Cell Phones Help Doctors Monitor Surgical Patients for Infections

The crystal-clear clarity with which smartphones can now capture images has been put to another innovative use: monitoring patients who have had emergency abdominal surgery for surgical site infections (SSI) and allowing doctors to diagnose them further. early in the postoperative period before they turn into a much bigger problem.

“Since the start of the COVID-19 pandemic, there have been big changes in the way post-surgery care is delivered,” Kenneth McLean, MBChB, University of Edinburgh, Scotland, observed in a statement.

“Patients and staff have become accustomed to remote consultations and we have shown that we can safely and effectively monitor wounds after surgery while patients recover at home – this will likely become the new normal,” he said. he added.

“Recovery can be an anxious time for everyone and these approaches are reassuring,” added lead author Ewen Harrison, PhD, professor of surgery and data science at the University of Edinburgh, Scotland, in the same release.

“We hope that early management of wound problems can lead to treatments that limit complications,” he added.

The study was published online on November 18, 2021 in npj Digital Medicine.

TWIST trial

A total of 492 patients were included in the TWIST trial, the majority of whom had undergone major surgeries, nearly three quarters of which were performed laparoscopically. Some 223 patients were randomized to the smartphone intervention, while the remaining 269 patients were randomized to routine care. Patients in the smartphone group were contacted on days 3, 7 and 15 after the operation and directed to an online site where they were asked about their wound and the symptoms they were exhibiting.

If they were symptomatic, they were then asked to take a photo of their wound and upload it to a secure website where a member of the surgical team would assess the photographs as well as the patient’s responses for signs. wound infection. Patients were followed for 30 days after surgery to document whether they were subsequently diagnosed with SSI.

Routine care patients were simply contacted 30 days after surgery to see whether or not they had been diagnosed with infection. “Overall, 8.3% … of the cohort developed operative site infections (SSI) during the 30-day postoperative period, with no significant difference in the rate of SSI between the arms of the ‘test “, report the investigators: 9.4% in the smartphone arm and 7.4% in the routine care arm (P = 0.513).

However, the mean time to diagnosis of ISO – the primary endpoint of the trial – was numerically shorter, at 9.3 days in the smartphone group versus 11.8 days in the routine care group, although that this difference is not statistically significant. On the other hand, a post-hoc analysis showed that patients who received a smartphone were almost four times more likely to have their SSI diagnosed within the first 7 postoperative days, with an odds ratio (OR) of 3.7. (95% confidence interval [CI], 1.02 – 13.51; P = .043) compared to those assigned to routine care.

“These surgical wound infections usually get worse over time and can spread into the bloodstream or deeper into the abdomen if left untreated,” McLean explained in an email to Medscape Medical News. “So if we can diagnose these infections before they become more pronounced, we can potentially avoid these more serious complications and the need for readmissions.” The wound assessment tool also had a high negative predictive value – “meaning that an SSI can be confidently excluded,” as the authors point out.

Indeed, among the patients diagnosed with SSI within the smartphone group, more than a third had used the tool 48 hours before the diagnosis – five were diagnosed on the same day – and all the infections identified were based on the patient statements. symptoms. “Incorporation of wound images offered a significant improvement in specificity from 84.4% (95% CI, 80.5 – 88.3%) to 93.6% (95% CI, 90, 9 – 96.2%) “, add the investigators.

The researchers also compared the use of health services between the two treatment groups. Overall, 14.3% of those who used a smartphone contacted a health service – community or hospital – about their wound. This compares to 22.3% of patients in the routine care group. Patients in the smartphone group also had 43% lower rates for needing community care services, with an OR of 0.57 (95% CI: 0.34 – 0.94; P = 0.577), although their hospital emergency department needs are similar to those required by patients receiving routine care.

And in a comparison of the patient experience over 30 days, those in the smartphone group reported significantly more positive experiences on all measures assessed, including access to care, ease of access to advice, and quality. advice received.

Some did not use the tool

The authors acknowledge that about a third of those assigned to the Smartphone Rating Tool have not used the tool at all. However, as McLean pointed out, there will always be a proportion of patients who are less likely to use a service if they feel it is not necessary – their injury was healing well, for example – so why worry about it? “It’s reassuring,” he added, “there was no evidence that, for example, older patients with smartphones were less likely to use the tool,” he said. declared.

The authors also pointed out that there are broader applications for the use of smartphones in the delivery of health care. For example, the remote follow-up approach could be broadened to include other potential complications after surgery. It could also be used to monitor chronic wounds like diabetic ulcers or other chronic diseases like asthma or chronic obstructive pulmonary disease.

“Delays in accessing appropriate emergency care, as well as unnecessary health care visits, can harm patients and increase the burden on health services,” McLean said.

“By increasing patients’ access to counseling, they are more likely to receive the right treatment at the right time and more work is currently underway to explore how it can be tailored to make [care] as accessible and inclusive as possible, ”he added.

Rapid adoption

Asked to comment on the results, Josh Totty, MD, NIHR Clinical Lecturer in Plastic Surgery, Hull York Medical School, UK, noted that the way technology is used has changed dramatically over the past 2 years.

“The rapid adoption of technology in healthcare, using powerful computers that the majority of people have access to in their pockets, has helped protect patients and clinicians and reduce risk, increase productivity and to facilitate patients’ access to their clinicians ”he said Medscape Medical News in an email.

As we emerge from the pandemic, Totty added, “we are constantly looking for ways to improve care that is acceptable to patients,” he said.

“And this study shows that smartphones could help diagnose important infections earlier in the disease process. In turn, earlier treatment potentially leads to better outcomes and less morbidity as a result,” Totty added. . He also said the study was both large and well-designed and adds to a growing body of evidence suggesting smartphones have a crucial role to play in how patients access healthcare.

And he underlined: “We must now undertake work to ensure that everyone, young and old, rich or poor, has access to this technology.

Npj Digital Med. Published online November 18, 2021. Full text

Totty and the study’s authors did not reveal any relevant financial relationships.

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