ABSTRACT
We investigated whether head CT images captured using a mobile phone would be of sufficient quality for neurosurgeons at a level 1 trauma centre to make decisions about whether to transfer patients from referring hospitals. All patients who had been transferred from outside facilities with reported intracranial pathology during 2008 were identified. Two emergency medicine physicians selected 1-3 images from the hospital archive that best represented the pathology described by the radiologist and the medical record. The images were photographed in a darkened room using a smart phone. The mobile phone images and clinical history were reviewed by two neurosurgeons independently. The neurosurgeons rated the adequacy and quality of the images, and indicated whether the images would have changed their transfer decision. Based on clinical data alone, neurosurgeon A would have transferred 64 (73%) patients and neurosurgeon B 39 (44%). After images were provided, A would have transferred 67 (76%) and B would have transferred 49 (56%). The availability of the images significantly altered the transfer decision by A in 25 cases (28%) (P = 0.024) and by B in 28 cases (32%) (P < 0.001). The level of agreement between the two neurosurgeons significantly increased from 53% (kappa = 0.11) to 75% (kappa = 0.47) (P < 0.001). Mobile-phone images of CT scans appear to provide adequate images for triaging patients and helping with transfer decisions of neurosurgical cases.
Subject(s)
Cell Phone , Craniocerebral Trauma/diagnostic imaging , Neurosurgery/methods , Photography/standards , Triage , Adult , Aged , Aged, 80 and over , Decision Making , Female , Humans , Male , Middle Aged , Photography/methods , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Numerous articles tell of the security breaches hospital emergency rooms face on a daily basis. The recent events of September 11 th have further complicated these breaches, and have shed new light on previously ignored issues surrounding bioterrorism. In previous disaster scenarios there has been a "script" to follow; however bioterrorism follows no script and presents a host of new security issues. Successful delineation of the characteristics of bioterrorist weapons is only the first step in dealing with such a scenario, and will set into motion a series of events seen only on small levels in the past.
