Mixed-method feasibility study comparing the outpatient assessment of burn patients using a tablet device versus the usual face-to-face encounter.

摘要

The number of verified burn centers across the U.S. has dramatically decreased, negatively impacting access to burn care. Telehealth is a solution for burn care, however there is minimal research evaluating burn care through telehealth. The primary purpose of this mixed method feasibility study was to examine the reliability of using a Motorola XOOM tablet to perform an outpatient standard burn assessment compared to the usual face-to-face examination. Qualitative information on patients' perception of using the tablet was also evaluated.;A convenience sample of 50 subjects, aged 19 to 76 years, with less than 10% total body surface area burned was recruited from an outpatient burn clinic. Descriptive statistics and the reliability of using a tablet device compared to a face-to-face encounter were measured between modalities, raters, and across raters and modalities using Cohen's Kappa and the Spearman correlation.;The reliability between two raters for the standard burn assessment showed substantial to near perfect agreement for skin graft take (Kappa = 0.892), burn depth (Kappa = 0.731), and cellulitis (Kappa = 0.847) when using a tablet device. The inter-modality reliability by rater showed substantial to perfect agreement for skin graft take (Kappa = 1.0), burn depth (Kappa = 0.848--1.0), and edema (Kappa = 0.876--0.958). The overall reliability of assessing a burn wound through a tablet device was similar to that obtained in face-to-face examination. Spearman correlations between the ratings made by the First Rater and the Second Rater when using a table device ranged from 0.531 to 0.852 and Spearman correlations from the face-to-face encounter ranged from 0.460 to 0.710.;Results from this study provide support for the reliability of a tablet device to assess for burn depth and skin graft take. Findings suggest inconsistency in the reliability of a tablet device to assess the presence of cellulitis, edema and purulence. Tablet device use in burn care can augment the usual, standard face-to-face interaction between patient and provider. Continued research is necessary to further validate its use in early and accurate assessment of burn wounds, burn-related complications, the evaluation of graft take, and the development of hypertrophic scarring.