Diagnostic accuracy of telemedicine for detection of surgical site infection: a systematic review and meta-analysis

Abstract

The Sars-CoV-2 pandemic catalysed integration of telemedicine worldwide. This systematic review assesses it's accuracy for diagnosis of Surgical Site Infection (SSI). Databases were searched for telemedicine and wound infection studies. All types of studies were included, only paired designs were taken to meta-analysis. QUADAS-2 assessed methodological quality. 1400 titles and abstracts were screened, 61 full text reports were assessed for eligibility and 17 studies were included in meta-analysis, mean age was 47.1 ± 13.3 years. Summary sensitivity and specificity was 87.8% (95% CI, 68.4-96.1) and 96.8% (95% CI 93.5-98.4) respectively. The overall SSI rate was 5.6%. Photograph methods had lower sensitivity and specificity at 63.9% (95% CI 30.4-87.8) and 92.6% (95% CI, 89.9-94.5). Telemedicine is highly specific for SSI diagnosis is highly specific, giving rise to great potential for utilisation excluding SSI. Further work is needed to investigate feasibility telemedicine in the elderly population group.

Fig. 1. PRISMA flow diagram for study selection process.

Identification of studies via databases and registers is found in the left column, and via other methods on the right.

Fig. 2. Risk of bias and applicability concerns summary: review authors’ judgements about each domain for each study.

High, unclear and low risk of bias and applicability concerns are represented as shown in the legend.

Fig. 3. Risk of bias and applicability concerns graph: review authors’ judgements about each domain presented as percentages across included studies.

High, unclear and low risk of bias or applicability concerns are represented as shown in the legend.

Fig. 4. Coupled forest plot presenting sensitivity and specificity of SSI diagnosis by telemedical methods.

Final two columns display the sensitivity and specificity respectively with 95% confidence intervals.

Fig. 5. Random effects bivariate summary receiver operator characteristic curve of telemedicine for the diagnosis of surgical site infection.

Summary curve and point estimates display high levels of accuracy. Elliptical data points represent weight sensitivity-specificity trade-off for each study. The summary point is expressed in the summary curve with dotted line 95% confidence region and dashed line 95% prediction region.

Fig. 6. Random effects bivariate summary receiver operator characteristic curve for photograph based recognition of surgical site infection.

Elliptical data points represent weight sensitivity-specificity trade-off for each study. The summary point is expressed in the summary curve with dotted line 95% confidence region and dashed line 95% prediction region.