Evaluation of telemedicine in the management of dentogenous infections

Abstract

Introduction/Aim. The first written evidence of telemedicine dates back to the times of Sava Nemanjic (the end of 12th and the beginning of 13th century). Nowadays, the use of telemedicine in Serbia gains momentum, and the cause of this lies in the creation of a central telemedicine system XPA3 Online and the establishment of the Center for Telemedicine at the Faculty of Medicine, University of Pristina/Kosovska Mitrovica, Kosovska Mitrovica, Serbia. Dentogenous infections are among the most urgent conditions in dentistry, which may have even a fatal outcome. The aim of this study was to assess the possibility of using telemedicine methods in the pathology of dentogenous infections. Methods. This experimental randomized study incl uded 414 patients with suspected dentogenous infection. The patients were enrolled at 7 sites, with systematic photograph-taking, collection, and digitalization of the available anamnestic and laboratory data, tests, and x-rays. Together with clinical findings, the data were uploaded on the XPA3 Online central telemedicine system; after that, 10 teleconsultants reviewed the material, set the diagnosis, and gave their opinion about the treatment. The agreement was determined using the Cohen?s kappa (k) coefficient, as well as diagnostic sensitivity (SE), specificity (SP), and efficacy (EFF). Statistical significance and comparisons were done using the z-test, and testing nonparametric properties using the McNemar?s ?2-test for the significance threshold of p = 0.05. Results. The results describing agreement of telemedicine diagnosis of the areas primarily involved with infection compared to clinical inspection, indicate an almost complete diagnostic agreement (k = 0.971). Diagnostic agreement as to the type of infection was also almost complete (k = 0.951), and a similar value was obtained also for the treatment agreement (k > =0.892). Conclusion. The method of telemedicine provides us with a tool to make a correct clinical diagnosis of dentogenous infections equally well as in real time, as well as to get a deeper and wider insight into their nature and to suggest adequate treatments.Uvod/Cilj. Prvi zapisi o primeni telemedicine u Srbiji datiraju iz vremena Save Nemanjica (kraj XII i pocetak XIII veka). Danas, primena telemedicine u Srbiji naglo raste, a uzrok lezi u stvaranju centralnog telemedicinskog sistema XPA3 Online i formiranju telemedicinskog centra Medicinskog fakulteta Univerziteta u Pristini/Kosovska Mitrovica, Srbija. Takodje, dentogene infekcije spadaju u najurgentnija stanja u stomatologiji, koja mogu da imaju i letalan ishod. Cilj rada bio je da se ispitaju mogucnosti primene telemedicine kod patologije dentogenih infekcija. Metode. Uradjena je eksperimentalna randomizirana studija na 414 pacijenata kod kojih je postojala sumnja na pristustvo dentogene infekcije. Pacijenti su primani na sedam lokacija, pri cemu su radjena sistematska fotografisanja, sakupljanje i digitalizacija dostupnih anamnestickih i laboratorijskih nalaza, testova, kao i radioloskih snimaka. Sve je to zajedno sa klinickim nalazom prosledjivano na XPA3 Online centralni telemedicinski sistem, nakon cega su deset telekonsultanata pregledali materijal, postavljali dijagnozu i davali terapijsko misljenje. Odredjena je saglasnost Cohenovim kappa (k) koeficijentom, dijagnosticka senzitivnost (SE), specificnost (SP) i efikasnost (EFF). Statisticka znacajnost i poredjenja vrsena su z-testom, a testiranje neparametarskih obelezja McNemmar-ovim ?2 kvadrat testom za prag znacajnosti od p = 0.05. Rezultati. Rezultati slaganja telemedicinskih dijagnoza primarno zahvacenih prostora infekcijom u poredjenju sa klinickim pregledom ukazuju na postignutu skoro potpunu dijagnosticku saglasnost (k = 0,971). Slaganje za vrstu infekcije ukazuje takodje na skoro potpunu dijagnosticku saglasnost (k = 0,951), a o predlozenoj terapiji slaganje je slicno (k = 0,892). Zakljucak. Primenom telemedicine moze se podjednako dobro, kao i klinickim pregledom u realnom vremenu, postaviti ispravna dijagnoza infekcija, sagledati njihova problematika i mogucnosti terapije.