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Cited by 92Telemedicine and Telehealth ImplementationDigital Imaging in MedicineDermatology and Skin Diseases

Diagnostic Accuracy of Pediatric Teledermatology Using Parent-Submitted Photographs: A Randomized Clinical Trial

Open access
O’Connor, Daniel M., Jew, Olivia S., Perman, Marissa J., Castelo-Soccio, Leslie A., Winston, Flaura K., McMahon, Patrick J.·2017·JAMA Dermatology
DOI 10.1001/jamadermatol.2017.4280PMC PMC5817452
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Abstract

Importance: Advances in smartphone photography (both quality and image transmission) may improve access to care via direct parent-to-clinician telemedicine. However, the accuracy of diagnoses that are reliant on parent-provided photographs has not been formally compared with diagnoses made in person. Objective: To assess whether smartphone photographs of pediatric skin conditions taken by parents are of sufficient quality to permit accurate diagnosis. Design, Setting, and Participants: A prospective study was conducted among 40 patient-parent dyads at a pediatric dermatology clinic at the Children's Hospital of Philadelphia from March 1 to September 30, 2016, to assess concordance between diagnoses made by an independent pediatric dermatologist based on in-person examination and those based on parental photographs. Half of the patient-parent dyads were randomized for a secondary analysis to receive instructions on how best to take photographs with smartphones. Clinicians were blinded to whether parents had received photography instructions. Exposures: Half of the patient-parent dyads received a simple, 3-step instruction sheet on how best to take photographs using a smartphone (intervention group); the other half did not (control group). Main Outcomes and Measures: Concordance between photograph-based vs in-person diagnosis in the intervention vs control groups, as quantified using Cohen κ, a measure of interrater agreement that takes into account the possibility of agreement occurring by chance. Results: Among the 40 patient-parent dyads (22 female children and 18 male children; mean [SD] age, 6.96 [5.23] years), overall concordance between photograph-based vs in-person diagnosis was 83% (95% CI, 71%-94%; κ = 0.81). Diagnostic concordance was 89% (95% CI, 75%-97%; κ = 0.88) in a subgroup of 37 participants with photographs considered of high enough quality to make a diagnosis. No statistically significant effect of photography instructions on concordance was detected (group that received instructions, 85%; group that did not receive instructions, 80%; P = .68). In cases of diagnostic disagreement, appropriate follow-up was suggested. Conclusions and Relevance: Parent-operated smartphone photography can accurately be used as a method to provide pediatric dermatologic care. Trial Registration: clinicaltrials.gov Identifier: NCT03246945.

Integrity signals

Registry

Crossref · 10.1001/jamadermatol.2017.4280

Cites

21 of 21 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 14 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    No sample characteristics (patient age, patient sex, smartphone age, or smartphone operating system) had a significant effect on image quality according to the multilevel mixed-effects ordered logistic regression model.

    “No sample characteristics (ie, patient age, patient sex, smartphone age, or smartphone operating system) had a significant effect on image quality according to our multilevel mixed-effects ordered logistic regression model.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Image quality differed significantly based on whether a diagnosis could be provided (mean PQRS score with diagnosis rendered, 8.9; mean score with no diagnosis, 7.0; P = .001).

    “Image quality differed significantly based on whether or not a diagnosis could be provided (mean PQRS score with diagnosis rendered, 8.9; mean score with no diagnosis, 7.0; P = .001).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Providing photography instructions significantly increased the quality of the best image submitted by each parent (mean PQRS score with instructions, 9.5; mean score without instructions, 8.9; P = .04).

    “Providing instructions significantly increased the quality of the best image submitted by each parent, a metric that takes into account both individual image quality and number of images taken (mean PQRS score with instructions, 9.5; mean score without instructions, 8.9; P = .04).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Overall concordance between photograph-based and in-person diagnosis was 83% (95% CI, 71%-94%; κ = 0.81) among the 40 patient-parent dyads.

    “overall concordance between photograph-based vs in-person diagnosis was 83% (95% CI, 71%-94%; κ = 0.81).”
    • Also stated in: § Diagnostic Concordance · plain
      “Overall concordance between photograph-based vs inperson diagnosis was 83% (95% CI, 71%-94%; κ = 0.81).”
    • Also stated in: § Key Points · plain
      “overall concordance between photograph-based vs in-person diagnosis was 83%.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: In-person examination diagnosis by a pediatric dermatologist is an accurate reference standard for the child's skin condition.
  • Findingown data

    Of the 40 dyads' photographs, 3 diagnoses were unable to be provided by the remote dermatologist owing to poor photograph quality.

    “Of the 40 dyads' photographs, 3 diagnoses were unable to be provided by the remote dermatologist owing to poor photograph quality.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 31
  • May combine two claims. 16

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The study included 87 images from the 40 patients.

    “Our study included 87 images from the 40 patients.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The sample represented a wide range of ages (mean [SD] age, 6.96 [5.23] years) and both sexes approximately equally.

    “Our sample represented a wide range of ages (mean [SD] age, 6.96 [5.23] years) and both sexes approximately equally (Table 1).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    All smartphone cameras used by parents had at least an 8-megapixel resolution, none was more than 4 years old, and more than two-thirds were less than 2 years old.

    “All smartphone cameras used by parents had at least an 8-megapixel resolution, none was more than 4 years old, and more than two-thirds were less than 2 years old.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Forty-eight patient-parent dyads were invited to participate, with 40 completing the study protocol between March 1 and September 30, 2016.

    “Forty-eight patient-parent dyads were invited to participate in this study, with 40 completing the study protocol between March 1 and September 30, 2016 (Figure ).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Of the 4 misdiagnosed cases, 3 were alopecia and 1 was a nodule.

    “Of the 4 cases that were misdiagnosed, there were 3 cases of alopecia and 1 nodule (Table 3).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: In-person examination diagnosis by a pediatric dermatologist is an accurate reference standard for the child's skin condition.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Failure to complete the protocol occurred with technical issues (e.g., inability to download the application or upload photographs) and time constraints.

    “Failure to complete the protocol occurred with technical issues (eg, inabil-ity to download the application or upload photographs) and time constraints.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The component of the PQRS with the highest score was color (84 images [97%] received a score of 2 on the 0-2 scale).

    “The component of the PQRS with the highest score was color (84 images [97%] received a score of 2 on the 0-2 scale,”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Most respondents (32 [80%]) were willing to pay to use the application, with a median price of $20 (range, $0-$160).

    “Most respondents (32 [80%]) were willing to pay to use the application, with a median price of $20 (range, $0-$160).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The group with instructions had increased average image quality and mean number of images provided by each parent, but these trends did not reach statistical significance.

    “The group with instructions had increased average image quality and mean number of images provided by each parent, although these trends did not reach statistical significance.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingown data

    Twenty dyads were randomly assigned to the study arm (instruction sheet provided) and 20 dyads were assigned to the control arm (no instruction sheet provided).

    “Twenty dyads were randomly assigned to the study arm (instruction sheet provided) and 20 dyads were assigned to the control arm (no instruction sheet provided).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Parents' median willingness to use a teledermatology application was 8 and the mode was 10 on a 1-10 scale.

    “On a scale of 1 (not willing) to 10 (very willing), the median response was 8 and the mode was 10.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Diagnostic accuracy varied by diagnostic category: concordance was 100% for birthmarks, 92% for rashes, and 64% for alopecia-related diagnoses.

    “For example, the concordance for birthmarks was 100%, 92% for rashes, and 64% for alopecia-related diagnoses.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: In-person examination diagnosis by a pediatric dermatologist is an accurate reference standard for the child's skin condition.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study protocol was approved by the Children's Hospital of Philadelphia institutional review board.

    “The study protocol in Supplement 1 (NCT03246945) was approved by the Children's Hospital of Philadelphia institutional review board.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Nearly three-quarters of all adults, and more than 90% of adults younger than 35 years, now own a smartphone.

    “The availability of this technology has also greatly increased, with nearly three-quarters of all adults, and more than 90% of adults younger than 35 years, now owning a smartphone.13”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] 13. Poushter J. Smartphone ownership and internet usage continues to climb in emerging economies. Pew Research Center. http://www .pewglobal.org/2016/02/22/smartphone -ownership-and-internet-usage -continues-to-climb-in-emerging-economies/. Accessed December 18, 2016.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    The greatest number of incorrect diagnoses occurred in cases of alopecia, likely because such diagnoses can be difficult to differentiate without dermoscopy and a thorough history.

    “The greatest number of incorrect diagnoses occurred in cases of alopecia, likely because such diagnoses can be difficult to differentiate without dermoscopy and a thorough history.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: In-person examination diagnosis by a pediatric dermatologist is an accurate reference standard for the child's skin condition.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Since patients were already being seen by a pediatric dermatologist and parents knew that the photographs taken for this study would not affect their child's diagnoses and treatments, they may not have been as diligent with photograph quality compared with parents using a teledermatology application from home when their child's care depends on image quality.

    “Furthermore, since patients were already being seen by a pediatric dermatologist and parents knew that the photographs taken for this study would not affect their child's diagnoses and treatments, they may not have been as diligent with photograph quality compared with parents using a teledermatology application from home when their child's care depends on image quality.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    The study's findings contribute to the large body of literature that supports the potential of teledermatology to provide quality care.

    “Although this study simulated rather than performed an actual teledermatology encounter, our findings contribute to the large body of literature that supports the potential of teledermatology to provide quality care.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Without the opportunity for in-person follow-up, patients may not receive accurate diagnoses when teledermatology is insufficient, may be sent to emergency departments, or may not receive further care at all.

    “Without the opportunity for in-person follow-up, patients may not receive accurate diagnoses when teledermatology is insufficient, may be sent to emergency departments, or may not receive further care at all.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    Direct-to-patient pediatric teledermatology could improve access for patients whose families face geographic, scheduling, or financial limitations and could reduce wait times.

    “Direct-to-patient pediatric teledermatology could also improve access for patients whose families face geographic, scheduling, or financial limitations 19 and could reduce wait times.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    The clinic-based setting may have altered factors such as lighting.

    “The clinic-based setting may have altered factors such as lighting, among others.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In adults, store-and-forward teledermatology has been shown to improve access to specialty care, consistently provide accurate diagnosis, reduce time to treatment, while achieving high patient satisfaction and cost-effectiveness.

    “In adults, store-and-forward teledermatology has been shown to improve access to specialty care, consistently provide accurate diagnosis, and reduce time to treatment, while achieving high patient satisfaction and cost-effectiveness.[5][6][7]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [5] 5. Shin H, Kim DH, Ryu HH, Yoon SY, Jo SJ. Teledermatology consultation using a smartphone multimedia messaging service for common skin diseases in the Korean army: a clinical evaluation of its diagnostic accuracy. J Telemed Telecare. 2014;20 (2):70-74. source
    • cites [6] 6. Barbieri JS, Nelson CA, James WD, et al. The reliability of teledermatology to triage inpatient dermatology consultations. JAMA Dermatol. 2014; 150(4):419-424. source
    • cites [7] 7. Warshaw EM, Hillman YJ, Greer NL, et al. Teledermatology for diagnosis and management of skin conditions: a systematic review. J Am Acad Dermatol. 2011;64(4):759-772. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Philp et al found that pediatric dermatologists were able to render a diagnosis via photography in 75% of cases.

    “Similarly, in a retrospective cohort study, Philp et al 9 found that pediatric dermatologists were able to render a diagnosis via photography in 75% of cases.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] 9. Philp JC, Frieden IJ, Cordoro KM. Pediatric teledermatology consultations: relationship between provided data and diagnosis. Pediatr Dermatol. 2013;30(5):561-567. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Skin conditions comprise 10% to 30% of nearly 200 million annual pediatric outpatient visits.

    “Furthermore, skin conditions comprise 10% to 30% of nearly 200 million annual pediatric outpatient visits.[1][2][3]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [1] 1. Hayden GF. Skin diseases encountered in a pediatric clinic: a one-year prospective study. AJDC. 1985;139(1):36-38.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [2] 2. Krowchuk DP, Bradham DD, Fleischer AB Jr. Dermatologic services provided to children and adolescents by primary care and other physicians in the United States. Pediatr Dermatol. 1994;11(3): 199-203. source
    • cites [3] 3. Uddin SG, O'Connor KS, Ashman JJ. Physician office visits by children for well and problem-focused care: United States, 2012. US Dept of Health and Human Services. https://www.cdc.gov/nchs/data/databriefs/db248 .pdf. Accessed May 2016.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    In this study, additional history that could have been gleaned from the electronic health record may have allowed for more accurate diagnoses.

    “In our study, additional history that could have been gleaned from the electronic health record may have allowed for more accurate diagnoses.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: In-person examination diagnosis by a pediatric dermatologist is an accurate reference standard for the child's skin condition.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Pediatric dermatologists appear to be highly interested in teledermatology.

    “Pediatric dermatologists also appear to be highly interested in teledermatology.10”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] 10. Fogel AL, Teng JMC. Pediatric teledermatology: a survey of usage, perspectives, and practice. Pediatr Dermatol. 2015;32(3):363-368. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Parents provided written consent for themselves and their children, and written patient assent was obtained when appropriate.

    “Parents (or legal guardians) provided written consent for both themselves and their children.Written patient assent was obtained when appropriate.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Providing care integrated into local health networks enables clinicians practicing telemedicine to view a patient's existing medical record and readily communicate with the patient's established medical professionals.

    “Providing care integrated into local health networks also enables clinicians practicing telemedicine to view a patient's existing medical record and readily communicate with the patient's established medical professionals.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The small sample size may have limited the ability to show an effect from providing instructions.

    “The small sample size may have limited our ability to show an effect from providing instructions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A 2012 study assessing infantile hemangiomas showed that more than 85% of parent photographs were of sufficiently high quality.

    “For example, a 2012 study assessing infantile hemangiomas showed that more than 85% of parent photographs were of sufficiently high quality.12”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] 12. Tollefson MM, Frieden IJ. Early growth of infantile hemangiomas: what parents' photographs tell us. Pediatrics. 2012;130(2):e314-e320. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All photographs were evaluated using the PQRS based on 5 criteria: clarity, perspective, darkness, brightness, and color.

    “All photographs were evaluated using the PQRS based on the following 5 criteria: clarity, perspective, darkness, brightness, and color (eFigure in Supplement 2).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 5-criteria PQRS is a valid measure of photograph quality sufficient for diagnostic purposes.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Patients were randomized in a 1:1 manner using simple, sequential allocation without stratification.

    “Patients were randomized in a 1:1 manner using simple, sequential allocation without stratification.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Generation of the allocation sequence occurred before enrollment.

    “Generation of the allocation sequence occurred before enrollment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Clinicians were blinded to whether parents had received photography instructions.

    “Clinicians were blinded to whether parents had received photography instructions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    A clinical investigator assigned participants using the allocation sequence during participant enrollment.

    “A clinical investigator assigned participants using this sequence during participant enrollment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A sample size of 40 patients would yield 80% power to detect a difference of 1 point in the PQRS score between the 2 groups, assuming α = .05 and normally distributed data with a variance of 2.5 for both groups.

    “We estimated that a sample size of 40 patients would yield 80% power to detect a difference of 1 point in the photograph quality rating scale (PQRS) score between the 2 groups, assuming α = .05,and normally distributed data with a variance of 2.5 for both groups.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The teledermatology physician was given only the photographs and basic survey information and was asked to make a diagnosis.

    “The teledermatology physician was given only the photographs and basic survey information and was asked to make a diagnosis.”
    Quote in the paperSubstantial claim
36 of 36

  • The paper relies on this without support.

    In-person examination diagnosis by a pediatric dermatologist is an accurate reference standard for the child's skin condition.

    “concordance between diagnoses based on in-person examinations and those based on parental photographs”

  • The paper relies on this without support.

    The 5-criteria PQRS is a valid measure of photograph quality sufficient for diagnostic purposes.

    “All photographs were evaluated using the PQRS based on the following 5 criteria: clarity, perspective, darkness, brightness, and color (eFigure in Supplement 2).”

  • The paper relies on this without support.

    The remote teledermatologist's diagnosis based only on photographs and basic survey information is representative of real-world teledermatology diagnosis.

    “The teledermatology physician was given only the photographs and basic survey information and was asked to make a diagnosis.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Image quality and diagnostic concordance are generally lower and more variable with patient-submitted images, which may impact their decision-making utility.

    “Image quality and diagnostic concordance are generally lower and more variable with patient-submitted images, which may impact their decision-making utility.”

    From Store-and-Forward Images in Teledermatology: Narrative Literature Review (2022) · cites this paper as [16]

    The Diagnostic Concordance section reports that poor photograph quality prevented diagnosis in 3 of 40 cases and that concordance varied by diagnostic category. It does not establish that patient-submitted images generally have lower or more variable quality and concordance than images from another source; the Key Points instead say parent photographs were typically sufficient for accurate diagnosis. Page numbers are unavailable in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Diagnostic concordance rates between dermatologists evaluating patient-generated SAF images and dermatologists evaluating patients at a face-to-face visit range from approximately 40% to 80%.

    “Several studies indicate that diagnostic concordance rates between dermatologists evaluating patient-generated SAF images and dermatologists evaluating patients at a FTF visit range from approximately 40% to 80% [5,8,16,17] (Table 1).”

    From Store-and-Forward Images in Teledermatology: Narrative Literature Review (2022) · cites this paper as [16]

  • Pre-COVID-19, a 2017 randomized controlled trial of 40 patient-parent dyads at a US pediatric dermatology clinic found high concordance between photograph-based and in-person diagnosis but lower concordance rates for alopecia and neoplasms.

    “Pre–COVID-19, a 2017 randomized controlled trial of 40 patient-parent dyads at a US pediatric dermatology clinic found high concordance between photograph-based and in-person diagnosis but had also highlighted that alopecia and neoplasms tended to have lower concordance rates between photographs and in-person diagnoses [14].”

    From A Glance at the Practice of Pediatric Teledermatology Pre- and Post–COVID-19: Narrative Review (2022) · cites this paper as [14]

  • Previous studies have shown that both store-and-forward and live interactive teledermatology could be diagnostically comparable.

    “Given that previous studies have shown that both store-and-forward and live interactive teledermatology could be diagnostically comparable, hybrid models may further help ameliorate physician-patient diagnostic and logistical difficulties.”

    From A Glance at the Practice of Pediatric Teledermatology Pre- and Post–COVID-19: Narrative Review (2022) · cites this paper as [14]

Cites

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Related

Authors
O’Connor, D. M., Jew, O. S., Perman, M. J., Castelo-Soccio, L. A., Winston, F. K., & McMahon, P. J.
Affiliations
  • Children's Hospital of Philadelphia (US)
  • Section of Dermatology, Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Corresponding author
McMahon, Patrick J.
ORCID
Venue
JAMA Dermatology
Publisher
American Medical Association (AMA)
Published
2017-12-01
Volume
153
Issue
12
Pages
1243
ISSN
2168-6068 (ISSN-L)
DOI
10.1001/jamadermatol.2017.4280
PMC
PMC5817452
OpenAlex
W2770670898
Cited by
89
References
23
Citations by year
2026: 7 · 2025: 6 · 2024: 3 · 2023: 9 · 2022: 15 · 2021: 14 · 2020: 23 · 2019: 7 · 2018: 5
FWCI
8.97
Type
journal article
Language
en
Open access
Locations
  • JAMA Dermatology (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Arthritis and Musculoskeletal and Skin Diseases (P30AR069589)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Digital Imaging in Medicine
  • Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
Keywords
smartphone photography, diagnostic accuracy, photography instruction, telemedicine, health care access
MeSH terms
Smartphone, Adolescent, Child, Child, Preschool, Dermatology, Female, Hospitals, Pediatric, Humans, Infant, Infant, Newborn, Male, Parents, Photography, Prospective Studies, Skin Diseases, Reproducibility of Results, Cohort Studies, Observer Variation, Telemedicine

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