可穿戴远程会诊设备在常见皮肤病诊断中的应用

Application of a wearable teleconsultation device in diagnosis of common skin diseases

目的对可穿戴远程会诊设备在常见皮肤病诊断中应用的可行性进行初步验证。方法前瞻性收集2023年11月1日至2023年12月31日于皮肤性病科门诊就诊的600例皮肤病患者,对这些患者同时进行现场诊断和远程诊断,在现场诊室有1位住院医师A及1位主任医师B,在远程诊室有1位住院医师C和1位主任医师D。以现场诊室医师B的诊断结果为参照,分别计算医师A、医师C、医师D的诊断一致率,并比较医师A与医师C,医师A与医师D的诊断结果。统计方法采用McNemar检验和Kappa一致性分析。结果纳入的600例皮肤病患者中,男285例(47.50%),女315例(52.50%);年龄(38.75±21.12)岁。皮肤病种类主要为皮炎和湿疹(138例,23.00%),其次为病毒性皮肤病(79例,13.17%),然后是荨麻疹类皮肤病(53例,8.83%)、毛发疾病(53例,8.83%)、皮肤肿物(46例,7.67%)、真菌性皮肤病(38例,6.33%)等。与医师B相比,医师A诊断一致477例(79.5%),不一致123例(20.5%);医师C诊断一致465例(77.5%),不一致135例(22.5%);医师D诊断一致568例(94.6%),不一致32例(5.33%)。医师A与医师C的诊断正确率差异无统计学意义(P=0.430),Kappa值为0.852,一致性极强。医师A与医师D之间诊断正确率差异有统计学意义(P=0.001),Kappa值为0.274,一致性微弱。结论皮肤科专家可通过远程会诊系统对初级医师进行医疗指导。

Objective To preliminarily verify the feasibility of applying a wearable teleconsultation device in the diagnosis of common skin diseases.Methods Totally,600 outpatients with skin diseases were prospectively enrolled from the Department of Dermatology from November 1 to December 312023,and both on-site and remote diagnoses were performed.In the face-to-face clinic,there was one resident physician A and one chief physician B,while there was one resident physician C and one chief physician D in the remote consultation clinic.Using the diagnostic results of physician B in the face-to-face clinic as a reference,diagnostic agreement rates of physicians A,C,and D were calculated separately.Additionally,diagnostic results were compared between physician A and physician C,as well as between physician A and physician D.Statistical analysis was carried out using McNemar's test and Kappa consistency analysis.Results Among the 600 patients with skin diseases,there were 285 males(47.50%)and 315 females(52.50%),and their age was 38.75±21.12 years.The most common skin diseases were dermatitis and eczema(138 cases,23.00%),followed by viral skin diseases(79 cases,13.17%),urticaria(53 cases,8.83%),hair diseases(53 cases,8.83%),skin tumors(46 cases,7.67%),fungal skin diseases(38 cases,6.33%),etc.Compared with the physician B,the physician A made consistent diagnoses in 477 cases(79.5%)and inconsistent diagnoses in 123 cases(20.5%),the physician C made consistent diagnoses in 465 cases(77.5%)and inconsistent diagnoses in 135 cases(22.5%),and the physician D made consistent diagnoses in 568 cases(94.6%)and inconsistent diagnoses in 32 cases(5.33%).There was no significant difference in the diagnostic accuracy between the physician A and physician C(P=0.430),with a Kappa value of 0.852,indicating very strong consistency.The diagnostic accuracy of the physician D was significantly higher than that of the physician A(P=0.001),with a Kappa value of 0.274,indicating weak consistency.Conclusion Chief dermatologists can provide medical guidance to resident physicians through a wearable teleconsultation system.