Smart consultation for musculoskeletal trauma: accuracy of using smart phones for fracture diagnosis.
INTRODUCTION
Musculoskeletal trauma occupies a significant proportion of the daily workload of most Emergency and Radiology departments. The diagnosis and management of patients with musculoskeletal trauma often require assessment of radiographs along with clinical assessment. With the advent of smart phones we hypothesised that they could be used as a means of smarter communication, particularly for the transfer of radiographic images between healthcare professionals.


PATIENTS AND METHOD
We performed a cross sectional study using thirty radiographs each of the distal radius, ankle and hip. The study was approved by Ethics Committee and all data were anonymized in accordance to Caldicott guidelines and data protection act 1998. Photographs of radiographs were taken using an iphone camera and sent to three independent Orthopaedic Registrars via Multimedia messaging service (MMS). Each Registrar independently assessed these images on their smart phone display in their own time and recorded the specific diagnosis along with the classification of fractures and specific treatment plan. The accuracy of diagnosis on smart phone was measured against the radiology report; and inter observer agreement was assessed among registrars for classification and treatment plan.


RESULTS
The overall accuracy of fracture diagnosis was 97.7% with sensitivity of 100% and specificity of 94.4%. The inter observer agreement analysis showed kappa (k) values of 0.67, 0.67 and 0.71 for classification of wrist, ankle and hip fractures respectively showing substantial agreement while kappa values for management plan were 0.65, 0.88 and 0.65 for the three fractures respectively showing substantial to near perfect agreement.


CONCLUSION
This study suggests that smart phone can be used as a safe and accurate tool for skeletal trauma consultation among oncall doctors and can help reduce the waiting time in emergency departments.
['Naqvi|G A|GA|', 'Daly|M|M|', 'Dawood|A|A|', 'Kurkuri|A|A|', 'Kutty|S|S|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D064386:Ankle Fractures D040421:Cell Phone D003430:Cross-Sectional Studies D006620:Hip Fractures D006801:Humans D008875:Middle Aged D015588:Observer Variation D009985:Orthopedics D010781:Photography D011859:Radiography D011885:Radius Fractures D012017:Referral and Consultation D012680:Sensitivity and Specificity D055815:Young Adult
Accuracy Smart phone Fracture Diagnosis