title: The use of mobile phone cameras in guiding treatment decisions for laceration care.
abstract: OBJECTIVE
  Mobile phone technology may be useful in helping to guide medical decisions for lacerations. We examined whether emergency department (ED) provider opinions on which lacerations require repair differed using mobile phone-generated images compared with in-person evaluations.
  
  
  METHODS
  Patients presenting to an urban ED for initial and follow-up laceration care were prospectively enrolled. Patients took four mobile phone pictures of their laceration and provided a medical history. Cases were reviewed by ED providers who assessed image quality and made a recommendation about whether the laceration needed repair. The same provider then assessed the patient in-person. Concordant decision-making between mobile phone and in-person assessments was calculated as well as the degree of undertriage.
  
  
  RESULTS
  In total, 94 patients were included over an 8-month period. There was complete agreement in 87% of cases (κ statistic=0.65). Of the 13 patients with discrepant decisions, 6 were due to poor image quality, in 3 the images did not properly represent the problem, in 3 others there were historical findings that altered care, and for 1 the image looked worse than the actual injury in-person. In total, 5 of 94 (5%) of cases would have been undertriaged using only the mobile phone recommendation. Median image quality was 6 out of 10 (with 10 being the best) (interquartile range, 4-8).
  
  
  CONCLUSIONS
  There are high rates of agreement when providers use mobile phone images to assess lacerations for possible repair in the ED. Image quality is in general good but highly variable and may drive incorrect assessments.
authors: Emergency Medicine, The George Washington University Medical Faculty Associates, Washington, DC 20037, USA. nsikka@mfa.gwu.edu
authors: Neal
authors: N
authors: Sikka
authors: Michael
authors: M
authors: Pirri
authors: Katrina Norbury
authors: KN
authors: Carlin
authors: Ryan
authors: R
authors: Strauss
authors: Faisal
authors: F
authors: Rahimi
authors: Jesse
authors: J
authors: Pines
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D040421:Cell Phone; D003661:Decision Support Techniques; D004219:District of Columbia; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D022125:Lacerations / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014741:Video Recording; D055815:Young Adult