Wirthlin DJ, Buradagunta S, Edwards RA, Brewster DC, Cambria RP, Gertler JP, LaMuraglia GM, Jordan DE, Kvedar JC, Abbott WM, et al.
Journal of vascular surgery. Date of publication 1998 Jun 1;volume 27(6):1089-99; discussion 1099-100.
1. J Vasc Surg. 1998 Jun;27(6):1089-99; discussion 1099-100.
Telemedicine in vascular surgery: feasibility of digital imaging for remote
management of wounds.
Wirthlin DJ(1), Buradagunta S, Edwards RA, Brewster DC, Cambria RP, Gertler JP,
LaMuraglia GM, Jordan DE, Kvedar JC, Abbott WM.
Author information:
(1)Department of Surgery, Massachusetts General Hospital, Boston 02114, USA.
PURPOSE: Telemedicine coupled with digital photography could potentially improve
the quality of outpatient wound care and decrease medical cost by allowing home
care nurses to electronically transmit images of patients' wounds to treating
surgeons. To determine the feasibility of this technology, we compared bedside
wound examination by onsite surgeons with viewing digital images of wounds by
remote surgeons.
METHODS: Over 6 weeks, 38 wounds in 24 inpatients were photographed with a Kodak
DC50 digital camera (resolution 756 x 504 pixels/in2). Agreements regarding wound
description (edema, erythema, cellulitis, necrosis, gangrene, ischemia, and
granulation) and wound management (presence of healing problems, need for
emergent evaluation, need for antibiotics, and need for hospitalization) were
calculated among onsite surgeons and between onsite and remote surgeons.
Sensitivity and specificity of remote wound diagnosis compared with bedside
examination were calculated. Potential correlates of agreement, level of surgical
training, certainty of diagnosis, and wound type were evaluated by multivariate
analysis.
RESULTS: Agreement between onsite and remote surgeons (66% to 95% for wound
description and 64% to 95% for wound management) matched agreement among onsite
surgeons (64% to 85% for wound description and 63% to 91% for wound management).
Moreover, when onsite agreement was low (i.e., 64% for erythema) agreement
between onsite and remote surgeons was similarly low (i.e., 66% for erythema).
Sensitivity of remote diagnosis ranged from 78% (gangrene) to 98% (presence of
wound healing problem), whereas specificity ranged from 27% (erythema) to 100%
(ischemia). Agreement was influenced by wound type (p < 0.01) but not by
certainty of diagnosis (p > 0.01) or level of surgical training (p > 0.01).
CONCLUSIONS: Wound evaluation on the basis of viewing digital images is
comparable with standard wound examination and renders similar diagnoses and
treatment in the majority of cases. Digital imaging for remote wound management
is feasible and holds significant promise for improving outpatient vascular wound
care.
PMID: 9652471 [Indexed for MEDLINE]
