title: Image-based medical expert teleconsultation in acute care of injuries. A systematic review of effects on information accuracy, diagnostic validity, clinical outcome, and user satisfaction.
abstract: OBJECTIVE
  To systematically review the literature on image-based telemedicine for medical expert consultation in acute care of injuries, considering system, user, and clinical aspects.
  
  
  METHODS
  Systematic review of peer-reviewed journal articles.
  
  
  METHODS
  Searches of five databases and in eligible articles, relevant reviews, and specialized peer-reviewed journals.
  
  
  METHODS
  Studies were included that covered teleconsultation systems based on image capture and transfer with the objective of seeking medical expertise for the diagnostic and treatment of acute injury care and that presented the evaluation of one or several aspects of the system based on empirical data. Studies of systems not under routine practice or including real-time interactive video conferencing were excluded.
  
  
  METHODS
  The procedures used in this review followed the PRISMA Statement. Predefined criteria were used for the assessment of the risk of bias. The DeLone and McLean Information System Success Model was used as a framework to synthesise the results according to system quality, user satisfaction, information quality and net benefits. All data extractions were done by at least two reviewers independently.
  
  
  RESULTS
  Out of 331 articles, 24 were found eligible. Diagnostic validity and management outcomes were often studied; fewer studies focused on system quality and user satisfaction. Most systems were evaluated at a feasibility stage or during small-scale pilot testing. Although the results of the evaluations were generally positive, biases in the methodology of evaluation were concerning selection, performance and exclusion. Gold standards and statistical tests were not always used when assessing diagnostic validity and patient management.
  
  
  CONCLUSIONS
  Image-based telemedicine systems for injury emergency care tend to support valid diagnosis and influence patient management. The evidence relates to a few clinical fields, and has substantial methodological shortcomings. As in the case of telemedicine in general, user and system quality aspects are poorly documented, both of which affect scale up of such programs.
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Marie
authors.initials: M
authors.lastname: Hasselberg
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Netta
authors.initials: N
authors.lastname: Beer
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Lisa
authors.initials: L
authors.lastname: Blom
authors.affiliation: Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Wallis
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; University of South Africa, Pretoria, South Africa.
authors.forename: Lucie
authors.initials: L
authors.lastname: Laflamme
mesh_terms: D003258:Consumer Behavior; D006801:Humans; D017216:Telemedicine; D014947:Wounds and Injuries / Q000628:therapy*