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dc.contributor.authorCrumley, I
dc.contributor.authorHalton, J
dc.contributor.authorGreig, J
dc.contributor.authorKahunga, L
dc.contributor.authorMwanga, JP
dc.contributor.authorChua, A
dc.contributor.authorKosack, C
dc.date.accessioned2020-01-29T14:10:10Z
dc.date.available2020-01-29T14:10:10Z
dc.date.issued2020-01-15
dc.date.submitted2020-01-27
dc.identifier.issn1932-6203
dc.identifier.pmid31940418
dc.identifier.doi10.1371/journal.pone.0227773
dc.identifier.urihttp://hdl.handle.net/10144/619587
dc.description.abstractIntroduction: 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.en_US
dc.language.isoenen_US
dc.publisherPublic Library of Scienceen_US
dc.rightsWith thanks to the Public Library of Science.en_US
dc.titleThe impact of computed radiography and teleradiology on patients' diagnosis and treatment in Mweso, the Democratic Republic of Congo.en_US
dc.identifier.journalPLoS Oneen_US
dc.source.journaltitlePloS one
refterms.dateFOA2020-01-29T14:10:11Z


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