title: Emergency department diagnosis and management of skin diseases with real-time teledermatologic expertise.
abstract: OBJECTIVE
  Skin conditions are a common reason for patients to consult emergency department (ED) physicians.
  
  
  OBJECTIVE
  To evaluate real-time teledermatologic expertise with the use of mobile telephones for the diagnosis and management of skin conditions in patients seen in the ED.
  
  
  METHODS
  This observational study of adults who consecutively consulted in the ED for a dermatologic condition was conducted under routine conditions in the ED from May 1, 2008, through June 30, 2010.
  
  
  METHODS
  Diagnosis agreement and management concordance.
  
  
  RESULTS
  One hundred eleven patients were enrolled in the study. Eighty-three patients (74.8%) were evaluated using videoconferencing. Dermatologic remote expertise invalidated, enlarged, or clarified ED physicians' diagnosis and management in 75 of 110 cases (68.2%). Videoconferencing improved the diagnostic performance in 57 of 83 cases (68.7%) (P < 10(-4)). Management concordance was moderate between ED physicians and dermatologists for specialist consultation within 24 hours (κ, 0.49; 95% CI, 0.14-0.84) and immediate hospitalization (κ, 0.49; 95% CI, 0.41-0.57). Patients were significantly more often discharged by dermatologists (46.8% vs 39.1%) (P < 10(-4)).
  
  
  CONCLUSIONS
  Compared with standard hardware, new-generation mobile devices reduce the cost of videoconferencing, increase the versatility of teledermatology, and decrease general practitioner investment time.
authors.affiliation: Department of Dermatology, Hôpital Henri Mondor, AP-HP, Créteil, France2Department of Design Engineering, Ecole Centrale Paris, Chatenay-Malabry, France.
authors.forename: Tu Anh
authors.initials: TA
authors.lastname: Duong
authors.affiliation: Department of Dermatology, Hôpital Saint Louis-Lariboisière, AP-HP, Paris, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Cordoliani
authors.affiliation: Department of Dermatology, Hôpital Saint Louis-Lariboisière, AP-HP, Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Julliard
authors.affiliation: Department of Dermatology, Hôpital Saint Louis-Lariboisière, AP-HP, Paris, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Bourrat
authors.affiliation: Department of Dermatology, Hôpital Saint Louis-Lariboisière, AP-HP, Paris, France.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Regnier
authors.affiliation: Emergency Department, Hôpital Jean Verdier, Bondy, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: de Pontual
authors.affiliation: Emergency Department, Hôpital Louis Mourier, AP-HP, Colombes, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Leroy
authors.affiliation: Emergency Department, Hôpital Saint Louis-Lariboisière, AP-HP, Paris, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Gallula
authors.affiliation: Emergency Department, Hôpital Saint Louis-Lariboisière, AP-HP, Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Aparicio
authors.affiliation: Emergency Department, Hôpital Saint Antoine, AP-HP, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Legendre
authors.affiliation: Department of Dermatology, Hôpital Saint Louis-Lariboisière, AP-HP, Paris, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Bagot
authors.affiliation: Department of Dermatology, Hôpital Saint Louis-Lariboisière, AP-HP, Paris, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Guibal
mesh_terms: D040421:Cell Phone; D003880:Dermatology / Q000379:methods*; D004635:Emergency Medicine / Q000379:methods*; D004636:Emergency Service, Hospital; D006760:Hospitalization; D006801:Humans; D012017:Referral and Consultation; D019114:Remote Consultation / Q000295:instrumentation / Q000379:methods*; D012871:Skin Diseases / Q000175:diagnosis* / Q000628:therapy*; D049269:Videoconferencing