Stahl Ido, Katsman Alexander, Zaidman Michael, Keshet Doron, Sigal Amit, Eidelman Mark
Pediatric Orthopedics, Ruth Rappaport Children's Hospital, Haifa, Israel.
Pediatr Emerg Care. 2019 Jun;35(6):403-406. doi: 10.1097/PEC.0000000000001211.
Smartphones have the ability to capture and send images, and their use has become common in the emergency setting for transmitting radiographic images with the intent to consult an off-site specialist. Our objective was to evaluate the reliability of smartphone-based instant messaging applications for the evaluation of various pediatric limb traumas, as compared with the standard method of viewing images of a workstation-based picture archiving and communication system (PACS).
X-ray images of 73 representative cases of pediatric limb trauma were captured and transmitted to 5 pediatric orthopedic surgeons by the Whatsapp instant messaging application on an iPhone 6 smartphone. Evaluators were asked to diagnose, classify, and determine the course of treatment for each case over their personal smartphones. Following a 4-week interval, revaluation was conducted using the PACS. Intraobserver agreement was calculated for overall agreement and per fracture site.
The overall results indicate "near perfect agreement" between interpretations of the radiographs on smartphones compared with computer-based PACS, with κ of 0.84, 0.82, and 0.89 for diagnosis, classification, and treatment planning, respectively. Looking at the results per fracture site, we also found substantial to near perfect agreement.
Smartphone-based instant messaging applications are reliable for evaluation of a wide range of pediatric limb fractures. This method of obtaining an expert opinion from the off-site specialist is immediately accessible and inexpensive, making smartphones a powerful tool for doctors in the emergency department, primary care clinics, or remote medical centers, enabling timely and appropriate treatment for the injured child. This method is not a substitution for evaluation of the images in the standard method over computer-based PACS, which should be performed before final decision-making.
智能手机具备拍摄和发送图像的能力，在紧急情况下，利用其传输X光影像以咨询异地专家已变得十分常见。我们的目的是评估基于智能手机的即时通讯应用程序在评估各种小儿肢体创伤方面的可靠性，并与基于工作站的图像存档和通信系统（PACS）查看图像的标准方法进行比较。
通过iPhone 6智能手机上的Whatsapp即时通讯应用程序，采集73例小儿肢体创伤代表性病例的X光图像，并发送给5名小儿骨科医生。要求评估人员通过个人智能手机对每个病例进行诊断、分类并确定治疗方案。间隔4周后，使用PACS进行重新评估。计算观察者内部在总体一致性和每个骨折部位的一致性。
总体结果表明，与基于计算机的PACS相比，智能手机上X光片解读之间的一致性“近乎完美”，诊断、分类和治疗计划的κ值分别为0.84、0.82和0.89。查看每个骨折部位的结果，我们也发现了实质性到近乎完美的一致性。
基于智能手机的即时通讯应用程序在评估多种小儿肢体骨折方面是可靠的。这种从异地专家获取专业意见的方法即时可用且成本低廉，使智能手机成为急诊科、基层医疗诊所或远程医疗中心医生的有力工具，能够为受伤儿童及时提供适当的治疗。这种方法不能替代通过基于计算机的PACS的标准方法对图像进行评估，在最终决策前应采用标准方法。
