Teleconsultation for emergency orthopaedic patients using the multimedia messaging service via mobile phones

Abstract

We investigated the accuracy and usefulness of teleconsultation using the mobile phone multimedia messaging service (MMS) in emergency orthopaedic patients. Pictures of radiographs were taken using a built-in 1.3 megapixel mobile phone camera from a digital display screen in the emergency room and then transmitted to the camera phones of four assessors. The cases comprised 59 emergency orthopaedic patients diagnosed with non- or minimally displaced fractures and 34 age-matched normal patients visiting the emergency department. Both clinical and radiographic follow up data were used as the gold standard. Inter- and intra-observer agreement were good (kappa>0.60). The overall sensitivity, specificity and accuracy were 78%, 54% and 65%, respectively. The overall misdiagnosis rate was 40%, with over-diagnosis of 12% and under-diagnosis of 27%. The consequence of misdiagnosis would have resulted in mismanagement in up to 48% of the cases. No association was found between the experience of the assessors, the region of the fracture or the age group of the patients and the misdiagnosis rate. Teleconsultation via MMS demonstrated good reliability, but poor diagnostic accuracy which could have major consequences in emergency orthopaedic patients.

Image-Based Medical Expert Teleconsultation in Acute Care of Injuries. A Systematic Review of Effects on Information Accuracy, Diagnostic Validity, Clinical Outcome, and User Satisfaction

“…In five of the nine other studies that assessed systems at the pilot or post-implementation stages, the assessors considered cases through the telemedicine modality only [22], [23], [32], [35], [39]; in two, both telemedicine and on-site interpretations were done one after the other [40], [41]. In two articles a telephone description was compared to the telemedicine modality [31], [42].…”

“…In two articles a telephone description was compared to the telemedicine modality [31], [42]. Three evaluations used a gold standard [22], [23], [39], and statistical analysis included kappa, correlation coefficient and descriptive statistics, and accuracy analysis (sensitivity and specificity). Results showed generally good diagnostic accuracy, except in one study [39].…”

Telemedicine in Primary Care

“…(Currell et al, 2000) For example, in one study, transmitting x-ray radiographs to a remote orthopedic surgeon using the mobile phone MMS (multimedia messaging service) resulted in under or over diagnosing that would have led to mismanagement in 48% of the cases. (Chandhanayingyong et al, 2007) Definitely, there are some limitations to the accuracy of the physical exam using teleconsultation such as the lack of palpation and smell. (Boodley, 2006) 2.…”

Self-Reported “Communication Technology” Usage in Patients Attending a Cardiology Outpatient Clinic in a Remote Regional Hospital

“…15 However, telecommunication is obviously less robust in terms of physical examination, and there is a danger that physical signs will be missed. 16 Furthermore, patients and physicians share some concerns regarding communication technology. 17 Security and confidentiality are a particular concern with e-mail and Web.…”

“…However, studies have shown that if support is given, new technologies can be successfully used even in very elderly populations. 16 Another concept is that of ''teleassistance'' where individuals in the community facilitate communication between physicians via telemedicine; these individuals could be community nurses, general practitioners, or others, although using non-healthcare professionals may be ethically challenging, and confidentiality of patients should always be protected.…”