Introdução A Teledermatologia é o uso de tecnologia de telecomunicação para fornecer cuidados de problemas cutâneos à distância. No Brasil ainda há poucos estudos abordando este tema. Objetivos Avaliar a concordância diagnóstica presencial e não presencial com imagens de lesões cutâneas. Metodologia Pacientes consecutivos referenciados (n=100) ao serviço de dermatologia foram divididos em dois grupos: no grupo 1 foram vistos ao vivo 20 pacientes por dois dermatologistas separadamente; No grupo 2, as lesões de 80 pacientes foram fotografadas previamente à consulta presencial. A fotografia digital e as informações referentes à história clinica foram enviadas para outro dermatologista para diagnóstico. Foi avaliada a taxa de concordância diagnóstica entre os 2 dermatologistas através do Kappa. Resultados O Kappa presencial encontrado foi de 0,91 (n=20) e o Kappa virtual foi de 0,66 (n=80). A teledermatologia mostrou um melhor resultado para avaliação de dermatoses classificadas como infecciosas/infestações (Kappa=0,71) e para alteração dos anexos (Kappa=0,69). Conclusões A concordância à distância foi menor que a concordância presencial. Acreditamos que a teledermatologia não possa substituir a consulta médica convencional, mas possa ser uma opção para triagem de pacientes, diminuindo o custo do sistema público de saúde e tempo de espera por atendimento médico especializado. / Introduction Teledermatology is the use of telecommunications technology in the provision of care of skin problems at a distance. Objective To evaluate the agreement between skin lesion diagnoses made by direct observation and that made at a distance using images of those lesions. Methodology Patients consecutively referred (n=100) to the dermatology service were divided into two groups. The patients of group one (n=20) were diagnosed by each of two dermatologists by direct observation. The patients of the second group had a history taken and their lesions photographed digitally before being diagnosed by direct observation. The history and image were sent to another dermatologist for diagnosis at a distance. Agreement between the diagnoses made by direct observation and those made at a distance, using the images and history, was evaluated using the Kappa statistics. Results Good agreenment was achieved between 2 dermatologists both making diagnoses by direct observation: Kappa=0.91 (n=20). Agreement between diagnoses made by direct observation of lesions and those made using images of the same lesions was somewhat less: Kappa=0.66 (n=80). Teledermatology worked best with dermatoses classified as infectious/infestations, Kappa=0.71, and alterations of skin appendages, Kappa=0.69. Conclusions The direct observation / distance image diagnostic agreement was less than that direct observation / direct observation diagnostic agreement. Based on the findings, teledermatology is not a substitute for direct observation but may serve as a basis patient referrals from community health setting to dermatologists thereby reducing referral costs to the community health system.
| Identifer | oai:union.ndltd.org:IBICT/oai:lume.ufrgs.br:10183/8762 |
| Date | January 2006 |
| Creators | D'Elia, Paula Berenhauser |
| Contributors | Fisher, Paul Douglas, Bordin, Ronaldo |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, instname:Universidade Federal do Rio Grande do Sul, instacron:UFRGS |
| Rights | info:eu-repo/semantics/openAccess |
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