Diagnostic Concordance and Interobserver Variability Between Tele-Dermatology (Store-and-Forward) and In-Person Evaluation for Inpatient Dermatology Consultations

BACKGROUND: Limited availability of dermatologists, the high burden of skin ailments in hospitalized patients, and lack of access to dermatology training within primary care highlight the need for tele-dermatology. Data about the diagnostic reliability of tele-dermatology and interobserver variability in inpatient settings are limited. AIM AND OBJECTIVES: To assess diagnostic concordance and interobserver variability between tele-dermatology (store-and-forward) and in-person evaluation for inpatient dermatology consultations. PATIENTS AND METHODS: One hundred hospitalized patients, sent by referring physicians for dermatology consultations, were evaluated in-person by certified dermatologists (CD) and trainee dermatologists (TrD). Another set of CD and TrD evaluated the store-and-forward case using tele-evaluation. Diagnosis and investigations recommended were recorded. Final diagnosis was made for each case by CD (in-person) after detailed investigations. The final diagnosis was considered the gold standard and used for comparisons. Percentage concordance between the evaluators and kappa values was calculated. RESULTS: CD (in-person) and CD (tele) were found to have maximum partial diagnostic concordance (88%), concordance in biopsy decisions (89%), and dermoscopy recommendations (85.7%) among all groups. Diagnostic categories by CD (tele) that matched with the final diagnosis were infections, pediatric, papulosquamous, and hair and nail disorders. TrDs (tele) were able to diagnose infections, eczematous disorders and papulosquamous disorders correctly. Discordant cases by CD (tele) were drug-induced and contact dermatitis. TrD (tele) had also diagnosed drug-induced and contact dermatitis incorrectly, in addition to lymphatic and vascular disorders. Referring physicians had the lowest diagnostic concordance with CD and TrD. LIMITATIONS: It was a single-center study, and dermatological emergency cases were excluded. CONCLUSION: Teleconsultation by CD and TrD can be an alternative to evaluation by non-dermatologists for providing dermatological services to inpatients. It may further supplement in-person evaluation, especially for complex or high-risk cases.