Teledermatology may be reliable in triaging inpatient dermatology consultations

Image: PD

1. Teledermatologists and in-person dermatologists showed strong concordance when triaging patients, showing 90% shared agreement when recommending same day evaluation. 

2. Teledermatologists were able to triage 10% of inpatient consults directly to the outpatient setting. 

Evidence Rating Level: 2 (Good) 

Study Rundown: Teledermatology is a potential alternative for hospitals that do not have inpatient Dermatology services or that have services with limited hours. While previous studies have established the reliability and accuracy of teledermatology in the outpatient setting, these authors sought to assess its reliability in the inpatient setting. In this study, authors compared teledermatologists (TDs) and in-person dermatologists (IPD) triage decisions, regarding when patients should be seen and need for biopsy. The study found TDs and IPD had similar triage plans with a trend towards more conservative management decisions by TDs. The strengths of the study result from study design, as they effectively blinded TDs and IPD when being consulted through the use of trained medical students, using a smartphone platform with camera. The study is limited by the small study size of 50 patients. Additionally, this study may not be generalizable, as it was performed at a large academic center, which may represent a different demographic of patients (e.g. more comorbidities, increased burden of disease, increased complexity of consultation, ect). Future areas of interest may include the economic implications of TDs, as they were found to manage more conservatively and biopsied more often than IPD.

Click to read the study in JAMA Dermatology

Click to read an accompanying editorial in JAMA Dermatology

Relevant Reading: State of teledermatology programs in the United States

In-Depth [prospective cohort]: This study analyzed 50 inpatient Dermatology consults at the University of Pennsylvania Hospital. Independently, two TD and one IPD made recommendations for each inpatient consultation, which were compared. The primary outcomes of this study were comparing TDs and IPDs decisions about initial triage and whether to biopsy. Initial triage decision was stratified into four categories: same day, next day, anytime within the hospitalization, or as an outpatient. Analysis using Kendall τ rank correlation showed moderate concordance in initial triage decision between the IPD/TD1 and IPD/TD2 to be 0.41 (95% CI, 0.18-0.60) and 0.48 (95% CI, 0.31-0.65), respectively. Combined, the TDs agreed with in-person recommendation for same day evaluation 90% of the time. TDs leaned towards more conservative management in recommending more next-day evaluations than IPD, though TDs were still able to triage 10% of patients to outpatient visits. The decision to biopsy was analyzed using Cohen κ coefficient, showing fair to moderate concordance in biopsy decision between IPD/TD1 and IPD/TD2 to be 0.35 (95% CI, 0.12-0.58) and .61 (95% CI, 0.39-0.82), respectively. If the IPD recommended a biopsy, TDs agreed with the IPD’s decision to biopsy 95% of the time.TD1 and TD2 requested more biopsies in general (64% and 54%, respectively) compared to the IPD (42%).

By Shirin Bajaj and Adam Whittington

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