@article {3583, title = {Teleradiology for remote consultation using iPad improves the use of health system human resources for paediatric fractures: prospective controlled study in a tertiary care hospital in Italy.}, journal = {BMC Health Serv Res}, volume = {14}, year = {2014}, month = {2014}, pages = {327}, abstract = {

BACKGROUND: The growing cost of health care and lack of specialised staff have set e-Health high on the European political agenda. In a prospective study we evaluated the effect of providing images for remote consultation through an iPad on the number of in-hospital orthopaedic consultations for children with bone fractures.

METHODS: Children from 0 to 18 years diagnosed with a bone fracture by the radiologist during the hours when an orthopaedic service is provided only on-call were eligible for enrollment. Cases were enrolled prospectively during September and October 2013. A standard approach (verbal information only, no X-Ray provided remotely) was compared to an experimental approach (standard approach plus the provision of X-ray for remote consultation through an iPad). The primary outcome was the number of orthopaedic in-hospital consultations that occurred. Other outcomes included: immediate activation of other services; time needed for decision-making; technical difficulties; quality of images and diagnostic confidence (on a likert scale of 1 to 10).

RESULTS: Forty-two children were enrolled in the study. Number of in-hospital consultancies dropped from 32/42 (76.1\%) when no X-ray was provided to 16/42 (38\%) when the X-rays was provided (p < 0.001). With remote X-ray consultation in 14/42 (33.3\%) cases services such as surgery and plaster room could be immediately activated, compared to no service activated without teleradiology (p < 0.001). Average time for decision making was 23.4 {\textpm} 21.8 minutes with remote X-ray consultation, compared to 56.2 {\textpm} 16.1 when the X-ray was not provided (p < 0.001). The comparison between images on the iPad and on the standard system for X- Ray visualisation resulted in a non statistically significant difference in the quality of images (average score 9.89 {\textpm} 0.37 vs 9.91 {\textpm} 0.30; p = 0.79), and in non statistically significant difference in diagnostic confidence (average score 9.91 {\textpm} 0.32 vs 9.92 {\textpm} 0.31; p = 0.88).

CONCLUSIONS: Remote X-ray consultation through Aycan OsiriX PRO and iPad should be considered as a means for reducing the need of in-hospital orthopaedic consultation during on-call times, and potentially decrease the cost of care for the health system. In the future, alternative systems less expensive than Aycan OsiriX PRO should be further developed and tested.

}, keywords = {Adolescent, Child, Child, Preschool, Computers, Handheld, Decision Making, Fractures, Bone, Humans, Infant, Infant, Newborn, Italy, Prospective Studies, Remote Consultation, Teleradiology, Time Factors}, issn = {1472-6963}, doi = {10.1186/1472-6963-14-327}, author = {Zennaro, Floriana and Grosso, Daniele and Fascetta, Riccardo and Marini, Marta and Odoni, Luca and Di Carlo, Valentina and Dibello, Daniela and Vittoria, Francesca and Lazzerini, Marzia} }