Raveendran Sreekanth, Thomas Binu Prathap, Jayaseelan Visalakshi
Dr. Paul Brand Centre for Hand Surgery, Christian Medical College Vellore, Vellore, Tamil Nadu, India.
Department of Biostatistics, Christian Medical College Vellore, Vellore, Tamil Nadu, India.
J Hand Microsurg. 2020 Dec;12(3):163-167. doi: 10.1055/s-0039-1683458. Epub 2019 Mar 24.
Teleconsultation over the smartphone is now widely used in modern medicine in the management of burns, flap cover, upper extremity trauma, and in the assessment of the feasibility of reimplantation in amputated fingers. The development of the WhatsApp application has enhanced the smartphone's efficiency remarkably to transmit images in clinical and academic settings with its failsafe and encrypted technology. In hand surgery, a teleconsultation technology must communicate details of finger vascularity effectively. However, there is a paucity of evidence on the functionality of these modern teleconsultation technologies in Hand Surgery. Here, the authors have estimated the efficiency of the WhatsApp teleconsultation in the assessment of finger vascularity. In two phases, the authors transmitted clinical photographs of vascular and avascular fingers to experienced hand surgeons over the WhatsApp and asked them to assess the finger vascularity. The efficiency of the WhatsApp teleconsultation in assessing the details of finger vascularity was estimated from their responses. Despite 81.06% of the hand surgeons rating the vascular fingers on the transmitted photographs correctly, only 44.95% detected the avascular digits accurately; that is, 55.05% of the surgeons failed to diagnose the avascularity of fingers. This suggests serious implications in a clinical setting. The intra- and the inter-rater reliability values were 0.232 and 0.6086 (with 95% confidence interval), respectively, which indicated poor reliability of the WhatsApp teleconsultation regarding the assessment of finger vascularity. The authors, therefore, conclude that WhatsApp is inadequate in teleconsultation given the value of vascularity details of the fingers in making a diagnosis in hand surgery.
智能手机远程会诊目前在现代医学中被广泛应用于烧伤处理、皮瓣覆盖、上肢创伤治疗以及断指再植可行性评估等方面。WhatsApp应用程序的发展显著提高了智能手机在临床和学术环境中传输图像的效率，其采用了可靠且加密的技术。在手外科领域，远程会诊技术必须有效地传达手指血管状况的细节。然而，关于这些现代远程会诊技术在手外科中的功能，证据却很匮乏。在此，作者评估了WhatsApp远程会诊在评估手指血管状况方面的效率。在两个阶段中，作者通过WhatsApp向经验丰富的手外科医生发送有血管和无血管手指的临床照片，并要求他们评估手指血管状况。根据他们的回复来评估WhatsApp远程会诊在评估手指血管细节方面的效率。尽管81.06%的手外科医生能正确判断所传输照片上有血管的手指，但只有44.95%的医生能准确检测出无血管的手指；也就是说，55.05%的医生未能诊断出手指无血管的情况。这在临床环境中意味着严重的问题。评分者内和评分者间的可靠性值分别为0.232和0.6086（95%置信区间），这表明WhatsApp远程会诊在评估手指血管状况方面可靠性较差。因此，作者得出结论，鉴于手指血管细节在手部手术诊断中的价值，WhatsApp在远程会诊方面并不适用。
