BackgroundEach year more than 10 million people worldwide are burned severely enough to require medical attention, with clinical outcomes noticeably worse in resource poor settings. Expert clinical advice on acute injuries can play a determinant role and there is a need for novel approaches that allow for timely access to advice. We developed an interactive mobile phone application that enables transfer of both patient data and pictures of a wound from the point-of-care to a remote burns expert who, in turn, provides advice back.Methods and ResultsThe application is an integrated clinical decision support system that includes a mobile phone application and server software running in a cloud environment. The client application is installed on a smartphone and structured patient data and photographs can be captured in a protocol driven manner. The user can indicate the specific injured body surface(s) through a touchscreen interface and an integrated calculator estimates the total body surface area that the burn injury affects. Predefined standardised care advice including total fluid requirement is provided immediately by the software and the case data are relayed to a cloud server. A text message is automatically sent to a burn expert on call who then can access the cloud server with the smartphone app or a web browser, review the case and pictures, and respond with both structured and personalized advice to the health care professional at the point-of-care.ConclusionsIn this article, we present the design of the smartphone and the server application alongside the type of structured patient data collected together with the pictures taken at point-of-care. We report on how the application will be introduced at point-of-care and how its clinical impact will be evaluated prior to roll out. Challenges, strengths and limitations of the system are identified that may help materialising or hinder the expected outcome to provide a solution for remote consultation on burns that can be integrated into routine acute clinical care and thereby promote equity in injury emergency care, a growing public health burden.

Whereas one smartphone camera ranked best more often, all three smartphones obtained results at least as good as those of the digital camera. Smartphone cameras can be a substitute for digital cameras for the purposes of medical teleconsulation.

Size and depth of burns on patients with dark-skin types could be assessed at least as well using photographs as at bedside with 67.5% and 66.0% average accuracy rates. Case characteristics significantly affected the accuracy for burn size, but medical specialty and country of practice seldom did in a statistically significant manner.

An approach to the analysis of mortality data gathered in long-term follow-up studies is described. The methodology is appropriate for situations in which it is of interest to contrast a study sample to a larger reference population. The main advantage of the approach is the ability to handle the age heterogeneity of the study group. Two variations of the general method are developed: the unconditional and conditional methods. The conditional approach is illustrated by application to data which arose in a study in psychiatric epidemiology.

Background: Inappropriate dispatch of urgent ambulances by callcentre personnel causes an unnecessary drain on existing resources. How often these urgent dispatches are appropriate has not been evaluated in the lower-middle-income setting, nor have factors been assessed that contribute to these decisions. This study aimed to establish the rates of pre-hospital over-triage in Cape Town, South Africa, and to assess the call-centre decision-making processes. Methods: This was a descriptive, retrospective study examining all urgent ambulance dispatches made from a large public sector ambulance call centre in Cape Town over a single month. This urgent dispatch was then compared to the on-scene South African Triage Scale (SATS) score assigned by the pre-hospital personnel to assess which cases were 'over-triaged' by the call taker. Factors potentially contributing to the call taker's decision were also analysed and included the time of day, nature of presenting complaint, and the call taker's training and experience -all of which may have affected the rates of over-triage. Results:In the course of one month in 2017, 4,169 urgent calls were assessed; of these, 2,701 were over-triaged (58.48%). The over-triage rate was similar during the day (58.02%) and night (59.11%). The most regularly over-triaged complaint was obstetric and gynaecological (84.87%), followed by motor vehicle accidents (65.70%); the lowest rate was for cardiac call-outs (47.12%). We reviewed the 38 highest workload call takers, and found no statistically significant factors that contributed to higher levels of over-triage when reviewing higher levels of training (Ambulance Emergency Assistant 62.16%, no medical training 59.42%; p=0.669), more years as a call taker (< 2 years 59.32%, > 5 years 60.23%; p=0.932), and more years working in the field (0 years 59.36%, > 5 years 63.66%; p=0.305). Conclusion:The rates of pre-hospital over-triage in Cape Town are marginally lower than those described internationally. The nature of the complaint had a strong impact on these rates, notably in terms of trauma and gynaecological disorders. The call taker's training and years of experience did not have a statistically significant impact on decision-making.