title: Telemedicine in vascular surgery: feasibility of digital imaging for remote management of wounds.
abstract: OBJECTIVE
  Telemedicine coupled with digital photography could potentially improve the quality of outpatient wound care and decrease medical cost by allowing home care nurses to electronically transmit images of patients' wounds to treating surgeons. To determine the feasibility of this technology, we compared bedside wound examination by onsite surgeons with viewing digital images of wounds by remote surgeons.
  
  
  METHODS
  Over 6 weeks, 38 wounds in 24 inpatients were photographed with a Kodak DC50 digital camera (resolution 756 x 504 pixels/in2). Agreements regarding wound description (edema, erythema, cellulitis, necrosis, gangrene, ischemia, and granulation) and wound management (presence of healing problems, need for emergent evaluation, need for antibiotics, and need for hospitalization) were calculated among onsite surgeons and between onsite and remote surgeons. Sensitivity and specificity of remote wound diagnosis compared with bedside examination were calculated. Potential correlates of agreement, level of surgical training, certainty of diagnosis, and wound type were evaluated by multivariate analysis.
  
  
  RESULTS
  Agreement between onsite and remote surgeons (66% to 95% for wound description and 64% to 95% for wound management) matched agreement among onsite surgeons (64% to 85% for wound description and 63% to 91% for wound management). Moreover, when onsite agreement was low (i.e., 64% for erythema) agreement between onsite and remote surgeons was similarly low (i.e., 66% for erythema). Sensitivity of remote diagnosis ranged from 78% (gangrene) to 98% (presence of wound healing problem), whereas specificity ranged from 27% (erythema) to 100% (ischemia). Agreement was influenced by wound type (p < 0.01) but not by certainty of diagnosis (p > 0.01) or level of surgical training (p > 0.01).
  
  
  CONCLUSIONS
  Wound evaluation on the basis of viewing digital images is comparable with standard wound examination and renders similar diagnoses and treatment in the majority of cases. Digital imaging for remote wound management is feasible and holds significant promise for improving outpatient vascular wound care.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston 02114, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Wirthlin
authors.forename: S
authors.initials: S
authors.lastname: Buradagunta
authors.forename: R A
authors.initials: RA
authors.lastname: Edwards
authors.forename: D C
authors.initials: DC
authors.lastname: Brewster
authors.forename: R P
authors.initials: RP
authors.lastname: Cambria
authors.forename: J P
authors.initials: JP
authors.lastname: Gertler
authors.forename: G M
authors.initials: GM
authors.lastname: LaMuraglia
authors.forename: D E
authors.initials: DE
authors.lastname: Jordan
authors.forename: J C
authors.initials: JC
authors.lastname: Kvedar
authors.forename: W M
authors.initials: WM
authors.lastname: Abbott
mesh_terms: D000671:Amputation, Surgical / Q000706:statistics & numerical data; D005069:Evaluation Studies as Topic; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D010781:Photography / Q000295:instrumentation / Q000379:methods; D012680:Sensitivity and Specificity; D017216:Telemedicine / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000601:surgery