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Prospective Study of Teleconsultation in Hand Surgery
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ABSTRACT
Telemedicine is a valuable but underused resource for health care delivery to patients in areas that are underserved. This study determined whether hand surgery teleconsultation for upper extremity injuries can be used to accurately diagnose and formulate treatment plans.
One hundred patients with acute upper extremity injuries were prospectively evaluated by one orthopedic resident. Evaluation involved a history and physical examination, digital images of the patient, and digital radiographs. The patient information was presented electronically to two hand surgeons 6 weeks after these surgeons directly evaluated patients in the outpatient clinic. Physicians formulated a diagnosis and treatment plan for the patients based on the blinded electronic information, and these findings were compared to the treatment plans made by the physicians directly at the earlier time point. Kappa coefficients (k) of intra- and interobserver reliability for diagnosis and treatment were generated.
Telemedicine consultation did not alter proposed treatment plans within observers (intraobserver agreement: k=0.89, high) or between observers (k=0.86, high). The actual number of diagnoses and treatments that changed within observers was four and five, respectively.
Telemedicine consultation resulted in no significant change in the proposed management of upper extremity injuries, and appears to provide an accurate and powerful method for delivery of orthopedic care.