title: Teledermatology: diagnostic reliability in 383 children.
abstract: BACKGROUND
  There are few studies of teledermatology focused on the pediatric age group. The aim of this study was to assess the validity and reliability of store-and-forward teledermatology (STD) as a diagnostic tool for pediatricians and to reduce face-to-face consultations.
  
  
  METHODS
  A retrospective, observational study of 383 children and adolescents under 15 years of age, referred from primary care to Dermatology Department of University Hospital of La Coruña, Spain, between 2011 and 2013, using a STD consult system.
  
  
  RESULTS
  Diagnoses concordance between pediatricians and teledermatologists was 39.2% of cases and partial concordance 16.7%. Agreement for global diagnosis was κ = 0.78 (p = 0.000) and for specific diagnosis was κ = 0.73 (p = 0.000). Management was concordant in 28.7% and partially concordant in 15.4%. Lower reliability was statistically associated with modification of the lesions by inappropriate treatments, incomplete clinical data or bad-quality photographic images included in the referral consultation, diagnosis of infectious diseases and rare dermatoses. The filtering percentage (as the percentage of avoided clinic-based evaluations) was 64.5%. The mean response time of the consultant dermatologists was 3.62 days. Referrals for live consultations due to poor clinical information or insufficient quality of pictures were necessary in only 10% of the cases.
  
  
  CONCLUSIONS
  The degree of diagnostic accuracy for the pediatric population using STD as a diagnostic tool was similar to that achieved in adults. Its usefulness for filtering dermatologic referral was also demonstrated in the study, so it could be suitable for integration into the routine practice of pediatricians.
authors.affiliation: Department of Dermatology, University Hospital of La Coruña, Xubias de Arriba, 84, 15006, La Coruña, Spain.
authors.forename: Sabela
authors.initials: S
authors.lastname: Paradela-De-La-Morena
authors.affiliation: Department of Dermatology, University Hospital of La Coruña, Xubias de Arriba, 84, 15006, La Coruña, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Fernandez-Torres
authors.affiliation: Department of Dermatology, University Hospital of La Coruña, Xubias de Arriba, 84, 15006, La Coruña, Spain.
authors.forename: Walter
authors.initials: W
authors.lastname: Martínez-Gómez
authors.affiliation: Department of Dermatology, University Hospital of La Coruña, Xubias de Arriba, 84, 15006, La Coruña, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Fonseca-Capdevila
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003880:Dermatology / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012017:Referral and Consultation; D019114:Remote Consultation / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012871:Skin Diseases / Q000175:diagnosis*
keywords: dermatology; pediatric; reproducibility of results; telemedicine