Teleconsultation for emergency orthopaedic patients using the multimedia messaging service via mobile phones

We investigated the accuracy and usefulness of teleconsultation using the mobile phone multimedia messaging service (MMS) in emergency orthopaedic patients. Pictures of radiographs were taken using a built-in 1.3 megapixel mobile phone camera from a digital display screen in the emergency room and then transmitted to the camera phones of four assessors. The cases comprised 59 emergency orthopaedic patients diagnosed with non- or minimally displaced fractures and 34 age-matched normal patients visiting the emergency department. Both clinical and radiographic follow up data were used as the gold standard. Inter- and intra-observer agreement were good (kappa>0.60). The overall sensitivity, specificity and accuracy were 78%, 54% and 65%, respectively. The overall misdiagnosis rate was 40%, with over-diagnosis of 12% and under-diagnosis of 27%. The consequence of misdiagnosis would have resulted in mismanagement in up to 48% of the cases. No association was found between the experience of the assessors, the region of the fracture or the age group of the patients and the misdiagnosis rate. Teleconsultation via MMS demonstrated good reliability, but poor diagnostic accuracy which could have major consequences in emergency orthopaedic patients.