Telemedicine for Surgical Site Infection Diagnosis in Rural Rwanda: Concordance and Accuracy of Image Reviews
Telemedicine for Surgical Site Infection Diagnosis in Rural Rwanda: Concordance and Accuracy of Image Reviews
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DOI：
10.1007/s00268-022-06597-8
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发表时间：
2022-06-04
影响因子：
2.6
通讯作者：
Kateera, Fredrick
中科院分区：
文献类型：
--
作者：
Hedt-Gauthier, Bethany;Miranda, Elizabeth;Kateera, Fredrick
背景 在获得医疗人员的机会有限的非洲农村地区，可以利用远程医疗来增强社区卫生工作者 (CHW) 的能力，以支持剖腹产 (c-section) 后有效的产后家庭护理。作为远程医疗的第一步，我们评估了卢旺达乡村医院剖腹产妇女手术部位感染 (SSI) 图像诊断的敏感性、特异性和受试者间可靠性。方法 纳入 2017 年 3 月至 10 月在 Kirehe 地区医院 (KDH) 接受剖腹产的 18 岁以上女性。术后第 10 天，参与者在 KDH 接受了全科医生的体检，全科医生诊断为 SSI 或无 SSI。经过训练的社区卫生工作者拍摄了患者的切口，并将收集到的图像展示给六名医生，他们在审查后为每张图像分配以下诊断之一：明确的 SSI、疑似 SSI、疑似无 SSI 和明确无 SSI，并将其与基于体检的诊断进行比较。我们使用 Gwet 的 AC1 报告敏感性和特异性，并评估审稿人的一致性。结果 纳入 569 张图像，其中 61 名女性 (10.7%) 被诊断患有 SSI。在 3414 份图像审核中，有 49 份 (1.4%) 由于图像质量问题无法进行诊断。中位敏感性和特异性分别为 0.83 和 0.69。 Gwet 的二元分类 AC1 估计值为 0.46。结论 对于基于照片的 SSI 诊断，我们表现出不错的准确性，但一致性较差。提高整体一致性的策略包括提供伴随照片的临床信息、提供用于比较的基线照片以及实施旨在提高图像质量的拍照过程。
Background In rural Africa where access to medical personnel is limited, telemedicine can be leveraged to empower community health workers (CHWs) to support effective postpartum home-based care after cesarean section (c-section). As a first step toward telemedicine, we assessed the sensitivity, specificity, and interrater reliability of image-based diagnosis of surgical site infections (SSIs) among women delivering via c-section at a rural Rwandan Hospital. Methods Women >= 18 years who underwent c-section from March to October 2017 at Kirehe District Hospital (KDH) were enrolled. On postoperative day 10 at KDH, participants underwent a physical examination by a general practitioner, who provided a diagnosis of SSI or no SSI. Trained CHWs photographed patients' incisions and the collected images were shown to six physicians, who upon review, assigned one of the following diagnoses to each image: definite SSI, suspected SSI, suspected no SSI, and definite no SSI, which were compared with the diagnoses based on physical exam. We report the sensitivity and specificity and assessed reviewer agreement using Gwet's AC1. Results 569 images were included, with 61 women (10.7%) diagnosed with an SSI. Of the 3414 image-reviews, 49 (1.4%) could not be assigned diagnoses due to image quality. The median sensitivity and specificity were 0.83 and 0.69, respectively. The Gwet's AC1 estimate for binary classification was 0.46. Conclusions We demonstrate decent accuracy but only moderate consistency for photograph-based SSI diagnosis. Strategies to improve overall agreement include providing clinical information to accompany photographs, providing a baseline photograph for comparison, and implementing photograph-taking processes aimed at improving image quality.