We compared the accuracy of teleconsultations for minor injuries with face-to-face consultations. Two hundred patients were studied. Colour change, swelling, decreased movement, tenderness, instability, radiological examination, severity of illness, treatment and diagnosis were recorded for both telemedicine and face-to-face consultations. Colour change showed an accuracy of 97%, presence of swelling or deformity of 98%, diminution of joint movement of 95%, presence of tenderness of 97%, weight bearing and gait of 99%, and radiological diagnosis of 98%. The severity of illness or injury was overestimated in one case and underestimated in five cases. Treatment was over-prescribed in one case and under-prescribed in three cases. The final diagnosis was correct in all but the two cases in which mistakes were made in the teleradiology. Overall, there was good accuracy using teleconsultations.

In 1996 we studied patients attending a minor accident and treatment service in London, some of whom were the subjects of teleconsultations with a main hospital emergency department. In the subsequent four years, 56,139 patients were seen at the minor accident and treatment service unit. Teleconsultations were performed in 2032 cases (3.6%). Most of the teleconsultations (58%) concerned patients with fractures. The main reason for teleconsultation was to review and discuss radiographs (46%). In comparison with the 1996 study, both the emergency nurse practitioners and the consultant had improved the accuracy of their teleradiology diagnosis, although the difference was not significant. Most of the telemedicine patients (90%) did not need a transfer to the main department. Thus telemedicine allowed local decision making in the majority of cases. In the 1996 survey, 75% of patients were sent to their general practitioner or to the main hospital department; in the present survey, this proportion had halved, to 38%. The present study showed that teleconsultations are an effective way of preventing patients being transferred unnecessarily from a minor accident and treatment service to the main hospital accident and emergency department.

In 1996 we studied patients attending a minor accident and treatment service in London, some of whom were the subjects of teleconsultations with a main hospital emergency department. In the subsequent four years, 56,139 patients were seen at the minor accident and treatment service unit. Teleconsultations were performed in 2032 cases (3.6%). Most of the teleconsultations (58%) concerned patients with fractures. The main reason for teleconsultation was to review and discuss radiographs (46%). In comparison with the 1996 study, both the emergency nurse practitioners and the consultant had improved the accuracy of their teleradiology diagnosis, although the difference was not significant. Most of the telemedicine patients (90%) did not need a transfer to the main department. Thus telemedicine allowed local decision making in the majority of cases. In the 1996 survey, 75% of patients were sent to their general practitioner or to the main hospital department; in the present survey, this proportion had halved, to 38%. The present study showed that teleconsultations are an effective way of preventing patients being transferred unnecessarily from a minor accident and treatment service to the main hospital accident and emergency department.

The technical performance of a telemedical system when used for remote trauma management was compared with face-to-face consultation. Two rooms, 20 yards apart, were linked telemedically in the same Accident & Emergency Department. Two hundred patients, with 'minor' and 'moderate' injuries, underwent the two types of consultation. The Accident & Emergency consultant marked physical parameters using a five-point pre-determined Likert scale. The following parameters were thought to be of excellent quality when compared to face-to-face consultation: overhead fluorescent lighting for the background illumination, video lighting for a close-up view, sound quality after volume adjustment, echo-cancellation after adjustment and lip synchronization. However, the following parameters scored poorly: sound before volume adjustment, echo-cancellation before adjustment, fine and coarse movements. It can be concluded that the quality of lighting and image quality are good in telemedicine. Sound and movement still present some problems. This technology is likely to be used more frequently for remote trauma management.

No abstract