title: Teleconsultation in paediatric orthopaedics in Djibouti: evaluation of response performance.
abstract: BACKGROUND
  Djibouti has no paediatric orthopaedics department and three options are available for difficult cases: transfer of the patient to another country; overseas mission transfer to Djibouti by a specialised surgical team; and management by a local orthopaedic surgeon receiving guidance from an expert. The extreme poverty of part of the population of Djibouti often precludes the first two options. Telemedecine can allow the local orthopaedic surgeon to receive expert advice. HYPOTHESES AND STUDY DESIGN: We prospectively recorded all the paediatric orthopaedics teleconsultations that occurred between November 2009 and November 2011. Our objective was to assess the performance of the teleconsultations. We hypothetized that this option was influential in decision making.
  
  
  METHODS
  We assessed the influence of the teleconsultation on patient management (i.e., change in the surgical indication and/or procedure). We then used the electronic patient records to compare the actual management to that recommended retrospectively by two independent orthopaedic surgeon consultants who had experience working overseas. Finally, we assessed the clinical outcomes in the patients.
  
  
  RESULTS
  Of 48 teleconsultations for 39 patients, 13 dealt with diagnostic problems and 35 with therapeutic problems. The teleconsultation resolved the diagnostic uncertainties in 90% of cases. Advice from the expert modified the management in 37 (77%) teleconsultations; the change was related to the surgical indication in 18 cases, the surgical technique in 13 cases, and both in six cases. Agreement between the advice from the independent consultants and the treatment delivered by the local surgeon was 2.2/3. Clinical outcomes were good or very good in 31 (81%) of the 38 treated patients.
  
  
  CONCLUSIONS
  This study establishes the feasibility and usefulness of paediatric orthopaedics teleconsultations in Djibouti. The introduction of telemedicine has changed our approach to challenges raised by patients in remote locations or precarious situations. Input from experts considerably benefits patient management.
  
  
  METHODS
  III, prospective comparative study.
authors.affiliation: Service de chirurgie orthopédique et traumatologique, 108, boulevard Pinel, 69005 Lyon, France. antoine_bertani@yahoo.fr
authors.forename: A
authors.initials: A
authors.lastname: Bertani
authors.forename: F
authors.initials: F
authors.lastname: Launay
authors.forename: P
authors.initials: P
authors.lastname: Candoni
authors.forename: L
authors.initials: L
authors.lastname: Mathieu
authors.forename: F
authors.initials: F
authors.lastname: Rongieras
authors.forename: F
authors.initials: F
authors.lastname: Chauvin
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D015730:Djibouti; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019637:Orthopedic Procedures; D017063:Outcome Assessment, Health Care; D010372:Pediatrics; D015397:Program Evaluation; D011446:Prospective Studies; D019114:Remote Consultation