Reliability and validity of a mobile phone for radiographic assessment of ankle injuries: A randomized inter- and intraobserver agreement study

Joshua N. Tennant, Shankar Viswanathan, Douglas R. Dirschl

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Current mobile phone technology may allow orthopaedic surgeons to make clinical decisions using radiographs viewed on a small mobile device screen. The purpose of this study was to examine the reliability and validity of interpreting ankle fracture images viewed on a mobile device and a computer monitor, with a hypothesis that the agreement in clinical decision making between the mobile device and computer monitor would be high. Methods: A randomized interobserver and intraobserver reliability study was conducted in which 16 mortise and lateral ankle images representing a severity spectrum of malleolar ankle, plafond, and extra-articular tibial fractures were shown to volunteer orthopaedic surgeons on both an Apple fourth-generation iPod Touch and a 23-inch liquid crystal display (LCD) computer monitor. Participants answered a multiple-choice questionnaire for each image regarding diagnosis, severity, need for higher level imaging, need for acute inpatient versus outpatient management, and plan of treatment. Inter- and intraobserver reliability was assessed by kappa (κ), multirater kappa statistics, and intraclass correlation coefficient (ICC). Results: Ninety-three orthopaedic surgeon volunteers completed the study. Excellent intraobserver agreement (κ ≥ 0.8) was found for all variables measured, including diagnosis (median κ = 0.84), need for computed tomography scan (κ = 0.86), need for reduction (κ = 0.82), treatment setting (κ = 0.82), and treatment type (κ = 0.87). Interobserver agreement was consistent between the mobile device and computer screen. Interobserver agreement for the severity assessment had a slightly higher ICC for the mobile device compared with the computer monitor (ICC = 0.83 vs 0.79). Sixty-seven percent (62/93) said at the completion of the study they were "completely" or "very" comfortable using a mobile device as a primary viewing device for new emergency room, inpatient, or transfer request consults. Conclusions: Strong reliability for radiographic assessment of ankle injuries existed between a 23-inch computer monitor and a handheld mobile device. Further study is warranted to validate the technology to apply to other anatomic locations and imaging modalities. Level of Evidence: Level II, diagnostic study.

Original languageEnglish (US)
Pages (from-to)228-233
Number of pages6
JournalFoot and Ankle International
Volume34
Issue number2
DOIs
StatePublished - Feb 2013

Fingerprint

Ankle Injuries
Cell Phones
Reproducibility of Results
Equipment and Supplies
Ankle
Inpatients
Volunteers
Ankle Fractures
Technology
Liquid Crystals
Tibial Fractures
Touch
Malus
Hospital Emergency Service
Outpatients
Therapeutics
Joints
Tomography

Keywords

  • Agreement
  • Ankle
  • Fracture
  • Mobile device

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Reliability and validity of a mobile phone for radiographic assessment of ankle injuries : A randomized inter- and intraobserver agreement study. / Tennant, Joshua N.; Viswanathan, Shankar; Dirschl, Douglas R.

In: Foot and Ankle International, Vol. 34, No. 2, 02.2013, p. 228-233.

Research output: Contribution to journalArticle

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