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Harris A, Lowery JC, Hamill JB, Rees RS, Wilkins EG. Telemedicine assessment of chronic wounds. Paper presented at: Michigan Academy of Plastic Surgeons Annual Meeting; 2000 Jul 23; Mackinac Island, MI.
Introduction: The objective of this study is to evaluate the clinical accuracy of a telemedicine system for assessing the status of pressure ulcers, both chronic and post-operative repairs. The telemedicine system consists of: (1) digital photographs of the ulcer (close-up and perspective shots); (2) measurements of ulcer area and volume; and (3) other clinical data collected by a nurse. The data are entered into a laptop computer and then transmitted to a central database, where a computer program performs several analyses and posts the data to a Web page for access by the consulting (telemedicine) physician.Methods: Two VA medical centers (Ann Arbor, MI, and Augusta, GA) and two specialties (plastic surgery and physical medicine and rehabilitation medicine) are participating in the study. All study patients with stage II, III, or IV pressure uclers are assessed both in-person (the 'gold standard') and with the telemedicine system for up to six visits. Participating physicians rotate roles as the in-person and telemedicine physicians, and their responses to the following questions are compared: (1) Is necrotic tissue present? (2) Is cellulitis suspected? (3) Is oseomyelitis suspected?Conclusions: When compared with 'baseline' % agreement (i.e., agreement between the same physicians when both assessed a different sample of patients in person), the above agreements are significantly lower for the PMandR physicians when identifying necrosis and osteomyelitis. Agreements for the plastic surgeons are not significantly different from baseline. Sensitivity and specificity data will also be presented to help determine if telemedicine assessments are accurate.
