title: Reliability and Effectiveness of Smartphone Technology for the Diagnosis and Treatment Planning of Pediatric Elbow Trauma.
abstract: BACKGROUND
  Mobile imaging, such as viewing radiographs as text messages, is increasingly prevalent in clinical settings. The purpose of this study was to determine whether remote diagnosis of pediatric elbow fractures using smartphone technology is reliable. In addition, this study aimed to determine whether the assessment regarding the decision for operative treatment is affected by evaluation of images on a mobile device as opposed to standard picture archiving and communication system (PACS).
  
  
  METHODS
  Standard anteroposterior and lateral radiographs of 50 pediatric elbow trauma cases were evaluated by 2 fellowship-trained pediatric orthopaedic surgeons and 2 senior orthopaedic residents. Raters were asked to classify the case as any of 6 diagnoses: supracondylar humerus, lateral condyle, medial epicondyle, radial neck fracture, positive posterior fat pad sign, or normal pediatric elbow. Raters were asked to choose operative or conservative treatment. After 1 week, photographs of the same images were taken from a standardized distance from a computer monitor with an iPhone 5 camera and transmitted by multimedia messaging to each rater. The same questions were again posed to raters. Interobserver and intraobserver reliabilities were calculated by Cohen κ-statistics with bootstrapped 95% confidence intervals.
  
  
  RESULTS
  Intraobserver reliability of classification of injuries on PACS compared with smartphone images was excellent, with an overall κ of 0.91. Treatment decision also demonstrated excellent intraobserver reliability (PACS vs. smartphones) with a κ of 0.86 for all raters.
  
  
  CONCLUSIONS
  Diagnosis of pediatric elbow injuries can be made equally reliably based on either PACS or transmitted multimedia messaging images taken with an iPhone camera from a computer screen and viewed on a smartphone. Treatment decisions can also be made reliably based on either image modality.
  
  
  CONCLUSIONS
  Using smartphones to transmit and display radiographs, which is common in current clinical practice, is effective and reliable for diagnosis and treatment planning of pediatric elbow injuries.
authors: *The Curtis National Hand Center, MedStar Union Memorial Hospital †Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD ‡St Christopher's Hospital for Children, Philadelphia, PA.
authors: Ebrahim
authors: E
authors: Paryavi
authors: Brandon S
authors: BS
authors: Schwartz
authors: Carissa L
authors: CL
authors: Meyer
authors: Martin J
authors: MJ
authors: Herman
authors: Joshua M
authors: JM
authors: Abzug
mesh_terms: D002648:Child; D000066491:Clinical Decision-Making; D004551:Elbow Joint / Q000000981:diagnostic imaging*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging* / Q000628:therapy; D015588:Observer Variation; D000072161:Orthopedic Surgeons; D010347:Patient Care Planning; D010372:Pediatrics; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging* / Q000628:therapy; D019114:Remote Consultation / Q000379:methods*; D015203:Reproducibility of Results; D000068997:Smartphone; D000092464:Elbow Injuries