Screen Deep: Navigating Dermatological Diagnoses Through Virtual Pathways

Original Article: Diagnostic Reliability in Teledermatology: A Systematic Review and Meta-Analysis

What are the key takeaways of this article?

Teledermatology, a concept that involves remote dermatological consultations utilizing digital platforms, gained prominence in response to the COVID-19 pandemic's challenges. Traditional face-to-face (F2F) consultations, while effective, became less feasible due to safety concerns and restrictions. As such, the study aims to scrutinize the reliability of teledermatology as an alternative means of diagnosis. This article presents a comprehensive overview of a systematic review and meta-analysis focused on comparing teledermatology and F2F agreement in primary diagnoses of dermatological conditions.

The study's methodology involved examining observational studies and randomized clinical trials that reported percentage agreement or kappa concordance (a statistical measure of agreement beyond chance) for primary diagnoses between teledermatology and F2F physicians. A total of 44 articles were selected from an extensive pool of 7173 citations.

The main results showed a pooled diagnostic agreement rate of 68.9% and a kappa concordance of 0.67 between teledermatology diagnoses and those made through traditional F2F consultations. This level of agreement and concordance highlights the reliability of teledermatology as a diagnostic tool. An additional intriguing finding emerged from the comparison of diagnostic agreements between specialists and non-specialists. Notably, dermatologists conducting both F2F and teledermatology consultations demonstrated a markedly higher overall diagnostic agreement (71%) compared to non-specialists (44%). This discovery implies that teledermatology might offer greater advantages as a complement to primary care rather than specialist care. The study also discovered that image acquisition and digital photography training positively impacted agreement rates, thereby solidifying the credibility of teledermatology as a reliable diagnostic tool.

Looking ahead, the article suggests avenues for future research. It highlights the necessity of examining treatment planning consistency between telemedicine and traditional in-person consultations. By delving into this aspect, the healthcare community can further enhance their understanding of guiding patient management through telemedicine as a whole.

In summary, this systematic review and meta-analysis emphasize the potential of teledermatology in transforming remote healthcare delivery, particularly in resource-limited settings. The study provides substantial evidence that teledermatology's diagnostic agreement with traditional in-person consultations is encouraging, especially when supplemented with image acquisition training and advanced imaging technologies. As telemedicine gains traction worldwide, teledermatology emerges as a reliable complement to primary care, offering enhanced accessibility, cost-efficiency, and a safer healthcare environment for patients.

Publication Date: September 17th, 2023

Reference: Bourkas AN, Barone N, Bourkas MEC, Mannarino M, Fraser RDJ, Lorincz A, Wang SC, Ramirez-GarciaLuna JL. Diagnostic reliability in teledermatology: a systematic review and a meta-analysis. BMJ Open. 2023 Aug 11;13(8):e068207. doi: 10.1136/bmjopen-2022-068207. PMID: 37567745; PMCID: PMC10423833.

Summary By: Sascha Azoulay