title: Validation of Videoconference With Smartphones in Telemedicine Facial Trauma Care: Analysis of Concordance to On-Site Evaluation.
abstract: BACKGROUND
  The continental size of some countries and heterogeneous hospital network prevents patients who live in remote areas from getting adequate initial assessment of facial trauma. The authors present an alternative model for trauma assessment by videoconference via smartphones and analyze the concordance between telemedicine and face-to-face management.
  
  
  METHODS
  Fifty patients with either a confirmed or suspected diagnosis of facial trauma were independently evaluated by 2 teams of physicians: Face-to-face and telemedicine-based. The face-to-face team attended patients at bedside (physical examination and computed tomography scan analysis). The telemedicine team consisted of a general surgery resident on duty in the emergency room and a plastic surgeon researcher remotely communicating via smartphones. Both teams answered a questionnaire, which contained data concerning patient's epidemiology, physical examination, computed tomography (CT) scan findings, and treatment option to be followed. Data were analyzed and compared regarding the similarity of answers.
  
  
  RESULTS
  The sample studied was consistent with the literature, showing a predominance of young males. Traffic accidents and personal violence were the main causes of trauma. The concurrency of answers for physical examination findings was considered substantial (κ = 0.720). For CT scan findings, it was almost perfect (κ = 0.899); for defining the treatment option, it was almost perfect (κ = 0.891). High concurrency of face CT scan findings was observed after we calculated the positive predictive value (89.9%), negative predictive value (99.3%), sensitivity (94.2%), specificity (98.8%), and accuracy (98.3%).
  
  
  CONCLUSIONS
  The proposed model to facial assessment trauma by videoconference via smartphones is feasible, showing high concordance level with face-to-face assessment.
authors.affiliation: From the *Division of Plastic Surgery, †Department of Surgery, Hospital das Clinicas, University of Sao Paulo Medical School; ‡Department of Plastic Surgery at Sirio Libanês Hospital; §Department of Head and Neck Surgery, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Alexandre Siqueira Franco
authors.initials: AS
authors.lastname: Fonseca
authors.forename: Dov Charles
authors.initials: DC
authors.lastname: Goldenberg
authors.forename: Guilherme Flosi
authors.initials: GF
authors.lastname: Stocchero
authors.forename: Arthur Vicentini Costa
authors.initials: AV
authors.lastname: Luiz
authors.forename: Rolf
authors.initials: R
authors.lastname: Gemperli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005151:Facial Injuries / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D000068997:Smartphone; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome; D049269:Videoconferencing; D055815:Young Adult