title: Teleradiology in orthopaedic surgery: impact on clinical decision making for acute fracture management.
abstract: OBJECTIVE
  To determine whether teleradiology improved clinical decision making for the treatment of patients with acute fractures.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  Level 1 trauma center.
  
  
  METHODS
  One-hundred eight consecutive patients with 123 acute fractures who visited our Level 1 trauma center, when the first author was the attending orthopedic surgeon on call, and had orthopaedic consultations were included.
  
  
  METHODS
  In each case, an orthopaedic junior resident performed the emergency department consultation. Radiographs were digitized and electronically transmitted to the attending orthopaedist. Treatment plans were formulated and recorded by the attending surgeon at three different times. The original plan was defined after traditional verbal communication of physical and radiographic findings. A revised plan was defined after the radiographic images were reviewed by the attending surgeon, and the final plan was defined after review of the original radiographs. Two different types of deviations from the original plan were distinguished. Changes in the acute management were defined as any emergency department procedures, emergent operative procedures, or dispositions that were not part of the original plan. Changes in the ultimate management were defined as changes to the original plan that did not affect emergency department treatment, emergent operative procedures, or the disposition of the patient.
  
  
  RESULTS
  In twenty-six of the 123 fractures (21 percent), the additional information provided by viewing electronically transmitted images of radiographs changed the acute management or the ultimate management. In none of the 123 cases did subsequent review of original radiographs result in any further changes to the treatment plan.
  
  
  CONCLUSIONS
  The routine use of electronically transmitted digitized radiographic images has the potential to improve clinical decision making for the care of patients with acute fractures.
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
authors.forename: William M
authors.initials: WM
authors.lastname: Ricci
authors.forename: Joseph
authors.initials: J
authors.lastname: Borrelli
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods; D012017:Referral and Consultation; D012680:Sensitivity and Specificity; D019112:Teleradiology / Q000379:methods*; D014193:Trauma Centers; D016896:Treatment Outcome