Image-based medical expert teleconsultation in acute care of injuries. A systematic review of effects on information accuracy, diagnostic validity, clinical outcome, and user satisfaction

• Published in: PloS one Vol. 9; no. 6; p. e98539
• Main Authors: Hasselberg, Marie, Beer, Netta, Blom, Lisa, Wallis, Lee A, Laflamme, Lucie
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 02.06.2014; Public Library of Science (PLoS)
• Subjects: Clinical aspects; Clinical decision making; Clinical outcomes; Computer and Information Sciences; Consultation; Consumer Behavior; Criteria; Decision making; Diagnostic systems; Emergency management; Emergency medical care; Emergency medical services; Evaluation; Feasibility studies; Global health; Health sciences; Humans; Information systems; Injuries; Interactive systems; Literature reviews; Low income groups; Management; Medical diagnosis; Medicin och hälsovetenskap; Medicine and Health Sciences; Portable computers; Public health; Quality; Research and Analysis Methods; Risk assessment; Social Sciences; Statistical analysis; Statistical tests; Studies; Systematic review; Systems analysis; Telemedicine; Trauma; Trauma care; User satisfaction; Validity; Videoconferencing; Wounds and Injuries - therapy; Sweden
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0098539

To systematically review the literature on image-based telemedicine for medical expert consultation in acute care of injuries, considering system, user, and clinical aspects. Systematic review of peer-reviewed journal articles. Searches of five databases and in eligible articles, relevant reviews, and specialized peer-reviewed journals. Studies were included that covered teleconsultation systems based on image capture and transfer with the objective of seeking medical expertise for the diagnostic and treatment of acute injury care and that presented the evaluation of one or several aspects of the system based on empirical data. Studies of systems not under routine practice or including real-time interactive video conferencing were excluded. The procedures used in this review followed the PRISMA Statement. Predefined criteria were used for the assessment of the risk of bias. The DeLone and McLean Information System Success Model was used as a framework to synthesise the results according to system quality, user satisfaction, information quality and net benefits. All data extractions were done by at least two reviewers independently. Out of 331 articles, 24 were found eligible. Diagnostic validity and management outcomes were often studied; fewer studies focused on system quality and user satisfaction. Most systems were evaluated at a feasibility stage or during small-scale pilot testing. Although the results of the evaluations were generally positive, biases in the methodology of evaluation were concerning selection, performance and exclusion. Gold standards and statistical tests were not always used when assessing diagnostic validity and patient management. Image-based telemedicine systems for injury emergency care tend to support valid diagnosis and influence patient management. The evidence relates to a few clinical fields, and has substantial methodological shortcomings. As in the case of telemedicine in general, user and system quality aspects are poorly documented, both of which affect scale up of such programs.