Reliability and accuracy of dermatologists' digital image consultations

J. D. Whited, R. P. Hall, D. L. Simel, M. E. Foy, K. M. Stechuchak, R. J. Drugge, James M Grichnik, S. A. Myers, R. D. Horner

Research output: Contribution to journalArticle

Abstract

We compared the reliability and accuracy of diagnoses and management plans generated by dermatologists performing digital image review with dermatologists performing traditional clinic-based consultations. Our patient sample included referrals to a dermatology consult service from the ambulatory care clinics at a VA Medical Center. Each patient underwent a standardized history assessment and digital imaging of the referred dermatologic condition. Two dermatologists independently evaluated the patients in a traditional clinic-based setting. Three different dermatologists independently reviewed the standardized histories and digital images. Examiners were asked to provide a diagnosis (single most likely and differential) and suggest a management plan (medications, diagnostic testing, or therapeutic interventions). Simple proportion agreement among the clinic-based dermatologists for their single most likely diagnosis was 0.54 (95% CI 0.46-0.61) and was 0.92 (95% CI 0.88-0.96) when both the single most likely diagnosis and differential diagnoses were considered, A comparable level of agreement was found among the six clinic-based/digital image examiner pairs ranging from 0.41 (95% CI 0.34-0.49) to 0.55 (95% CI 0.48-0.63) and 0.79 (95% CI 0.72-0.85) to 0.95 (95% CI 0.92-0.98), respectively and among the three digital image examiner pairs ranging from 0.49 (95% CI 0.41-0.56) to 0.55 (95% CI 0.48-0.63) and 0.84 (95% CI 0.79-0.90) to 0.92 (95% CI 0.88-0.96), respectively. There was less reliability among examiner pairs for management decisions. Diagnostic accuracy, assessed among the subset of lesions that underwent definitive diagnostic testing, did not differ among the five examiners for their single most likely diagnosis (p = 0.21). When accuracy assessments included examiners' single most likely diagnosis and differential diagnoses there was a difference among examiners in the proportion of correct diagnoses (p = 0.03). One digital examiner accounted for the difference in accuracy and when removed from the analysis the remaining four examiners were comparably accurate (p = 0.64). Compared to traditional clinic-based consultations, dermatologic consultations that use digital imaging technology result in reliable diagnostic outcomes. Our study also suggests that accuracy may not differ by consult modality.

Original languageEnglish
JournalJournal of Investigative Medicine
Volume47
Issue number2
StatePublished - Feb 1 1999
Externally publishedYes

Fingerprint

Referral and Consultation
Differential Diagnosis
Dermatology
Ambulatory Care
Imaging techniques
Dermatologists
Testing
History
Technology

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Whited, J. D., Hall, R. P., Simel, D. L., Foy, M. E., Stechuchak, K. M., Drugge, R. J., ... Horner, R. D. (1999). Reliability and accuracy of dermatologists' digital image consultations. Journal of Investigative Medicine, 47(2).

Reliability and accuracy of dermatologists' digital image consultations. / Whited, J. D.; Hall, R. P.; Simel, D. L.; Foy, M. E.; Stechuchak, K. M.; Drugge, R. J.; Grichnik, James M; Myers, S. A.; Horner, R. D.

In: Journal of Investigative Medicine, Vol. 47, No. 2, 01.02.1999.

Research output: Contribution to journalArticle

Whited, JD, Hall, RP, Simel, DL, Foy, ME, Stechuchak, KM, Drugge, RJ, Grichnik, JM, Myers, SA & Horner, RD 1999, 'Reliability and accuracy of dermatologists' digital image consultations', Journal of Investigative Medicine, vol. 47, no. 2.
Whited JD, Hall RP, Simel DL, Foy ME, Stechuchak KM, Drugge RJ et al. Reliability and accuracy of dermatologists' digital image consultations. Journal of Investigative Medicine. 1999 Feb 1;47(2).
Whited, J. D. ; Hall, R. P. ; Simel, D. L. ; Foy, M. E. ; Stechuchak, K. M. ; Drugge, R. J. ; Grichnik, James M ; Myers, S. A. ; Horner, R. D. / Reliability and accuracy of dermatologists' digital image consultations. In: Journal of Investigative Medicine. 1999 ; Vol. 47, No. 2.
@article{3ed7b71d033a4cd1882163f1b6f30621,
title = "Reliability and accuracy of dermatologists' digital image consultations",
abstract = "We compared the reliability and accuracy of diagnoses and management plans generated by dermatologists performing digital image review with dermatologists performing traditional clinic-based consultations. Our patient sample included referrals to a dermatology consult service from the ambulatory care clinics at a VA Medical Center. Each patient underwent a standardized history assessment and digital imaging of the referred dermatologic condition. Two dermatologists independently evaluated the patients in a traditional clinic-based setting. Three different dermatologists independently reviewed the standardized histories and digital images. Examiners were asked to provide a diagnosis (single most likely and differential) and suggest a management plan (medications, diagnostic testing, or therapeutic interventions). Simple proportion agreement among the clinic-based dermatologists for their single most likely diagnosis was 0.54 (95{\%} CI 0.46-0.61) and was 0.92 (95{\%} CI 0.88-0.96) when both the single most likely diagnosis and differential diagnoses were considered, A comparable level of agreement was found among the six clinic-based/digital image examiner pairs ranging from 0.41 (95{\%} CI 0.34-0.49) to 0.55 (95{\%} CI 0.48-0.63) and 0.79 (95{\%} CI 0.72-0.85) to 0.95 (95{\%} CI 0.92-0.98), respectively and among the three digital image examiner pairs ranging from 0.49 (95{\%} CI 0.41-0.56) to 0.55 (95{\%} CI 0.48-0.63) and 0.84 (95{\%} CI 0.79-0.90) to 0.92 (95{\%} CI 0.88-0.96), respectively. There was less reliability among examiner pairs for management decisions. Diagnostic accuracy, assessed among the subset of lesions that underwent definitive diagnostic testing, did not differ among the five examiners for their single most likely diagnosis (p = 0.21). When accuracy assessments included examiners' single most likely diagnosis and differential diagnoses there was a difference among examiners in the proportion of correct diagnoses (p = 0.03). One digital examiner accounted for the difference in accuracy and when removed from the analysis the remaining four examiners were comparably accurate (p = 0.64). Compared to traditional clinic-based consultations, dermatologic consultations that use digital imaging technology result in reliable diagnostic outcomes. Our study also suggests that accuracy may not differ by consult modality.",
author = "Whited, {J. D.} and Hall, {R. P.} and Simel, {D. L.} and Foy, {M. E.} and Stechuchak, {K. M.} and Drugge, {R. J.} and Grichnik, {James M} and Myers, {S. A.} and Horner, {R. D.}",
year = "1999",
month = "2",
day = "1",
language = "English",
volume = "47",
journal = "Journal of Investigative Medicine",
issn = "1081-5589",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Reliability and accuracy of dermatologists' digital image consultations

AU - Whited, J. D.

AU - Hall, R. P.

AU - Simel, D. L.

AU - Foy, M. E.

AU - Stechuchak, K. M.

AU - Drugge, R. J.

AU - Grichnik, James M

AU - Myers, S. A.

AU - Horner, R. D.

PY - 1999/2/1

Y1 - 1999/2/1

N2 - We compared the reliability and accuracy of diagnoses and management plans generated by dermatologists performing digital image review with dermatologists performing traditional clinic-based consultations. Our patient sample included referrals to a dermatology consult service from the ambulatory care clinics at a VA Medical Center. Each patient underwent a standardized history assessment and digital imaging of the referred dermatologic condition. Two dermatologists independently evaluated the patients in a traditional clinic-based setting. Three different dermatologists independently reviewed the standardized histories and digital images. Examiners were asked to provide a diagnosis (single most likely and differential) and suggest a management plan (medications, diagnostic testing, or therapeutic interventions). Simple proportion agreement among the clinic-based dermatologists for their single most likely diagnosis was 0.54 (95% CI 0.46-0.61) and was 0.92 (95% CI 0.88-0.96) when both the single most likely diagnosis and differential diagnoses were considered, A comparable level of agreement was found among the six clinic-based/digital image examiner pairs ranging from 0.41 (95% CI 0.34-0.49) to 0.55 (95% CI 0.48-0.63) and 0.79 (95% CI 0.72-0.85) to 0.95 (95% CI 0.92-0.98), respectively and among the three digital image examiner pairs ranging from 0.49 (95% CI 0.41-0.56) to 0.55 (95% CI 0.48-0.63) and 0.84 (95% CI 0.79-0.90) to 0.92 (95% CI 0.88-0.96), respectively. There was less reliability among examiner pairs for management decisions. Diagnostic accuracy, assessed among the subset of lesions that underwent definitive diagnostic testing, did not differ among the five examiners for their single most likely diagnosis (p = 0.21). When accuracy assessments included examiners' single most likely diagnosis and differential diagnoses there was a difference among examiners in the proportion of correct diagnoses (p = 0.03). One digital examiner accounted for the difference in accuracy and when removed from the analysis the remaining four examiners were comparably accurate (p = 0.64). Compared to traditional clinic-based consultations, dermatologic consultations that use digital imaging technology result in reliable diagnostic outcomes. Our study also suggests that accuracy may not differ by consult modality.

AB - We compared the reliability and accuracy of diagnoses and management plans generated by dermatologists performing digital image review with dermatologists performing traditional clinic-based consultations. Our patient sample included referrals to a dermatology consult service from the ambulatory care clinics at a VA Medical Center. Each patient underwent a standardized history assessment and digital imaging of the referred dermatologic condition. Two dermatologists independently evaluated the patients in a traditional clinic-based setting. Three different dermatologists independently reviewed the standardized histories and digital images. Examiners were asked to provide a diagnosis (single most likely and differential) and suggest a management plan (medications, diagnostic testing, or therapeutic interventions). Simple proportion agreement among the clinic-based dermatologists for their single most likely diagnosis was 0.54 (95% CI 0.46-0.61) and was 0.92 (95% CI 0.88-0.96) when both the single most likely diagnosis and differential diagnoses were considered, A comparable level of agreement was found among the six clinic-based/digital image examiner pairs ranging from 0.41 (95% CI 0.34-0.49) to 0.55 (95% CI 0.48-0.63) and 0.79 (95% CI 0.72-0.85) to 0.95 (95% CI 0.92-0.98), respectively and among the three digital image examiner pairs ranging from 0.49 (95% CI 0.41-0.56) to 0.55 (95% CI 0.48-0.63) and 0.84 (95% CI 0.79-0.90) to 0.92 (95% CI 0.88-0.96), respectively. There was less reliability among examiner pairs for management decisions. Diagnostic accuracy, assessed among the subset of lesions that underwent definitive diagnostic testing, did not differ among the five examiners for their single most likely diagnosis (p = 0.21). When accuracy assessments included examiners' single most likely diagnosis and differential diagnoses there was a difference among examiners in the proportion of correct diagnoses (p = 0.03). One digital examiner accounted for the difference in accuracy and when removed from the analysis the remaining four examiners were comparably accurate (p = 0.64). Compared to traditional clinic-based consultations, dermatologic consultations that use digital imaging technology result in reliable diagnostic outcomes. Our study also suggests that accuracy may not differ by consult modality.

UR - http://www.scopus.com/inward/record.url?scp=33750116364&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33750116364&partnerID=8YFLogxK

M3 - Article

AN - SCOPUS:33750116364

VL - 47

JO - Journal of Investigative Medicine

JF - Journal of Investigative Medicine

SN - 1081-5589

IS - 2

ER -