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Reliability of Smartphone-Based Instant Messaging Application for Diagnosis, Classification, and Decision-making in Pediatric Orthopedic Trauma

Stahl, Ido MD*; Katsman, Alexander MD; Zaidman, Michael MD; Keshet, Doron MD*†; Sigal, Amit MD; Eidelman, Mark MD

doi: 10.1097/PEC.0000000000001211
Original Articles

Objective 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).

Methods 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.

Results 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.

Conclusions 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.

From the *Division of Orthopedic Surgery, Rambam Healthcare Campus; and

Pediatric Orthopedics, Ruth Rappaport Children's Hospital, Haifa, Israel.

Disclosures: No author has anything to declare.

Reprints: Ido Stahl, MD, Division of Orthopedic Surgery, Rambam Healthcare Campus, POB 9602, Haifa 31096, Israel (e-mail:

Online date: July 11, 2017

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