Teleradiology for remote consultation using iPad improves the use of health system human resources for paediatric fractures: prospective controlled study in a tertiary care hospital in Italy

• Published in: BMC health services research Vol. 14; no. 1; p. 327
• Main Authors: Zennaro, Floriana, Grosso, Daniele, Fascetta, Riccardo, Marini, Marta, Odoni, Luca, Di Carlo, Valentina, Dibello, Daniela, Vittoria, Francesca, Lazzerini, Marzia
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 28-07-2014; BioMed Central
• Subjects: Adolescent; Child; Child, Preschool; Children & youth; Childrens health; Clinical medicine; Computers, Handheld; Confidentiality; Consent; Decision Making; Departments; Emergency medical care; Families & family life; Fractures; Fractures, Bone - diagnostic imaging; Health care; Health services; Hospitals; Humans; Infant; Infant, Newborn; Italy; Maternal & child health; Medical equipment; Orthopedics; Patients; Pediatrics; Prospective Studies; Radiography; Radiology; Remote Consultation - instrumentation; Review boards; Teleradiology - instrumentation; Time Factors; Work stations
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/1472-6963-14-327

The growing cost of health care and lack of specialised staff have set e-Health high on the European political agenda. In a prospective study we evaluated the effect of providing images for remote consultation through an iPad on the number of in-hospital orthopaedic consultations for children with bone fractures.
Children from 0 to 18 years diagnosed with a bone fracture by the radiologist during the hours when an orthopaedic service is provided only on-call were eligible for enrollment. Cases were enrolled prospectively during September and October 2013. A standard approach (verbal information only, no X-Ray provided remotely) was compared to an experimental approach (standard approach plus the provision of X-ray for remote consultation through an iPad). The primary outcome was the number of orthopaedic in-hospital consultations that occurred. Other outcomes included: immediate activation of other services; time needed for decision-making; technical difficulties; quality of images and diagnostic confidence (on a likert scale of 1 to 10).
Forty-two children were enrolled in the study. Number of in-hospital consultancies dropped from 32/42 (76.1%) when no X-ray was provided to 16/42 (38%) when the X-rays was provided (p < 0.001). With remote X-ray consultation in 14/42 (33.3%) cases services such as surgery and plaster room could be immediately activated, compared to no service activated without teleradiology (p < 0.001). Average time for decision making was 23.4 ± 21.8 minutes with remote X-ray consultation, compared to 56.2 ± 16.1 when the X-ray was not provided (p < 0.001). The comparison between images on the iPad and on the standard system for X- Ray visualisation resulted in a non statistically significant difference in the quality of images (average score 9.89 ± 0.37 vs 9.91 ± 0.30; p = 0.79), and in non statistically significant difference in diagnostic confidence (average score 9.91 ± 0.32 vs 9.92 ± 0.31; p = 0.88).
Remote X-ray consultation through Aycan OsiriX PRO and iPad should be considered as a means for reducing the need of in-hospital orthopaedic consultation during on-call times, and potentially decrease the cost of care for the health system. In the future, alternative systems less expensive than Aycan OsiriX PRO should be further developed and tested.