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Teledermatology via smartphone reliably triaged inpatients

Teledermatology using a smartphone was reliable for patient triage when compared with hospital inpatient consultation by a dermatologist, according to recent study results.

“Dermatology support is essential for hospitalized patients, but unfortunately, many hospitals lack dermatology coverage,” researcher Misha Rosenbach, MD, assistant professor of dermatology and director of the inpatient dermatology service at Penn Medicine, Philadelphia, said in a press release. “Teledermatology may help optimize time spent by dermatologists in the inpatient setting by … allowing some dermatologists to batch consultations or schedule nonurgent inpatients to be seen after discharge.”

Rosenbach and colleagues conducted a study of 50 hospitalized patients (mean age, 55.2 years; 64% women) between September 2012 and April 2013 for whom a dermatology consultation was requested. Mean length of stay before consultation request was 9.5 days. An in-person dermatologist and two independent teledermatologists using a smartphone platform and camera independently evaluated the patients.

Compared with the in-person dermatologist’s recommendation that the patient be seen the same day, both teledermatologists matched the recommendation in 90% of cases. In cases where the in-person dermatologist recommended a biopsy, the teledermatologists advocated for a biopsy in a mean of 95% of consultations.

Initial triage agreement between the in-person dermatologist and each teledermatologist had Kendall’s tau coefficients of 0.41 (95% CI, 0.18-0.6) and 0.48 (95% CI, 0.31-0.65), respectively. There was a fair to moderate concordance to order biopsy with a Cohen kappa coefficient of 0.35 (95% CI, 0.12-0.58) between the in-person dermatologist and the first teledermatologist and 0.61 (95% CI, 0.39-0.82) for the dermatologist and the second teledermatologist.

Sixty percent of consultation patients were triaged by the teledermatologists to be seen on the next day or later. Ten percent of patients, on average, were triaged by the teledermatologists and seen as outpatients.

“A substantial agreement between in-person and teledermatology consultants in this study demonstrates the reliability and potential of this platform,” Rosenbach said.

Disclosure: Researcher Ryan Littman-Quinn received 25% of his salary from Vignet for consultation on unrelated projects.