Asynchronous Video-Otoscopy with a Telehealth Facilitator
Asynchronous Video-Otoscopy with a Telehealth Facilitator
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DOI：
10.1089/tmj.2012.0161
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发表时间：
2013-04-01
影响因子：
4.7
通讯作者：
Vinck, Bart
中科院分区：
文献类型：
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作者：
Biagio, Leigh;Swanepoel, De Wet;Vinck, Bart
目的：该研究调查了远程医疗诊所服务员拍摄的视频耳镜图像是否足以在异质人群中由耳鼻喉科医生进行准确的异步诊断。受试者和方法：采用受试者内比较设计，从初级保健诊所的患者中招募了61名成人。远程保健诊所服务员没有接受过正式的保健培训。由耳鼻喉科医生进行的现场耳镜检查被认为是金标准诊断。由耳鼻喉科医生和协助者从每只耳朵记录单个视频耳镜图像，并将图像上传到安全服务器。由另一名研究者为图像分配随机编号，6周后，耳鼻喉科医生访问服务器，对每张图像进行评级，并在没有参与者人口统计学或病史的情况下做出诊断。结果如下：与主持人记录的图像（75.4%）相比，耳鼻喉科医生采集的图像（83.6%）被评为可接受和优秀。10.0%的协助者记录的视频耳镜图像无法做出诊断，而耳鼻喉科医生记录的视频耳镜图像仅占4.2%。由耳鼻喉科医生和辅助者获得的视频耳镜图像的异步诊断之间测量到中度一致性（Kappa = 0.596）。由耳鼻喉科医生和协助者获得的视频耳镜图像的灵敏度分别为0.80和0.91。耳鼻喉科医生和协助者获取的图像的特异性分别为0.85和0.89，使用耳鼻喉科医生获取的图像的诊断优势比为41.0，使用协助者获取的图像的诊断优势比为46.0。结论：一个训练有素的远程医疗服务提供者可以提供一个平台，在服务不足的初级卫生保健设置使用视频耳镜耳科状态的异步诊断。
Objective: The study investigated whether video-otoscopic images taken by a telehealth clinic facilitator are sufficient for accurate asynchronous diagnosis by an otolaryngologist within a heterogeneous population. Subjects and Methods: A within-subject comparative design was used with 61 adults recruited from patients of a primary healthcare clinic. The telehealth clinic facilitator had no formal healthcare training. On-site otoscopic examination performed by the otolaryngologist was considered the gold standard diagnosis. A single video-otoscopic image was recorded by the otolaryngologist and facilitator from each ear, and the images were uploaded to a secure server. Images were assigned random numbers by another investigator, and 6 weeks later the otolaryngologist accessed the server, rated each image, and made a diagnosis without participant demographic or medical history. Results: A greater percentage of images acquired by the otolaryngologist (83.6%) were graded as acceptable and excellent, compared with images recorded by the facilitator (75.4%). Diagnosis could not be made from 10.0% of the video-otoscopic images recorded by the facilitator compared with 4.2% taken by the otolaryngologist. A moderate concordance was measured between asynchronous diagnosis made from video-otoscopic images acquired by the otolaryngologist and facilitator (kappa = 0.596). The sensitivity for video-otoscopic images acquired by the otolaryngologist and the facilitator was 0.80 and 0.91, respectively. Specificity for images acquired by the otolaryngologist and the facilitator was 0.85 and 0.89, respectively, with a diagnostic odds ratio of 41.0 using images acquired by the otolaryngologist and 46.0 using images acquired by the facilitator. Conclusions: A trained telehealth facilitator can provide a platform for asynchronous diagnosis of otological status using video-otoscopy in underserved primary healthcare settings.