Incorporating teledermatology into emergency medicine

The aim of the present study was to investigate the feasibility of using a store-and-forward Skin Emergency Telemedicine Service (SETS) to provide rapid specialist diagnostic and management advice for dermatological cases in an ED.

This pilot study was conducted at the Princess Alexandra Hospital between August 2008 and August 2009. Study subjects were consenting patients over 18 years of age who presented with a dermatological condition to the ED. The ED doctor sent the patient's history, examination findings and the digital images of the skin conditions to a secure email address, which automatically forwarded this to the teledermatologist. The teledermatologist reviewed the cases and sent advice on diagnosis and management to the referring ED doctor via email and/or telephone. Face-to-face follow-up consultations with the patients were conducted within 2 weeks. The diagnostic and management concordance between ED doctors, teledermatologists and reviewing dermatologists were analysed.

A total of 60 patients participated in the present study. SETS provided a rapid response with 56 (93%) of ED consultations receiving a dermatology opinion within 2 h. Face-to-face follow up occurred in 50 patients (83%). Statistical analysis showed significant levels of agreement between tele-diagnosis and ED diagnosis of 71.2% (Kappa 0.42) and tele-diagnosis and final clinical diagnosis of 98% (Kappa: 0.93). The clinical management concordance was 96% in complete agreement and 4% in relative agreement between the teledermatologists and reviewing dermatologists, based on chart review.

The present study has shown that SETS can provide rapid and accurate diagnostic and treatment advice from a specialist for dermatological presentations to the ED.