Teleconsultation for emergency orthopaedic patients using the multimedia messaging service via mobile phones
Teleconsultation for emergency orthopaedic patients using the multimedia messaging service via mobile phones
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DOI：
10.1258/135763307780908049
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发表时间：
2007-01-01
影响因子：
4.7
通讯作者：
Kiriratnikom, Theerasan
中科院分区：
文献类型：
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作者：
Chandhanayingyong, Chandhanarat;Tangtrakulwanich, Boonsin;Kiriratnikom, Theerasan
我们调查了使用移动的电话多媒体消息服务（MMS）在急诊骨科患者中进行远程会诊的准确性和有用性。使用内置的130万像素移动的手机摄像头从急诊室的数字显示屏上拍摄X光照片，然后传输到四名评估员的手机摄像头上。这些病例包括59名诊断为无移位或最小移位骨折的急诊骨科患者和34名年龄匹配的急诊科正常患者。临床和影像学随访数据均用作金标准。观察者间和观察者内一致性良好（kappa>0.60）。总的敏感性、特异性和准确性分别为78%、54%和65%。总误诊率为40%，过度诊断率为12%，欠诊断率为27%。误诊的后果将导致高达48%的病例管理不善。未发现评估者的经验、骨折部位或患者年龄组与误诊率之间存在相关性。通过MMS进行的会诊显示出良好的可靠性，但诊断准确性较差，这可能对急诊骨科患者造成严重后果。
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.