Protocollo standardizzato di Teledermatologia «Store and Forward»: confidenza ed accuratezza diagnostica in ambito militare

Introduction: Teledermatology, a branch of telemedicine, leverages communication technologies to deliver dermatological services remotely. In the Italian military context, this service is initiated by a medical officer stationed abroad in a remote location, who transmits photos and medical history data to a dermatologist at the "Celio" Military Hospital in Rome. Objective: To evaluate the impact of standardized versus freeform methods for collecting clinical and medical history data on diagnostic confidence and accuracy. Materials and Methods: An open-label, two-arm interventional study was conducted. The measured variables included: 1) initial diagnostic confidence expressed by the dermatologist based on the data initially received; 2) the number of additional communications exchanged between the deployed physicians and consultants to obtain missing information necessary for diagnosis; 3) the number of further evaluations following the first teleconsultation; 4) the ranking of the final diagnosis, obtained after various requests for further information and tests, compared to the top ten results of DermExpert™ by VisualDx®, using the most significant macroscopic image and the initial medical history data. Statistical analysis was performed using the two-sample t-test, Poisson test, and Mood’s test, with calculations carried out using Minitab® 21.4 software. The significance threshold for the p-value was set at <0.05. Results: 42 patients were enrolled in the control arm and 30 in the experimental arm. The experimental group showed greater diagnostic confidence (8.17/10.00 vs. 5.12/10.00), fewer additional communications (0.23 vs. 1.89 per patient), fewer subsequent evaluations (0.40 vs. 1.21 per patient), and a better ranking for the final diagnosis (2.50/10.00 vs. 6.00/10.00). Conclusion: These statistically significant results, even with the Bonferroni correction applied, indicate that standardized procedures in military teledermatology significantly enhance diagnostic confidence and accuracy compared to freeform methods.