Accuracy of acute burns diagnosis made using smartphones and tablets: a questionnaire-based study among medical experts

Abstract

BackgroundRemote assistance for burns by medical experts can support nurses and general physicians in emergency care with diagnostic and management advice. Previous studies indicate a high diagnostic accuracy based on images viewed on a computer screen, but whether image-based analysis by experts using handheld devices is accurate remains to be determined.MethodA review of patient data from eight emergency centres in the Western Cape, South Africa, revealed 10 typical cases of burns commonly seen in children and adults. A web-based questionnaire was created with 51 images of burns representing those cases. Burns specialists from two countries (South Africa and Sweden (n = 8 and 7 respectively)) and emergency medicine specialists from South Africa (n = 11) were contacted by email and asked to assess each burn’s total body surface area (TBSA) and depth using a smartphone or tablet. The accuracy and inter-rater reliability of the assessments were measured using intraclass correlation coefficients (ICC), both for all cases aggregated and for paediatric and adult burn cases separately. Eight participants repeated the questionnaire on a computer and intra-rater reliability was calculated.ResultsThe assessments of TBSA are of high accuracy all specialists aggregated (ICC = 0.82 overall and 0.81 for both child and adult cases separately) and remain high for all three participant groups separately. The burn depth assessments have low accuracy all specialists aggregated, with ICCs of 0.53 overall, 0.61 for child and 0.46 for adult cases. The most accurate assessments of depth are among South African burns specialists (reaching acceptable for child cases); the other two groups’ ICCs are low in all instances. Computer-based assessments were similar to those made on handheld devices.ConclusionAs was the case for computer-based studies, burns images viewed on handheld devices may be a suitable means of seeking expert advice even with limited additional information when it comes to burn size but less so in the case of burn depth. Familiarity with the type of cases presented could facilitate image-based diagnosis of depth.Electronic supplementary materialThe online version of this article (10.1186/s12873-017-0151-4) contains supplementary material, which is available to authorized users.

The effects of mobile health on emergency care in low- and middle-income countries: A systematic review and narrative synthesis

“…Finally, a single study found somewhat limited utility of remote visual diagnostics in pediatric burn patients. Remote specialists had highly accurate total body surface area (TBSA) estimates but poor depth assessments [ 25 ]. All nine studies concluded that mobile health decision support interventions were an effective means to improve EC in LMICs.…”

mHealth for image-based diagnostics of acute burns in resource-poor settings: studies on the role of experts and the accuracy of their assessments

“…The four studies [25][26][27][28] of the thesis [29] took place when an app for acute burns was under development, intended to be used between emergency care nurses and physicians and burns experts in Western Cape province, South Africa [10,11]. The app was based on local initiatives and went through a long process of development in close collaboration with local stakeholders from burns and emergency medicine.…”

“…An application of the context of emergency care of burns (text in red) in light of the congruence model (adapted from [30]) and the four studies focusing on the work of experts. [26] and third [27] study examined image quality and diagnostic accuracy in relation to assessment of burns using smartphone or tablet.…”

“…In the third study [27], 26 burns and emergency medicine experts assessed 51 images of burns using their own smartphone or tablet.…”

“…The tasks are the basic activities that should be done by the organisation which could be studied for example by investigating the nature of the tasks and the skills needed to perform the tasks. The second [ 26 ] and third [ 27 ] study examined image quality and diagnostic accuracy in relation to assessment of burns using smartphone or tablet.…”