The impact of computed radiography and teleradiology on patients’ diagnosis and treatment in Mweso, the Democratic Republic of Congo


Autoři: Iona Crumley aff001;  Jarred Halton aff001;  Jane Greig aff002;  Lucien Kahunga aff003;  Jean-Paul Mwanga aff003;  Arlene Chua aff004;  Cara Kosack aff001
Působiště autorů: Diagnostic Network, MSF International, Amsterdam, Netherlands aff001;  Manson Unit, MSF, London, England, United Kingdom aff002;  Hôpital General de Reference, Mweso, North Kivu, Democratic Republic of Congo aff003;  Diagnostic Network, MSF International, Geneva, Switzerland aff004
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227773

Souhrn

Introduction

High quality diagnostic imaging can provide increased diagnostic accuracy and help guide medical decision-making and management, however challenges for radiology in resource-limited settings are numerous. Diagnostic imaging and teleradiology have financial and logistical implications, so evidence of impact is crucial. We sought to test the hypothesis that the implementation of computed radiography with teleradiology consultation support will significantly change diagnoses and treatment plans in a resource limited setting.

Method

Paired before-after study to determine the therapeutic impact of an add-on diagnostic test. ‘Preliminary Plan’ and ‘Final Plan’ forms allowed direct comparison of diagnosis and treatment plans at initial consultation and following radiography and teleradiology. Consecutive consenting patients were included until the sample size (600) was reached. Changes in both diagnosis and treatment plan were analysed in the whole cohort, with sub-analyses of children aged <5 years, and cases of chest radiography.

Results

Final analysis included 536 cases. Diagnosis changed following radiography and teleradiology in 62% of cases, and treatment plans changed in 61%. In chest radiography cases, 70% of diagnoses and 62% of treatment plans changed, while in children <5 years 66% of diagnoses and 58% of treatment plans changed.

Reduced final treatment plans were most common for exploratory surgery (72% decrease), surgical orthopaedic intervention (62% decrease), and TB treatment (52% decrease), allowing more conservative medical or surgical management in 61 cases. Increased final treatment plans were highest in the orthopaedic and interventional surgery and referral categories. Of 42 cases requiring interventional surgery in the final plan, 26 (62%) were identified only after radiography and teleradiology. 16 additional cases were indicated for orthopaedic surgery, 10 cases required patient transfer, and TB treatment was indicated in 45 cases. A change in the original prescription plan occurred in 41% of 536 cases, with one or more prescriptions stopped in 28% of all cases.

Conclusion

We found that computed radiography with teleradiology had significant clinical value in this resource-limited setting, with the potential to affect both patient outcomes and treatment costs through providing improved diagnostics and avoiding unnecessary treatments and medications.

Klíčová slova:

Antibiotics – Diagnostic medicine – Diagnostic radiology – Orthopedic surgery – Physicians – Radiology and imaging – Surgical and invasive medical procedures – Telemedicine


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Článek vyšel v časopise

PLOS One


2020 Číslo 1