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J Korean Soc Emerg Med > Volume 26(5); 2015 > Article
Journal of The Korean Society of Emergency Medicine 2015;26(5): 417-423.
Validity of iPad for Remote Diagnosis of Rib Fracture
Sangil Kim, Youngshin Cho, Youngju Lee, Hyeyoung Jang, Joonbum Park
Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea
Correspondence  Joonbum Park ,Tel: 02) 709 9119, Fax: 02) 710 3199, Email: jesumania@gmail.com,
Received: June 28, 2015; Revised: June 30, 2015   Accepted: August 4, 2015.  Published online: October 30, 2015.
In elderly and patients with underlying diseases, mortality rate is increased when compared to rib fractures which occurred in other patients. Because there is a shortage of emergency physicians or real-time consultation with radiologists in many countries, it is necessary to receive a formal image reading remotely from an expert. We suggested the use of iPad in X-ray reading and compared the diagnostic validity of iPad, which was highly portable, with that of liquid crystal display (LCD) monitor.
Fifty four X-ray cases of rib fracture and 54 cases without rib fracture were randomized and reviewed by 10 emergency physicians. A total of 108 cases were divided 1st to 54th and 55th to 108th. Two sessions were separated with a four-week interval. If the reviewer interpreted the 1st to 54th with iPad, they did 55th to 108th with LCD monitor. Reviewers reported the presence of rib fracture, the number of fractured ribs, and diagnostic confidence of 5-scale.
The interobserver agreement among reviewers in LCD and iPad was 0.551, 0.524 in Fleiss-kappa value. The intraobserver agreement between tools for each reviewer was 0.410-0.859 (Mean=0.628±0.150). Reviewers showed sensitivity over 0.810 regardless of the tool; 0.810- 0.966 (Mean=0.879± 0.054) in LCD, 0.828-1.000 (Mean=0.898±0.052) in iPad. The specificity was 0.520- 0.860 (Mean=0.750±0.117) in LCD and 0.560-0.880 (Mean=0.708±0.111) in iPad. Therefore, remote consultation of X-ray by iPad with a specialist was possible with minimized temporal and spatial limits in the emergency room.
In our study, there was no statistical difference in the diagnosis of rib fracture by X-ray via iPad or LCD. Therefore, remote consultation of X-ray by iPad with a specialist in the emergency room was possible, with temporal and spatial limits by iPad.
Key words: Teleradiology, Rib fractures, X-rays
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