Emergency Medicine, The George Washington University Medical Faculty Associates, Washington, DC 20037, USA.
Telemed J E Health. 2012 Sep;18(7):554-7. doi: 10.1089/tmj.2011.0216. Epub 2012 Jul 23.
Mobile phone technology may be useful in helping to guide medical decisions for lacerations. We examined whether emergency department (ED) provider opinions on which lacerations require repair differed using mobile phone-generated images compared with in-person evaluations.
Patients presenting to an urban ED for initial and follow-up laceration care were prospectively enrolled. Patients took four mobile phone pictures of their laceration and provided a medical history. Cases were reviewed by ED providers who assessed image quality and made a recommendation about whether the laceration needed repair. The same provider then assessed the patient in-person. Concordant decision-making between mobile phone and in-person assessments was calculated as well as the degree of undertriage.
In total, 94 patients were included over an 8-month period. There was complete agreement in 87% of cases (κ statistic=0.65). Of the 13 patients with discrepant decisions, 6 were due to poor image quality, in 3 the images did not properly represent the problem, in 3 others there were historical findings that altered care, and for 1 the image looked worse than the actual injury in-person. In total, 5 of 94 (5%) of cases would have been undertriaged using only the mobile phone recommendation. Median image quality was 6 out of 10 (with 10 being the best) (interquartile range, 4-8).
There are high rates of agreement when providers use mobile phone images to assess lacerations for possible repair in the ED. Image quality is in general good but highly variable and may drive incorrect assessments.
手机技术可能有助于指导创伤的医学决策。我们研究了与亲自评估相比，使用手机生成的图像是否会导致急诊医生（ED）对需要修复的创伤的看法不同。
前瞻性招募了因初次和随访创伤护理而到城市 ED 就诊的患者。患者对其创伤拍摄了四张手机照片，并提供了病史。ED 提供者对这些病例进行了回顾，评估了图像质量并对创伤是否需要修复提出了建议。然后，同一提供者对患者进行了亲自评估。计算了手机和亲自评估之间一致决策的比例以及过度分诊的程度。
在 8 个月的时间里，共有 94 名患者被纳入研究。在 87%的病例中存在完全一致（κ 统计量=0.65）。在 13 名决策不一致的患者中，有 6 名是由于图像质量差，3 名是由于图像不能正确反映问题，另外 3 名是由于病史改变了治疗方案，1 名是由于图像看起来比实际创伤更严重。总的来说，仅使用手机推荐就会有 94 例中的 5 例（5%）被过度分诊。中位数图像质量为 10 分制中的 6 分（满分 10 分）（四分位数范围，4-8 分）。
提供者使用手机图像评估 ED 中可能需要修复的创伤时，有很高的一致率。图像质量总体良好但差异很大，可能会导致错误的评估。
