Smartphone Post-op Photos: Proceed With Caution

Albert B. Lowenfels, MD


December 28, 2018

Does remote wound assessment, which includes photography, improve accuracy of diagnosing postoperative surgical-site infection (SSI)? In a paper published in JAMA Surgery, the authors reported their results from a study carried out in the United States and the Netherlands using actual clinical case studies.[1] A sample of 523 surgeons were asked to evaluate 512 patient-generated impressions of their wound, either with or without a photograph of the wound.

The results were compared with observations obtained when the same patients were seen postoperatively at the original hospital or clinic. Adding a wound photograph decreased sensitivity (58% to 50%) but increased specificity (56% to 63%). Having a wound photograph available increased the surgeon's confidence in evaluating the wound remotely but did not increase accuracy.

It's Best Not to Rely on Smartphone Images to Assess Wound Status

Over three fourths of the population in the United States now owns a cellphone. Already, healthcare providers are using smartphones to assess patients' symptoms for various illnesses.

Could a remote photograph of the patient's postoperative wound help diagnose SSIs and complications? The results of this comparative study suggest that adding a wound photograph to other information provided by the patient by telephone or email wasn't of much help, although it reassured the surgeon about the accuracy of a treatment decision, even when that decision, based on remotely acquired information, was wrong.[2]

There is a problem with this report: Only 2% of the surgeons asked to participate in the study agreed to fill out the necessary forms. Nevertheless, as the authors point out, if we want to rely on remote postoperative patient assessment of wound status, we need improved tools or better training protocols.

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