Telemedicine in burn patients: reliability and patient preference

Abstract

Introduction: Burn care is demanding and time intensive. After initial evaluation and treatment, remote follow-up of suitable patients might reduce the on-site workload and efficiency. In this study, the reliability of telemedicine assessment of burn patients and preference of patients to use telemedicine was investigated.

Methods: The study was designed as cross-sectional, and included 100 acute burn patients admitted to our burn service between 1 December 2018 and 31 May 2019. Informed consent was obtained from the patients for imaging of the burn wound. Burn wounds were evaluated in the outpatient clinic by an experienced burn specialist, and lesion images that were sent using WhatsApp were evaluated by another. Patients were offered telemedicine follow-up using WhatsApp communication without being present. The data of assessments, demographic and epidemiological data, and reasons for preference of follow-up via telemedicine were examined.

Results: The mean age of our patients was 21.21 ± 21.7 years. The percentage of burned total body surface area was 3.66 ± 3.4 on examination and 3.44 ± 3.2 on WhatsApp and the level of concordance was very high (ICC = 0.993). The inter-rater reliability values for the face-to-face examination and telemedicine groups in terms of "burn depth" and "decision of hospitalization" was congruent. Of the patients, 61% did not choose follow up with telemedicine. Demand of face-to-face assessment by burn expert was the most common reason (60.7%). In 26 patients who chose to be followed up with telemedicine, the most common reason was "living distance from the burn center" (92.3%). The remaining 13 patients indicated they did not have a preference.

Conclusions: In the assessment of burn wounds, telemedicine and face-to-face examination resulted in agreement in terms of burn depth, decision of hospitalization and percentage of total body surface area. Although WhatsApp is a reliable method, the majority of patients preferred a face-to-face follow-up. WhatsApp application can be used in remote follow up of eligible burn patients after giving brief information about the procedure.

Keywords: Burn; Tele follow-up; Telemedicine; WhatsApp.