title: Use of digital images to aid in the decision-making for acute upper extremity trauma referral.
abstract: This study evaluated the use of digital smartphone images in the decision-making for acute upper extremity trauma referrals. Surgeons (n = 15) were presented with ten upper limb trauma scenarios for consideration of immediate transfer. Based on verbal history and with additional images, participants were asked questions regarding diagnosis, injured tissues, recommended management and diagnostic and treatment confidence. Statistical analyses evaluated confidence level changes and relationships between confidence levels and independent variables. Confidence levels for diagnosis and treatment were increased with the provision of smartphone images, and this was statistically significant. The decision to transfer was changed in 22%. The photographs were more useful for amputation versus non-amputation injuries (diagnosis and treatment) and hand versus forearm injuries (diagnosis), and these differences reached statistical significance. Smartphone digital images were shown to be useful for decision-making in acute upper extremity trauma referrals. This improved communication may have implications for health cost savings and patient burden by minimizing unnecessary acute transfers.
  
  
  METHODS
  Diagnostic Level III.
authors.affiliation: Toronto Western Hospital Hand Program, Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: M A
authors.initials: MA
authors.lastname: Plant
authors.affiliation: Toronto Western Hospital Hand Program, Department of Surgery, University of Toronto, Toronto, ON, Canada Christine.novak@uhn.ca.
authors.forename: C B
authors.initials: CB
authors.lastname: Novak
authors.affiliation: Toronto Western Hospital Hand Program, Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: S J
authors.initials: SJ
authors.lastname: McCabe
authors.affiliation: Toronto Western Hospital Hand Program, Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: H P
authors.initials: HP
authors.lastname: von Schroeder
mesh_terms: D000066491:Clinical Decision-Making; D006801:Humans; D010781:Photography; D012017:Referral and Consultation; D000068997:Smartphone; D034941:Upper Extremity / Q000293:injuries*
keywords: Upper extremity; assessment; digital images; referral; smartphone; trauma