A MIXED-METHOD FEASIBILITY STUDY COMPARING THE OUTPATIENT ASSESSMENT OF BURN PATIENTS USING A TABLET DEVICE VERSUS THE USUAL FACE-TO-FACE ENCOUNTER

Abstract

The number of verified burn centers across the U.S. has dramatically decreased, negatively impacting access to burn care. Telehealth is a solution for burn care, however there is minimal research evaluating burn care through telehealth. The primary purpose of this mixed method feasibility study was to examine the reliability of using a Motorola XOOM tablet to perform an outpatient standard burn assessment compared to the usual face-to-face examination. Qualitative information on patients’ perception of using the tablet was also evaluated. A convenience sample of 50 subjects, aged 19 to 76 years, with less than 10% total body surface area burned was recruited from an outpatient burn clinic. Descriptive statistics and the reliability of using a tablet device compared to a face-to-face encounter were measured between modalities, raters, and across raters and modalities using Cohen’s Kappa and the Spearman correlation. The reliability between two raters for the standard burn assessment showed substantial to near perfect agreement for skin graft take (Kappa = 0.892), burn depth (Kappa = 0.731), and cellulitis (Kappa = 0.847) when using a tablet device. The inter-modality reliability by rater showed substantial to perfect agreement for skin graft take (Kappa = 1.0), burn depth (Kappa = 0.848–1.0), and edema (Kappa = 0.876–0.958). The overall reliability of assessing a burn wound through a tablet device was similar to that obtained in face-to-face examination. Spearman correlations between the ratings made by the First Rater and the Second Rater when using a table device ranged from 0.531 to 0.852 and Spearman correlations from the face-to-face encounter ranged from 0.460 to 0.710. Results from this study provide support for the reliability of a tablet device to assess for burn depth and skin graft take. Findings suggest inconsistency in the reliability of a tablet device to assess the presence of cellulitis, edema and purulence. Tablet device use in burn care can augment the usual, standard face-to-face interaction between patient and provider. Continued research is necessary to further validate its use in early and accurate assessment of burn wounds, burn-related complications, the evaluation of graft take, and the development of hypertrophic scarring.