Initial plastic surgery experience with the first telemedicine links for the British Forces

Scerri, G.V.; Vassallo, DJ

doi:10.1054/bjps.1999.3104

Cited by 27 publications

(15 citation statements)

References 6 publications

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“…The British Defense Medical Services have used digital cameras and electronic mail to transmit wound images between a hospital in Bosnia and a British Defense hospital in the United Kingdom. 8 Wirthlin et al described a store-and-forward system for the remote management of vascular wounds. 9…”

Section: Introductionmentioning

confidence: 99%

Accuracy of a Web-based System for Monitoring Chronic Wounds

Kim¹,

Lowery²,

Hamill³

et al. 2003

Telemedicine Journal and e-Health

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This study evaluated the accuracy of a store-and-forward telemedicine system for assessing the status of chronic wounds, including those surgically repaired. Digital photos and other patient and wound data were collected by a nurse using a laptop and transmitted via the Internet to a database, which organized and posted the data onto a web page for access by the telemedicine physician. Two Veterans' Affairs (VA) medical centers and two specialties (plastic surgery, physical medicine and rehabilitation) participated in the study. Study patients included inpatients and outpatients with pressure ulcers of stage II, III, or IV, plus outpatients with diabetic foot ulcers or venous stasis ulcers. All patients were assessed both in-person (the "gold standard") and with the telemedicine system using yes/no responses and a 5-point scale, respectively, on four diagnostic questions concerning wound healing and infection, based on AHCPR guidelines. A total of 70 patients were enrolled, with data collected on 430 visits: up to 6 visits per wound. Percentage agreement for all visits ranged from 67.1 for "not healing" to 88.8 for "cellulitis present." Sensitivity ranged from 0.32 for cellulitis to 0.63 for necrosis; and specificity ranged from 0.80 for necrosis to 0.91 for cellulitis. Although agreement of the telemedicine system was not high, it was not significantly less than interphysician agreement on in-person assessments. A relatively inexpensive store-and-forward telemedicine system for monitoring the status of chronic wounds has the potential to improve access to specialty care for patients who are not currently receiving routine monitoring by specialized nurses or physicians.

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Section: Introductionmentioning

confidence: 99%

Accuracy of a Web-based System for Monitoring Chronic Wounds

Kim¹,

Lowery²,

Hamill³

et al. 2003

Telemedicine Journal and e-Health

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“…2 Use of the Internet to send clinical images has been reported to be adapted for use by general practitioners and hospital doctors to facilitate referrals to plastic surgery departments. [2][3][4][5] However, the portability of the equipment used in the image transfer should always be a concern. It was estimated that 65% of emergency medicine teleconsultations were between 7 PM and 8 AM, 26% were on Fridays, and 24% were on Saturdays and Sundays, 6 thus making image retrieval in remote sites on a computer desktop not always an available or possible option.…”

mentioning

confidence: 99%

Teleconsultation with the Mobile Camera-Phone in Remote Evaluation of Replantation Potential

Hsieh

Jeng²,

Chen³

et al. 2005

The Journal of Trauma: Injury, Infection, and Critical Care

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“…It is difficult to make an exact diagnosis and appropriate recommendations solely through a verbal report describing the traumatic illness. Additional digital photographs transmitted through the Internet have been shown to be valuable for both on-site and remote physicians, 11,12 particularly for the evaluation of radiographs and complex wounds of the hand and face. 11,13 However, image retrieval at remote sites by using a desktop workstation or laptop computer in many telemedicine systems is not always available or convenient.…”

mentioning

confidence: 99%

Teleconsultation with the Mobile Camera-Phone in Digital Soft-Tissue Injury: A Feasibility Study

Hsieh

Tsai

Yin

et al. 2004

Plastic and Reconstructive Surgery

108

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The purpose of this study was to examine the feasibility of teleconsultation using a mobile camera-phone to evaluate the severity of digital soft-tissue injury and to triage the injury with regard to management recommendations. With a built-in 110,000-pixel digital camera, pictures of the injured digit(s) or radiograph were taken by surgical residents in the emergency room and transmitted to another camera-phone to be viewed by the remote consultant surgeon. A brief medical and trauma history of each patient was relayed also by mobile phone. The consultant surgeon then reviewed all of these patients in the emergency room shortly after the initial telemedicine referral. Separate triaging for each digital injury into three groups was recorded during remote teleconsultation and according to actual treatment by the attending surgeon as follows: group I, the injury could be managed with conservative treatment, such as secondary intention wound healing, or primary closure with or without bone shortening; group II, skin grafting or local flap coverage was required for management of the injury; and group III, microsurgery such as replantation or free flap coverage was necessary to deal with the injury. Later, triaging was also performed individually by three junior plastic residents according to image review and patient referral information. Teleconsultation through a mobile camera-phone was performed for 45 patients with injuries of 81 digits from January to May of 2003. Of these 81 digital injuries, there were 12 cases (15 percent) where disagreement of triaging occurred between the teleconsultation and the actual treatment by the attending surgeon. In image reviewing, there was 79 percent sensitivity and 71 percent specificity in remote diagnosis of the skin defect and 76 percent sensitivity and 75 percent specificity in remote identification of the bone exposure regarding the concordance of opinions of all three surgeons; there was significant discordance in triaging in 20 cases (25 percent), and the difference in triaging was partly attributed to the inability to show instances of tiny exposed digital bone or tendon in some cases under the low-resolution digital image and the situation of a bloody oozing wound. In some cases, the difficulty in evaluating the probability of primary closure of severely avulsed skin edges or the probability of executing replantation for finger amputation also contributed to different triaging outcomes. Two neglected diagnoses of transected digital nerves were found and influenced triaging, highlighting the importance of on-site physical examination during teleconsultation. The telemedicine system using a mobile camera-phone based on the global system for mobile communication is feasible and valuable for early diagnosis and triaging of digital soft-tissue injury in emergency cases, with on-line verbal communication and review of the transmitted captured image. This system has the advantages of ease of use, low cost, high portability, and mobility. With advances in hardware for digital i...

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Initial plastic surgery experience with the first telemedicine links for the British Forces

Cited by 27 publications

References 6 publications

Accuracy of a Web-based System for Monitoring Chronic Wounds

Accuracy of a Web-based System for Monitoring Chronic Wounds

Teleconsultation with the Mobile Camera-Phone in Remote Evaluation of Replantation Potential

Teleconsultation with the Mobile Camera-Phone in Digital Soft-Tissue Injury: A Feasibility Study

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