Diagnostic Accuracy of Pediatric Teledermatology Using Parent-Submitted Photographs A Randomized Clinical Trial
Diagnostic Accuracy of Pediatric Teledermatology Using Parent-Submitted Photographs A Randomized Clinical Trial
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DOI：
10.1001/jamadermatol.2017.4280
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发表时间：
2017-12-01
期刊：
影响因子：
10.9
通讯作者：
McMahon, Patrick J.
中科院分区：
文献类型：
--
作者：
O'Connor, Daniel M.;Jew, Olivia S.;McMahon, Patrick J.
智能手机摄影（质量和图像传输）的进步可以通过直接的父母到临床医生的远程医疗来改善护理。然而，依赖于父母提供的照片的诊断的准确性还没有被正式地与亲自进行的诊断进行比较。目的评估父母拍摄的儿科皮肤病的智能手机照片是否具有足够的质量以允许准确的诊断。和参与者一项前瞻性研究在40名患者中进行，2016年3月1日至9月30日，费城儿童医院儿科皮肤科诊所的父母对，评估独立儿科皮肤科医生基于亲自检查和基于父母照片的诊断之间的一致性。一半的患者-父母配对被随机分配进行二次分析，以获得如何最好地使用智能手机拍照的指导。临床医生不知道父母是否接受了摄影指导。暴露一半的患者-父母二人组接受了关于如何使用智能手机最好地拍照的简单的3步指导表（干预组）;另一半没有（对照组）。主要结果和测量干预组与对照组中基于电子邮件的诊断与亲自诊断之间的一致性，如使用Cohen量化的。结果在40个患者-父母二人组（22个女孩和18个男孩;平均[SD]年龄，6.96 [5.23]岁）中，基于诊断的诊断与亲自诊断的总体一致性为83%（95%CI，71%-94%）。= 0.81）。诊断一致性为89%（95% CI，75%-97%）。= 0.88），在一个由37名参与者组成的亚组中，照片被认为质量足够高，可以做出诊断。摄影指导对一致性没有统计学显著影响（接受指导的组，85%;未接受指导的组，80%; P = 0.68）。在诊断不一致的情况下，适当的后续household.CONCLUSIONS和RELEVANCE家长操作的智能手机摄影可以准确地被用作方法，提供儿科皮肤病护理。
IMPORTANCE Advances in smartphone photography (both quality and image transmission) may improve access to care via direct parent-to-clinician telemedicine. However, the accuracy of diagnoses that are reliant on parent-provided photographs has not been formally compared with diagnoses made in person.OBJECTIVE To assess whether smartphone photographs of pediatric skin conditions taken by parents are of sufficient quality to permit accurate diagnosis.DESIGN, SETTING, AND PARTICIPANTS A prospective studywas conducted among 40 patient-parent dyads at a pediatric dermatology clinic at the Children's Hospital of Philadelphia from March 1 to September 30, 2016, to assess concordance between diagnoses made by an independent pediatric dermatologist based on in-person examination and those based on parental photographs. Half of the patient-parent dyads were randomized for a secondary analysis to receive instructions on how best to take photographs with smartphones. Clinicians were blinded to whether parents had received photography instructions.EXPOSURES Half of the patient-parent dyads received a simple, 3-step instruction sheet on how best to take photographs using a smartphone (intervention group); the other half did not (control group).MAIN OUTCOMES AND MEASURES Concordance between photograph-based vs in-person diagnosis in the intervention vs control groups, as quantified using Cohen., a measure of interrater agreement that takes into account the possibility of agreement occurring by chance.RESULTS Among the 40 patient-parent dyads (22 female children and 18 male children; mean [SD] age, 6.96 [5.23] years), overall concordance between photograph-based vs in-person diagnosis was 83%(95% CI, 71%-94%;. = 0.81). Diagnostic concordance was 89% (95% CI, 75%-97%;. = 0.88) in a subgroup of 37 participants with photographs considered of high enough quality to make a diagnosis. No statistically significant effect of photography instructions on concordance was detected (group that received instructions, 85%; group that did not receive instructions, 80%; P = .68). In cases of diagnostic disagreement, appropriate follow-up was suggested.CONCLUSIONS AND RELEVANCE Parent-operated smartphone photography can accurately be used as amethod to provide pediatric dermatologic care.