Diagnostic quality of low resolution images for tele-woundcare

The use of digital wound images would allow remote consultation between patients, physicians, or other caregivers over the Internet. To evaluate the efficacy and validity of digital images for assessment of wounds, we compared the ability and reliability of surgeons to diagnose and make treatment suggestions using either digital or slide images of several types of wounds. Twenty-four wound images on 35-mm slides were selected for use in this study. Each slide image was digitized at 24-bit color with a resolution of 640 pixels horizontal by 425 pixels vertical, and stored as a JPEG file. Six physicians, of varying experience, examined the images, first in digital format and then later in the original slide form. Each observer assessed each wound for condition and possible treatment options by filling out a questionnaire using a series of yes/no questions. For all observers, there was an 87% agreement of answers between digital and slide images (p = 0.004). The agreement between the digital and slide images was also measured for each individual observer using a kappa coefficient. The agreement kappa correlated with the experience of the observer, with the kappa values ranging from greater than 0.8 (almost perfect agreement) for an experienced woundcare professional to just greater than 0.5 (moderate agreement) for a surgical intern. With this study, we have demonstrated the feasibility of distance wound consultation using digital images of a quality consistent with consumer-grade digital photography.