Can paediatric radiographs be accurately interpreted using an inter-hospital telemedicine system?

Children make up a significant proportion of attendances at accident and emergency departments but there is little published information about the use of telemedicine for viewing paediatric radiographs in the emergency setting. The radiographs and case-notes of 30 children were randomly selected from attendances at an accident and emergency department and were then transmitted over a telemedicine link equipped with a document camera. The doctor recorded the diagnosis and proposed management, along with the confidence in diagnosis and satisfaction with the image. This process was repeated using hard-copy radiographs and a standard viewing box. Five accident and emergency specialists took part in the study; there were in total 300 radiograph viewings. There was one missed fracture out of 75 positive radiographs viewed by telemedicine compared with no missed fractures on direct inspection of the film. Thirteen radiographs viewed over the telemedicine link were thought to be positive or suspicious of injury when the formal report was of no bony injury. The sensitivity of fracture diagnosis using telemedicine was 98.6% compared with 100% on direct inspection of the film, and specificities were 82.6% and 86.6%, respectively. Our study suggests that telemedicine can be used to aid diagnosis and make management decisions in children with minor trauma.