Videoconferencing linked to improved dermatological care in ED

Image: PD 

1. In the emergency department (ED), videoconferencing was superior to the use of still images as a means of teledermatology consultation.

2. Having easy access to a dermatology consultation (e.g. teledermatology) can significantly alter diagnosis and improve management of patients in the ED. 

Evidence Rating Level: 2 (Good) 

Study Rundown: Studies have shown that up to 10% of adult ED visits are due to a dermatologic chief concern. Furthermore, the literature has previously demonstrated that non-dermatologists often cannot accurately diagnose dermatologic conditions. Thus, this study evaluated the utility of still image and videoconferencing teledermatology as a means to improve access to dermatology consultation in the ED. The study revealed that ED physician’s diagnostic performance was improved in 68.7% of the cases with videoconferencing. Furthermore, when compared to still image, diagnostic accuracy was higher with videoconferencing. In regards to management, ED physicians recommended immediate hospitalization more frequently and discharged patients less often when without dermatologic consultation. A strength of this study was its parallel study design between videoconferencing and still image for both diagnosis and management.  Limitations included its small size and the hospitals’ location in France, which may hinder the generalizability.

Click to read the study in JAMA Dermatology

Relevant Reading: The Reliability of Teledermatology to Triage Inpatient Dermatology Consultations

In-Depth [observational study]: In this study, 111 participants were enrolled from patients who presented to the ED and were evaluated by both teledermatologists and ED physicians for a dermatologic complaint. The teledermatologic evaluation was in the form of still image or videoconferencing both via smartphone. Diagnosis and management decisions were compared for agreement and concordance using X2 test and t-test, respectively. The most common diagnoses were infectious and allergic dermatologic conditions, which was consistent with results from previous studies. Videoconferencing as compared to still image improved diagnostic accuracy by 68.7% (p<10-4). The ED physician as compared to the teledermatologist recommended hospitalization more frequently (8.2% vs. 7.2%, p<10-4). Teledermatologists also were more likely to recommend discharge (46.8% vs. 39.1%, p<10-4). This study suggested a high utility for the role of videoconferencing via smartphone for teledermatologic consultation in the ED and possibly opened the door for improved access and better management of dermatologic conditions in the ED setting.

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