TELEMEDICINE IN VASCULAR-SURGERY - FEASIBILITY OF DIGITAL IMAGING FORREMOTE MANAGEMENT OF WOUNDS

Purpose: Telemedicine coupled with digital photography could potential ly improve the quality of outpatient wound care and decrease medical c ost by allowing home care nurses to electronically transmit images of patients' wounds to treating surgeons. To determine the feasibility of this technology, we compared bedside wound examination by onsite surg eons with viewing digital images of wounds by remote surgeons. Methods : Over 6 weeks, 38 wounds in 24 inpatients were photographed with a Ko dak DC50 digital camera (resolution 756 x 504 pixels/in(2)). Agreement s regarding wound description (edema, erythema, cellulitis, necrosis, gangrene, ischemia, and granulation) and wound management (presence of healing problems, need for emergent evaluation, need for antibiotics, and need for hospitalization) were calculated among onsite surgeons a nd between onsite and remote surgeons. Sensitivity and specificity of remote wound diagnosis compared with bedside examination were calculat ed. Potential correlates of agreement, level of surgical training, cer tainty of diagnosis, and wound type were evaluated by multivariate ana lysis. Results: Agreement between onsite and remote surgeons (66% to 9 5% for wound description and 64% to 95% for wound management) matched agreement among onsite surgeons (64% to 85% for wound description and 63% to 91% for wound management). Moreover, when onsite agreement was low (i.e., 64% for erythema) agreement between onsite and remote surge ons was similarly low (i.e., 66% for erythema). Sensitivity of remote diagnosis ranged from 78% (gangrene) to 98% (presence of wound healing problem), whereas specificity ranged from 27% (erythema) to 100% (isc hemia). Agreement was influenced by wound type (p < 0.01) but not by c ertainty of diagnosis (p > 0.01) or level of surgical training (p > 0. 01). Conclusions Wound evaluation on the basis of viewing digital imag es is comparable with standard wound examination and renders similar d iagnoses and treatment in the majority of cases. Digital imaging for r emote wound management is feasible and holds significant promise for i mproving outpatient vascular wound care.