Evaluation of Injured Structures and Circulation of Fingers From Photos Taken in the Emergency Department After Hand Injury

Abstract

This study aimed to assess the diagnostic accuracy of smartphone photographs, taken at the emergency department (ED) and shared with hand surgeons, in identifying critical circulatory issues and neurovascular bundle injury, as well as tendon and bone injuries. The photographs of hand injuries of 50 patients who were referred to our ED between January 2020 and January 2022 were used to design a questionnaire. This questionnaire, including closed-ended questions about the injured structures, was shared with a group of hand surgeons via a WhatsApp group in Turkey. The experience levels of the surgeons were categorized as 0-5 years, 5-10 years, and above 10 years. Diagnostic accuracy was assessed by comparing the results with surgery notes as the reference standard. A total of 94 hand surgeons participated in the study. The accuracy of predicting critical circulatory issues in the hand/fingers from the smartphone photographs was 81.9%, with a sensitivity of 48.0% and a specificity of 91.4%. For neurovascular bundle injuries, the accuracy was 63.0%, with a sensitivity of 63.9% and a specificity of 61.5%. The accuracy of predicting tendon injuries was 64.9%, with a sensitivity of 81.1% and a specificity of 42.5%. The accuracy of predicting fracture was 74.7%, with a sensitivity of 70.9% and a specificity of 79.9%. Identifying critical circulatory issues solely based on the shared photograph is inadequate. Similarly, evaluation based only on the photograph was insufficient for the detection of neurovascular bundle injuries, tendon ruptures, and fractures. Digital images acquired in an ED setting and subsequent review of these images by hand surgeons may not be an adequately reliable strategy for determining the necessity of patient transfer.