eConsultation in Plastic and Reconstructive Surgery

Area of Science:

• Plastic Surgery
• Telemedicine
• Digital Health

Background:

• Previous telemedicine studies focused on feasibility, not accuracy.
• Inpatient and outpatient arms were designed to assess accuracy of remote vs. on-site evaluations.

Purpose of the Study:

• To compare the accuracy of remote telemedicine evaluations with on-site assessments in plastic surgery.
• To evaluate the diagnostic and management agreement between on-site and remote surgeons.
• To assess the impact of telemedicine on patient triage and healthcare system efficiency.

Main Methods:

• 43 inpatients and 100 outpatients underwent both on-site and remote evaluations using digital imaging.
• Agreement on diagnosis (e.g., skin lesion, wound type) and management (e.g., hospitalization, antibiotics) was calculated.
• Store-and-forward technology was utilized for remote image transfer.

Main Results:

• On-site and remote agreement for wound description ranged from 46%-86%, comparable to on-site surgeon agreement.
• Remote evaluation showed lower sensitivity for detecting wound drainage (46%).
• The outpatient arm reported 32% overall diagnostic agreement, with high specificity (96.92%) and negative predictive value (96.83%) for remote assessments.

Conclusions:

• e-Consultation provides outcomes similar to standard on-site examinations for select plastic surgery patients.
• Remote evaluation can improve triage, reduce emergency room visits, and supplement satellite consultations.
• Telemedicine enhances postoperative monitoring, potentially improving quality and reducing healthcare costs.