title: A comparison of the concordance of digital images, live examinations, and skin biopsies for the diagnosis of hospitalized dermatology consultation patients.
abstract: OBJECTIVE
  The goal of this study was to compare live and digital image examination of hospitalized dermatology consultation patients.
  
  
  METHODS
  A medical student digitally imaged patients with a Nikon Coolpix 950 digital camera (Nikon Corp., Tokyo, Japan). A resident reviewed these images and the student recorded the differential diagnosis. Digital examination was followed by live dermatologic examination by the dermatology resident and then by a supervising board certified dermatologist. The diagnoses in 29 of these cases were compared with definitive diagnostic tests (e.g., skin biopsy).
  
  
  METHODS
  Montefiore Hospital, Bronx, NY Patients. In March, 2000, 48 of 58 consecutive hospitalized patients for whom dermatology consultations were requested and from whom consent for photographs could be obtained.
  
  
  METHODS
  The accuracy and consistency of the examiners top (up to three) digital diagnoses, (up to three) live diagnoses, and histopathologic diagnoses were compared.
  
  
  RESULTS
  Eighty-one percent (38/47) of resident digital consult diagnoses agreed with live resident diagnoses. Live resident diagnosis agreement with live supervising board certified dermatologists diagnosis was 90% (18/20). Resident digital image diagnosis correlation with definitive diagnostic test results was 76% (22/29). Live supervising board certified dermatologist diagnosis correlation with definitive diagnostic test results was 73% (14/19).
  
  
  CONCLUSIONS
  Digital image review results in reliable and accurate diagnosis compared to live consultations. For inpatient consultations, three-dimensional lesions are more amenable to digital diagnosis than flat, generalized rashes.
authors.affiliation: The Department of Dermatology, St. Luke's-Roosevelt Hospital Center, 1090 Amsterdam Avenue, Suite 11D, New York, NY 10025, USA. Scheinfeld@rcn.com
authors.forename: Noah
authors.initials: N
authors.lastname: Scheinfeld
authors.forename: Jeremy
authors.initials: J
authors.lastname: Kurz
authors.forename: Ellen
authors.initials: E
authors.lastname: Teplitz
mesh_terms: D001706:Biopsy / Q000379:methods; D003937:Diagnosis, Differential; D006801:Humans; D010781:Photography / Q000379:methods*; D010808:Physical Examination / Q000379:methods*; D012017:Referral and Consultation; D012867:Skin / Q000473:pathology*; D012871:Skin Diseases / Q000175:diagnosis* / Q000473:pathology