Interobserver Variability of Radiographic Assessment using a Mobile Messaging Application as a Teleconsultation Tool

Abstract

Background: To examine whether interobserver reliability, decision-making, and confidence in decision-making in the<br />treatment of distal radius fractures changes if radiographs are viewed on a messenger application on a mobile phone<br />compared to a standard DICOM viewer.<br />Methods: Radiographs of distal radius fractures were presented to surgeons on either a smart phone using a mobile<br />messenger application or a laptop using a DICOM viewer application. Twenty observers participated: 10 (50%) were<br />randomly assigned to the DICOM viewer group and 10 (50%) to the mobile messenger group. Each observer was asked<br />to evaluate the cases and (1) classify the fracture type according to the AO classification, (2) recommend operative or<br />conservative treatment and (3) rate their confidence about this decision.<br />Results: There was no significant difference in interobserver reliability for AO classification and recommendation for<br />surgery for distal radius fractures in both groups. The percentage of recommendation for surgery was significantly<br />higher in the messenger application group compared to the DICOM viewer group (89% versus 78%, P=0.019) and the<br />confidence for treatment decision was significantly higher in the mobile messenger group compared to the DICOM viewer<br />group (8.9 versus 7.9, P=0.026).<br />Conclusion: Messenger applications on mobile phones could facilitate remote decision-making for patients with distal<br />radius fractures, but should be used with caution.