED physicians’ diagnosis and management in 75 of 110 cases (68.2%). Videoconferencing improved the diagnostic performance in 57 of 83 cases (68.7%) (P < 10−4). Management concordance was moderate between ED physicians and dermatologists for specialist consultation within 24 hours (κ, 0.49; 95% CI, 0.14-0.84) and immediate hospitalization (κ, 0.49; 95% CI, 0.41-0.57). Patients were significantly more often discharged by dermatologists (46.8% vs 39.1%) (P < 10−4).

CONCLUSIONS AND RELEVANCE

Compared with standard hardware, new-generation mobile devices reduce the cost of videoconferencing, increase the versatility of teledermatology, and decrease general practitioner investment time.

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