Telemedicine, defined by the World Health Organization as the practice of health care using interactive audio, visual, and data communications, can include health care delivery, diagnosis, consultation, and treatment as well as education and transfer of medical data, according to background information in the article. Because leg ulcers and chronic wounds represent important cost factors for health care systems, with transportation costs representing a large percentage of these costs, telemedical wound care is an potentially important application of teledermatology, the authors suggest.
Ralph Peter Braun, M.D., of University Hospital of Geneva, Switzerland, and his colleagues performed a prospective study comparing face-to-face evaluation of leg wounds with remote evaluations to address the feasibility of taking images with cell phones, transmitting them to an expert at a distance and getting the expert's advice immediately. Over the course of three months, patients at their outpatient clinic, a total of 52 patients with 61 chronic wounds were evaluated by a physician who also took two images of the leg ulcer, an overview image covering the lower leg and the ulcer and a close-up picture covering the leg ulcer with surrounding skin. The images, taken under normal lighting conditions, were immediately transmitted (via the mobile telephone) to the e-mail accounts of two physicians who then made the remote diagnoses.
"…We considered the face-to-face evaluation to be the gold standard because the physician saw the patient, saw and smelled the ulcer and the wound dressings, and was able to judge the context of the whole patient, his or her medical history and medical chart, and the presence of other diseases such as diabetes mellitus or arterial insufficiency," the researchers write.
The three physicians separately evaluated the 61 leg ulcers for nine variables. "The image quality was judged to be good in 36 cases (59 percent) and very good in 12 (20 percent). The participants felt comfortable making a diagnosis based on the pictures in 50 cases (82 percent)," the authors state. To compare the results, the researchers used a statistical analysis which measures agreement between two raters when both rate the same object. The value range is one to zero, where one is perfect agreement and zero is no agreement between the two raters. "Overall, the agreement between the remote and face-to-face evaluations was very good, with … values of up to 0.94," the authors state.
"In this study, we were able to show for the first time that telemedicine for chronic wounds is feasible under routine conditions using this new generation of mobile telephones and direct transfer via e-mail," the authors conclude. "We had the impression that a high percentage of the problems related to leg ulcers could be solved with this type of teleconsultation. The transport of the patient to the patient to the hospital or the physician's office could be replaced, and this approach could potentially save the health care system money. …we plan a second study that will investigate whether this type of teleconsultation can efficiently replace the face-to-face consultation in routine conditions."
(Arch Dermatol. 2005; 141:254-258. Available post-embargo at www.archdermatol.com.)
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