Concordance and accuracy Of Teledermatology using mobile phones in the outpatient clinic Of Jose R. Reyes Memorial Medical Center: A Cross-sectional study (Preprint)

Abstract

Dermatologists rely on visual findings, thus teledermatology is uniquely compatible to provide dermatologic care. The use of mobile phones in a store-and-forward approach, where gathered data is sent to a distant health provider for later review, may be a potential bridge to seek dermatologic care.

To determine the agreement between face-to-face consult and teledermatologic consult through the store-and-forward approach using mobile phone, and its accuracy compared to histopathologic diagnosis.

The study design is a cross-sectional study of participants consecutively recruited from dermatology patients who presented with skin or mucosal complaint and without prior dermatologist consultation. Photographs were taken using a standard phone (iPhone 6s plus) and a 4-mm skin punch biopsy was taken on each patient, the gold standard to which the study result was compared to. The photographs were sent to three consultant dermatologists using a store-and-forward approach, for independent diagnosis and treatment plan.

A total of 64 patients were included, with a median age of 41 years old. There was moderate to almost perfect agreement in terms of final diagnosis between face to face dermatologic diagnosis and teledermatologic diagnoses. The third teledermatologist had the highest agreement with the clinical dermatologist in terms of final diagnosis (kappa = 0.84; p <.001). Between the three dermatologists, there was moderate to almost perfect agreement as well. Agreement between pairs of teledermatologists ranges from 0.45 to 0.84. The three teledermatologists had moderate to substantial agreement with the biopsy results, with the third teledermatologist having the highest accuracy (kappa = 0.77; p < .001). Overall, there was a moderate agreement in the diagnosis of patients across raters.

Teledermatology is a viable alternative to face-to-face consultations. Our results show moderate to substantial agreement in diagnoses from face-to-face consultation and store-and-forward teledermatology.