19 Nov iPhone can aid in triage of head injury patients

AuntMinnie.com | November 19 – Digital photographs of CT images taken with an iPhone can be used to predict the need to transfer patients with head injuries, preventing unnecessary patient transfers and reducing healthcare costs, according to research from Florida.

In a pair of retrospective studies presented at the American College of Emergency Physicians (ACEP) Research Forum in Las Vegas in September, a study team found that providing access to iPhone-captured digital photos of CT images would have improved the appropriateness of patient transfer decisions by neurosurgeons. A second study also determined that having access to the images significantly enhanced interobserver agreement on these transfer decisions.

In an effort to improve resource utilization at their urban level I trauma center (Orlando Regional Medical Center), the Orlando Health researchers sought to determine if the availability of digital images provided via an iPhone digital capture could improve the appropriateness of patient transfers. In a retrospective cohort study, the researchers identified all patients who were transferred from outside facilities in 2007 with reported intracranial pathology and who had accompanying images.

The archived images of the 88 cases in the study were displayed on a digital image monitor, and the iPhone was used to photograph one to three CT images per case. The number of photographs taken depended on the nature of the lesion.

Blinded to both the purpose of the study and to the clinical outcome of the head-injured patients, two independent neurosurgeons were given a brief history of the cases and the radiologist’s description of the findings. The neurosurgeons were asked to fill out a form providing their transfer decisions based first on clinical data alone, and then after viewing the cell phone images.

Of the 88 cases included in the study, 43 (49%) required no intervention, 29 (33%) required a neurosurgical procedure, seven (8%) required specialized imaging, six (7%) required supportive measures, and three (3%) had nonsurvivable injuries, according to the researchers.

The group measured the change in unnecessary transfers (defined as requiring no intervention and nonsurvivable injuries) and the change in necessary transfers (defined by requiring specialized care or operative management).

“It actually helped both ways,” said lead author Marcy Rosenberg, MD. “The patients that did not need neurosurgical intervention — that would have done fine just staying at their original hospitals — it reduced those number of patients. And the patients that actually needed neurosurgical intervention, they would have transferred more of them based on using the images.”

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