The general public and professionals have adopted the use of mobile devices with Internet access in a range of fields. In 2009, more than two thirds of the world's population owned a mobile phone and about 4.2 trillion text messages were sent. Since then, the popularity of mobile technology has transformed the use of these devices into an almost mandatory part in modern life, with most people taking their phones everywhere they go [1], [2].
In this scenario of rapid technological expansion, many applications have been developed to provide support for professionals involved in healthcare, such as text message (SMS (short message service) and WhatsApp Messenger, for example), e-mails, and access to electronic records and specific literature [1], [2], [3]. New applications are being created at a high rate for specific areas of medicine, which includes viewing of radiological images on mobile phones, called “teleradiology” [1], [2], [4].
Initially, teleradiology was regarded by some with scepticism, not only because it was a relatively new technology, but mainly because of the characteristics of the mobile device – for example the size and resolution of display [1]. Since then both mobile phones (smartphones) and the transmission and reception of data has improved, opening up possibilities for its application both in the medical and dental areas [5].
However, recent studies have shown modest benefits for clinical diagnosis and other health interventions with the use of SMS, especially because of the low quality of the images [1], [6], [7]. Two studies using photos taken with mobile phone demonstrated a reduced accuracy in the diagnosis of fractures compared with the gold standard, the simple X-ray [8], [9]. Low camera resolution and loss of data quality due to the conversion from analogue to digital were the main problems found in these studies.
After reaching a million users by the end of 2009, the WhatsApp downloads increased 10 times by 2010 [10]. Gradually this application has become one of the most popular for mobile smartphones and is currently among the most downloaded in 40 countries of the European Community, Asia, Middle East, and Latin America. In Germany it leads the ranking downloads of 2011 and in Spain has more than six million, according to the Xyologic [11].
The authors’ hypothesis is that using WhatsApp technology does not reduce the quality of the images in their conversion from analogue to digital and therefore provides the ability to identify sufficient details for diagnosis and the classification of fractures. The aim of this study is to evaluate the inter- and intra-observer agreement in the initial diagnosis and classification by means of plain radiographs and CT scan of tibial plateau fractures photographed versus images sent via WhatsApp Messenger.
The radiographs and CT scans of 13 patients who had tibial plateau fractures treated at our institution between June 2012 and July 2013 were selected from our Unit database. The privacy and security of the patients during acquisition, storage, and transmission of their medical information was protected. The identity of the patients was not disclosed.
All patients were surgically managed during their hospitalization and had adequate preoperative radiographic and tomographic studies, allowing us
On average, there was excellent to perfect (0.75 < κ < 1.0) intra-observer agreement on all six questions on both occasions, 15 days apart. There was a perfect (κ = 1.0) agreement in respect of question number six with all participants answering “yes” (Fig. 5).
The average inter-observer agreement was excellent (0.75 < κ < 1.0) on all six questions on both occasions, 15 days apart. As observed in the intra-observer analysis, there was a perfect (κ = 1.0) agreement in respect of question number six with all
In 1973, the first portable mobile phone was developed by Martin Cooper, a Motorola employee, and was commercially introduced to the U.S. market 5 years later [15]. During the 1990s, the second generation of mobile phones was developed, which featured a major innovation – the text message or SMS. In conjunction with the changes introduced by the new generation of mobile phones, their dispersion and mass consumer market uptake represented an advance in the ease of communication, mainly
All authors provided: (1) substantial contributions to the conception and design, acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; (3) final approval of the version to be published.
The authors have no competing or conflicting interests to report. Summary points More than two thirds of the world population owned a mobile phone and about 4.2 trillion text messages are sent daily. Many applications have been developed to provide support for professionals involved in healthcare, such as text message (SMS (short message service) and WhatsApp Messenger, for example), e-mails, and access to electronic records and specific literature. Recent studies have shown modest benefits for
In the herein study, we analyse the ethical limits, coverage, and validation of non-medical applications adapted for medical use. Messaging apps have been widely used in medicine for quick reference, clinical, academic, and therapeutic endorsements, as well as interpersonal communication of healthcare providers and patients [1,3,6-8]. Unlike medical devices, subject to standardized assay methods and regulatory agencies around the world, non-medical apps lack legal regulation, posing a real risk of harm and illegal exposure to patients [9,10].
This support is usually obtained via social media applications like WhatsApp through smartphones in the non-integrated hospitals in our country. The medical evaluations done via WhatsApp have frequently been debated in manuscripts [3-5]. However, the reliability of these assessments is worth discussing.
Although scientific studies on the use of WhatsApp Messenger remain scarce in the medical literature (in view of fear of data sharing), increasing numbers of health professionals have adopted it as a communication interface and for the exchange of images and videos. Its use does not seem to reduce image quality in the conversion from analog to digital formats, thus providing the ability to provide sufficient details for better decision making compared to other modalities used for the same purposes.9–12 A recent literature review concluded that WhatsApp is a promising tool for communication and sharing information among health care professionals.5
