Cell phone pix: A new diagnostic tool
Photos taken by patients help speed flow
Initial data on the use of cell phone photos of injuries, taken by the patients themselves in the ED at The George Washington University Hospital in Washington, DC, offers the promise that they might have the potential to speed treatment without sacrificing diagnostic accuracy.
The patients send their pictures to a secure e-mail account, where they can be downloaded by ED physicians. "You look at a patient who comes in with a slice injury, for example, and sometimes you're not sure if they need stitches or not," notes Neil Sikka, MD, an assistant professor of medicine at the George Washington University School of Medicine and chief of the Section of Innovative Projects. "When the patients present, we enroll them in the study, they take a picture of their wound, fill out a questionnaire [which covers their history and symptoms], and the doctor will look at the pictures to see if in fact they need stitches."
A research assistant helps the patient with the consent process, as well as the questionnaire and a survey that asks their opinion of the process. "They also help them shoot the close-ups from one or two feet away," says Sikka, noting that up to four photos may be used to show different angles on the injury.
The study is "very focused," looking only at patients who come in with acute lacerations or soft tissue infections, he says.
Sikka says that thus far, he has data from 125 patients after several months. He is encouraged by the results. The accuracy rate for determining whether acute lacerations require stitches is in the "high 80% range," Sikka reports. In terms of whether, upon follow-up, patients are getting better or worse, the rates are similar to those of patients who did not participate in the program. "Where we are not as good is in determining management of soft tissue infection," says Sikka, adding that the accuracy rate there is in the upper 60s. "This is probably limited by the fact that we only have 2-D pictures, which can't tell depth or level of swelling," he says.
Sikka also believes the rate could be improved by asking better questions of the patient. "History is the majority of medicine," he says.
Leena Salazar, RN, BSN, director of emergency services, was quite interested in the study when Sikka began it. "From a nursing perspective, it seemed very worthwhile," she says. "Anything that can help to alleviate long waits in the ED and still get the same quality treatment patients expect is a definite plus."