The majority of skin lesions in pediatric primary care attention could be managed by Teledermatology
Autoři:
Mara Giavina Bianchi aff001; Andre Pires Santos aff001; Eduardo Cordioli aff001
Působiště autorů:
Department of Telemedicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
aff001
Vyšlo v časopise:
PLoS ONE 14(12)
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pone.0225479
Souhrn
Background
Teledermatology is a tool that provides accurate diagnosis and has been gaining more emphasis over time. It can be used for triage in primary care attention to address skin conditions improving access and reducing time to treatment for surgical, severe or even lethal diseases.
Objectives
Our main goal was to evaluate the proportion of pediatric patient’s lesions that could be managed using teledermatology in primary care attention. Secondly, we wanted to assess the ten most frequent skin conditions, the most common treatments and the referrals made by the teledermatologists to biopsy, in-presence dermatologist or kept at primary care attention.
Methods
A cross-sectional retrospective study involving 6,879 individuals and 10,126 lesions was conducted by store-and-forward teledermatology during one year in the city of Sao Paulo, Brazil. If the photographs taken had enough quality, teledermatologist would diagnose, treat and orient each lesion (if possible), and choose one of three options for referral: direct to biopsy, in-presence dermatologist or kept at primary care attention.
Results
Teledermatology managed 62% of the lesions to be kept at primary care attention, 37% were referred to dermatologists and 1% to biopsy, reducing the mean waiting time for an in-presence visit in 78%. In patients 0–2 years old, lesions related to eczema and benign congenital lesions predominated. From 3–12 years old, eczema was still a major cause of complaint, as well as warts and molluscum. From 13–19 years old, acne was the most significant problem, followed by atopic dermatitis, nevi and warts. The most frequent treatment was emollient.
Conclusion
Teletriage addressed 63% of the lesions without the need for an in-presence visit, suggesting that teledermatology can manage common diseases and optimize dermatological appointments for the most serious, surgical or complex skin illnesses, reducing the mean waiting time for them.
Klíčová slova:
Lesions – Primary care – Biopsy – Telemedicine – Acne – Warts – Dermatology – Pediatric dermatology
Zdroje
1. Heffner VA, Lyon VB, Brousseau DC, Holland KE, Yen K. Store-and-forward teledermatology versus in-person visits: a comparison in pediatric teledermatology clinic. J Am Acad Dermatol. 2009;60(6):956–61. doi: 10.1016/j.jaad.2008.11.026 19362751
2. O'Connor DM, Jew OS, Perman MJ, Castelo-Soccio LA, Winston FK, McMahon PJ. Diagnostic Accuracy of Pediatric Teledermatology Using Parent-Submitted Photographs: A Randomized Clinical Trial. JAMA Dermatol. 2017;153(12):1243–8. doi: 10.1001/jamadermatol.2017.4280 29141082
3. Ranjani P, Carla B, Toni M. Teledermatology initiative to increase access for community helath center patients. new england journal of medicine catalyst [Internet]. 2019. Available from: https://catalyst.nejm.org/teledermatology-access-community-health/.
4. IBGE [Internet]. PANORAMA SÃO PAULO [cited 2019 Sept 07]. Available from: https://cidades.ibge.gov.br/brasil/sp/sao-paulo/panorama
5. IPEA 2016 [Internet]. Rede Brasil Atual [cited 2019 Sept 07]. Available from: https://www.redebrasilatual.com.br/saude/2016/10/no-estado-de-sao-paulo-25-milhoes-de-pacientes-dependem-do-sus-1016.html
6. Kroemer S, Frühauf J, Campbell TM, Massone C, Schwantzer G, Soyer HP, et al. Mobile teledermatology for skin tumour screening: diagnostic accuracy of clinical and dermoscopic image tele-evaluation using cellular phones. Br J Dermatol. 2011;164(5):973–9. doi: 10.1111/j.1365-2133.2011.10208.x 21219286
7. Ferrándiz L, Ruiz-de-Casas A, Martin-Gutierrez FJ, Peral-Rubio F, Mendez-Abad C, Rios-Martin JJ, et al. Effect of teledermatology on the prognosis of patients with cutaneous melanoma. Arch Dermatol. 2012;148(9):1025–8. doi: 10.1001/archdermatol.2012.778 22986852
8. Bruce AF, Mallow JA, Theeke LA. The use of teledermoscopy in the accurate identification of cancerous skin lesions in the adult population: A systematic review. J Telemed Telecare. 2018;24(2):75–83. doi: 10.1177/1357633X16686770 28056600
9. Pak H, Triplett CA, Lindquist JH, Grambow SC, Whited JD. Store-and-forward teledermatology results in similar clinical outcomes to conventional clinic-based care. J Telemed Telecare. 2007;13(1):26–30. doi: 10.1258/135763307779701185 17288655
10. Giavina Bianchi M, Santos A, Cordioli E. Dermatologists' perceptions on the utility and limitations of teledermatology after examining 55,000 lesions. J Telemed Telecare. 2019:1357633X19864829.
11. Spergel JM. Epidemiology of atopic dermatitis and atopic march in children. Immunol Allergy Clin North Am. 2010;30(3):269–80. doi: 10.1016/j.iac.2010.06.003 20670812
12. Laughter D, Istvan JA, Tofte SJ, Hanifin JM. The prevalence of atopic dermatitis in Oregon schoolchildren. J Am Acad Dermatol. 2000;43(4):649–55. doi: 10.1067/mjd.2000.107773 11004621
13. Uludağ A, Kılıc SO, Isık S, Haydar Ertekin Y, Tekin M, Cevizci S, et al. Prevalence of skin disorders in primary and secondary school age children in Canakkale, Turkey: a community-based survey. Postepy Dermatol Alergol. 2016;33(3):176–81. doi: 10.5114/ada.2016.60610 27512351
14. Chen TS, Goldyne ME, Mathes EF, Frieden IJ, Gilliam AE. Pediatric teledermatology: observations based on 429 consults. J Am Acad Dermatol. 2010;62(1):61–6. doi: 10.1016/j.jaad.2009.05.039 19926163
15. Kilcline C, Frieden IJ. Infantile hemangiomas: how common are they? A systematic review of the medical literature. Pediatr Dermatol. 2008;25(2):168–73. doi: 10.1111/j.1525-1470.2008.00626.x 18429772
16. Seiffert A, Schneider M, Roessler J, Larisch K, Pfeiffer D. Incidence, Treatment Patterns, and Health Care Costs of Infantile Hemangioma: Results of a Retrospective German Database Analysis. Pediatr Dermatol. 2017;34(4):450–7. doi: 10.1111/pde.13187 28675551
17. Kilkenny M, Marks R. The descriptive epidemiology of warts in the community. Australas J Dermatol. 1996;37(2):80–6. doi: 10.1111/j.1440-0960.1996.tb01010.x 8687332
18. Olsen JR, Gallacher J, Piguet V, Francis NA. Epidemiology of molluscum contagiosum in children: a systematic review. Fam Pract. 2014;31(2):130–6. doi: 10.1093/fampra/cmt075 24297468
19. Kaufman BP, Aman T, Alexis AF. Postinflammatory Hyperpigmentation: Epidemiology, Clinical Presentation, Pathogenesis and Treatment. Am J Clin Dermatol. 2018;19(4):489–503. doi: 10.1007/s40257-017-0333-6 29222629
20. Skroza N, Tolino E, Mambrin A, Zuber S, Balduzzi V, Marchesiello A, et al. Adult Acne Versus Adolescent Acne: A Retrospective Study of 1,167 Patients. J Clin Aesthet Dermatol. 2018;11(1):21–5. 29410726
21. Wollenberg A, Barbarot S, Bieber T, Christen-Zaech S, Deleuran M, Fink-Wagner A, et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II. J Eur Acad Dermatol Venereol. 2018;32(6):850–78. doi: 10.1111/jdv.14888 29878606
22. Simpson EL, Chalmers JR, Hanifin JM, Thomas KS, Cork MJ, McLean WH, et al. Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. J Allergy Clin Immunol. 2014;134(4):818–23. doi: 10.1016/j.jaci.2014.08.005 25282563
Článok vyšiel v časopise
PLOS One
2019 Číslo 12
- Metamizol jako analgetikum první volby: kdy, pro koho, jak a proč?
- Masturbační chování žen v ČR − dotazníková studie
- Nejasný stín na plicích – kazuistika
- Těžké menstruační krvácení může značit poruchu krevní srážlivosti. Jaký management vyšetření a léčby je v takovém případě vhodný?
- Somatizace stresu – typické projevy a možnosti řešení
Najčítanejšie v tomto čísle
- Methylsulfonylmethane increases osteogenesis and regulates the mineralization of the matrix by transglutaminase 2 in SHED cells
- Oregano powder reduces Streptococcus and increases SCFA concentration in a mixed bacterial culture assay
- The characteristic of patulous eustachian tube patients diagnosed by the JOS diagnostic criteria
- Parametric CAD modeling for open source scientific hardware: Comparing OpenSCAD and FreeCAD Python scripts