Remote diagnosis of surgical-site infection using a mobile digital intervention: a randomised controlled trial in emergency surgery patients

Abstract Surgical site infections (SSI) cause substantial morbidity and pose a burden to acute healthcare services after surgery. We aimed to investigate whether a smartphone-delivered wound assessment tool can expedite diagnosis and treatment of SSI after emergency abdominal surgery. This single-bl...

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Autores principales:	Kenneth A. McLean, Katie E. Mountain, Catherine A. Shaw, Thomas M. Drake, Riinu Pius, Stephen R. Knight, Cameron J. Fairfield, Alessandro Sgrò, Matt Bouamrane, William A. Cambridge, Mathew Lyons, Aya Riad, Richard J. E. Skipworth, Stephen J. Wigmore, Mark A. Potter, Ewen M. Harrison, TWIST Collaborators
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Computer applications to medicine. Medical informatics R858-859.7
Acceso en línea:	https://doaj.org/article/ac3ff51ec06c40639ad19df305de1632
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spelling	oai:doaj.org-article:ac3ff51ec06c40639ad19df305de16322021-11-21T12:05:38ZRemote diagnosis of surgical-site infection using a mobile digital intervention: a randomised controlled trial in emergency surgery patients10.1038/s41746-021-00526-02398-6352https://doaj.org/article/ac3ff51ec06c40639ad19df305de16322021-11-01T00:00:00Zhttps://doi.org/10.1038/s41746-021-00526-0https://doaj.org/toc/2398-6352Abstract Surgical site infections (SSI) cause substantial morbidity and pose a burden to acute healthcare services after surgery. We aimed to investigate whether a smartphone-delivered wound assessment tool can expedite diagnosis and treatment of SSI after emergency abdominal surgery. This single-blinded randomised control trial (NCT02704897) enroled adult emergency abdominal surgery patients in two tertiary care hospitals. Patients were randomised (1:1) to routine postoperative care or additional access to a smartphone-delivered wound assessment tool for 30-days postoperatively. Patient-reported SSI symptoms and wound photographs were requested on postoperative days 3, 7, and 15. The primary outcome was time-to-diagnosis of SSI (Centers for Disease Control definition). 492 patients were randomised (smartphone intervention: 223; routine care: 269). There was no significant difference in the 30-day SSI rate between trial arms: 21 (9.4%) in smartphone vs 20 (7.4%, p = 0.513) in routine care. Among the smartphone group, 32.3% (n = 72) did not utilise the tool. There was no significant difference in time-to-diagnosis of SSI for patients receiving the intervention (−2.5 days, 95% CI: −6.6−1.6, p = 0.225). However, patients in the smartphone group had 3.7-times higher odds of diagnosis within 7 postoperative days (95% CI: 1.02−13.51, p = 0.043). The smartphone group had significantly reduced community care attendance (OR: 0.57, 95% CI: 0.34−0.94, p = 0.030), similar hospital attendance (OR: 0.76, 95% CI: 0.28−1.96, p = 0.577), and significantly better experiences in accessing care (OR: 2.02, 95% CI: 1.17−3.53, p = 0.013). Smartphone-delivered wound follow-up is feasible following emergency abdominal surgery. This can facilitate triage to the appropriate level of assessment required, allowing earlier postoperative diagnosis of SSI.Kenneth A. McLeanKatie E. MountainCatherine A. ShawThomas M. DrakeRiinu PiusStephen R. KnightCameron J. FairfieldAlessandro SgròMatt BouamraneWilliam A. CambridgeMathew LyonsAya RiadRichard J. E. SkipworthStephen J. WigmoreMark A. PotterEwen M. HarrisonTWIST CollaboratorsNature PortfolioarticleComputer applications to medicine. Medical informaticsR858-859.7ENnpj Digital Medicine, Vol 4, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Computer applications to medicine. Medical informatics R858-859.7
spellingShingle	Computer applications to medicine. Medical informatics R858-859.7 Kenneth A. McLean Katie E. Mountain Catherine A. Shaw Thomas M. Drake Riinu Pius Stephen R. Knight Cameron J. Fairfield Alessandro Sgrò Matt Bouamrane William A. Cambridge Mathew Lyons Aya Riad Richard J. E. Skipworth Stephen J. Wigmore Mark A. Potter Ewen M. Harrison TWIST Collaborators Remote diagnosis of surgical-site infection using a mobile digital intervention: a randomised controlled trial in emergency surgery patients
description	Abstract Surgical site infections (SSI) cause substantial morbidity and pose a burden to acute healthcare services after surgery. We aimed to investigate whether a smartphone-delivered wound assessment tool can expedite diagnosis and treatment of SSI after emergency abdominal surgery. This single-blinded randomised control trial (NCT02704897) enroled adult emergency abdominal surgery patients in two tertiary care hospitals. Patients were randomised (1:1) to routine postoperative care or additional access to a smartphone-delivered wound assessment tool for 30-days postoperatively. Patient-reported SSI symptoms and wound photographs were requested on postoperative days 3, 7, and 15. The primary outcome was time-to-diagnosis of SSI (Centers for Disease Control definition). 492 patients were randomised (smartphone intervention: 223; routine care: 269). There was no significant difference in the 30-day SSI rate between trial arms: 21 (9.4%) in smartphone vs 20 (7.4%, p = 0.513) in routine care. Among the smartphone group, 32.3% (n = 72) did not utilise the tool. There was no significant difference in time-to-diagnosis of SSI for patients receiving the intervention (−2.5 days, 95% CI: −6.6−1.6, p = 0.225). However, patients in the smartphone group had 3.7-times higher odds of diagnosis within 7 postoperative days (95% CI: 1.02−13.51, p = 0.043). The smartphone group had significantly reduced community care attendance (OR: 0.57, 95% CI: 0.34−0.94, p = 0.030), similar hospital attendance (OR: 0.76, 95% CI: 0.28−1.96, p = 0.577), and significantly better experiences in accessing care (OR: 2.02, 95% CI: 1.17−3.53, p = 0.013). Smartphone-delivered wound follow-up is feasible following emergency abdominal surgery. This can facilitate triage to the appropriate level of assessment required, allowing earlier postoperative diagnosis of SSI.
format	article
author	Kenneth A. McLean Katie E. Mountain Catherine A. Shaw Thomas M. Drake Riinu Pius Stephen R. Knight Cameron J. Fairfield Alessandro Sgrò Matt Bouamrane William A. Cambridge Mathew Lyons Aya Riad Richard J. E. Skipworth Stephen J. Wigmore Mark A. Potter Ewen M. Harrison TWIST Collaborators
author_facet	Kenneth A. McLean Katie E. Mountain Catherine A. Shaw Thomas M. Drake Riinu Pius Stephen R. Knight Cameron J. Fairfield Alessandro Sgrò Matt Bouamrane William A. Cambridge Mathew Lyons Aya Riad Richard J. E. Skipworth Stephen J. Wigmore Mark A. Potter Ewen M. Harrison TWIST Collaborators
author_sort	Kenneth A. McLean
title	Remote diagnosis of surgical-site infection using a mobile digital intervention: a randomised controlled trial in emergency surgery patients
title_short	Remote diagnosis of surgical-site infection using a mobile digital intervention: a randomised controlled trial in emergency surgery patients
title_full	Remote diagnosis of surgical-site infection using a mobile digital intervention: a randomised controlled trial in emergency surgery patients
title_fullStr	Remote diagnosis of surgical-site infection using a mobile digital intervention: a randomised controlled trial in emergency surgery patients
title_full_unstemmed	Remote diagnosis of surgical-site infection using a mobile digital intervention: a randomised controlled trial in emergency surgery patients
title_sort	remote diagnosis of surgical-site infection using a mobile digital intervention: a randomised controlled trial in emergency surgery patients
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/ac3ff51ec06c40639ad19df305de1632
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Remote diagnosis of surgical-site infection using a mobile digital intervention: a randomised controlled trial in emergency surgery patients

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