Use of photograph-based telemedicine in postoperative wound assessment to diagnose or exclude surgical site infection
Use of photograph-based telemedicine in postoperative wound assessment to diagnose or exclude surgical site infection
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DOI：
10.12968/jowc.2018.27.3.128
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发表时间：
2018-03-01
影响因子：
1.9
通讯作者：
Chetter, Ian C.
中科院分区：
文献类型：
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作者：
Totty, Joshua P.;Harwood, Amy E.;Chetter, Ian C.
目的：本研究旨在评估临床医生检查伤口照片是否可以替代临床检查，以识别或排除手术部位感染 (SSI)。方法：我们进行了一项混合方法研究，包括定性公众参与练习和对接受清洁或清洁污染血管手术的患者进行的前瞻性、非随机、单中心研究。对于定性研究，进行了两次半结构化焦点小组访谈。在前瞻性研究中，患者被邀请在术后 5-7 天和 30 天进行伤口检查。在审查时，研究护士或医生根据 ASEPSIS 量表对伤口进行评分。拍摄匿名伤口照片并进行独立审查，并由两名对原始临床审查的 ASEPSIS 评分不知情的独立研究人员进行 ASEPSIS 评分。结果：在定性研究中，在两个日期对三名女性患者进行了访谈。新出现的主题包括 SSI 的负担、医院随访和远程医疗随访。共有37例患者纳入定量分析，平均年龄61.14岁。总共进行了 53 次伤口检查。除红斑外，所有类别的照片和临床评价者之间的一致性均大于 85%。照片检查诊断 SSI 的特异性为 90%。 ASEPSIS 总分的组内相关系数为 R=0.806（95% CI 0.694，0.881），表明评审者之间具有很强的可靠性。结论：我们的数据表明，在 SSI 评估中，面对面临床和远程摄影评审之间存在良好的相关性。将这种伤口评估方法纳入术后后续护理途径可以使患者和临床医生免去不必要的医院就诊，特别是在进行健康研究时。
Objective: This study aims to assess whether a clinician reviewing photographs of a wound was an acceptable substitute for clinical review in order to identify or exclude surgical site infection (SSI).Method: We undertook a mixed methods study consisting of a qualitative public involvement exercise and a prospective, non-randomised, single-centre study of patients undergoing clean or clean-contaminated vascular surgery. For the qualitative study, two semi-structured focus group interviews were conducted. For the prospective study, patients were invited to attend a wound review at 5-7 days and 30 days postoperatively. At review, wounds were scored by a study nurse or doctor, according to the ASEPSIS scale. Anonymised wound photographs were taken and independently reviewed, and ASEPSIS scored by two independent investigators blinded to the original clinical review' ASEPSIS score.Results: In the qualitative study, three female patients were interviewed across two dates. Emerging themes included the burden of SSI, hospital follow-up and telemedical follow-up. A total of 37 patients with a mean age of 61.14 years were included in the quantitative analysis. There was a total of 53 wound reviews. There was >85% agreement between photograph and clinical reviewers in all categories except erythema. The specificity of photograph review for diagnosis of SSI was 90%. The intraclass correlation coefficient for total ASEPSIS score was R=0.806 (95% CI 0.694, 0.881), indicating strong reliability between reviewers.Conclusion: Our data shows that, in the assessment of SSI, there is good correlation between face-to-face clinical and remote photographic review. Incorporating this method of wound assessment into a postoperative follow-up care pathway may save patients and clinicians from unnecessary hospital visits, particularly when conducting health research.