Background: The ability to evaluate and triage plastic surgery patients using telemedicine has recently become a topic of great interest. Early studies have been descriptive, relatively small in size, and dealt with feasibility rather than objective evaluation of accuracy and concordance between onsite and remote wound evaluation. Previously, we compared wound evaluation by onsite surgeons with viewing digital images by remote surgeons and determined the accuracy of digital images as compared to bedside examination. In the current study arm, we prospectively compare the diagnosis and management of onsite and remote clinicians in a busy urban plastic and reconstructive surgery clinic.

Methods: One hundred consecutive clinic patients were evaluated by onsite and remote surgeons as performed in previous study arms with a Canon A80 digital camera (resolution 4.0 mega pixels) and store-and-forward technology. Agreements regarding diagnosis (skin lesion, hand injury, wound type, scar character) and management (presence of a healing problem requiring intervention, need for emergent evaluation, need for antibiotics, and need for hospitalization) were calculated between onsite and remote surgeons.
Results: Previous study arms revealed that agreement between onsite and remote surgeons (46% to 86% for wound description and 65% to 81% for management) generally matched agreement among onsite surgeons (68% to 100% for description and 84% to 89% for management). Moreover, when onsite agreement was low (i.e., 68% for edema) agreement between onsite and remote surgeons was similarly low (i.e., 57% for edema). Remote evaluation was least sensitive in detecting wound drainage (46%). Regarding management decisions, remote surgeons tended to overtreat wounds; more often prescribing IV antibiotics and admitting the patient. This arm of one hundred consecutive clinical telemedical consults provides further evidence of the accuracy and utility of remote evaluation in the clinic setting. Cases in which patient transfer decisions were made and postoperative surgical site monitoring was performed via electronic transfer of digital images are also presented.

Conclusions: Digital consultation is comparable with standard examination, rendering similar diagnoses and treatment plans in the majority of cases. Though remote evaluation cannot replace bedside examination, it may assist the surgeon in triage decisions, thereby decreasing emergency room throughput time and frequency of office visits, supplementing consultation to remote satellite facilities by plastic and reconstructive surgeons, and providing real-time postoperative assessments, ultimately improving quality and reducing healthcare costs.