Yves Tourne

This prospective work was designed to evaluate the concordance of the opinions of four experts interrogated via a long-distance inter-hospital data transmission system by an orthopedic surgeon seeking advise on foot and ankle surgery patients. The surgeon requested advice concerning patients presenting difficult diagnostic or therapeutic situations. The requests were submitted via email to four experts working in regional referral centers. A standardized method defined by pathological categories was used for case description and imaging. Requests concerning 30 among 450 patients presenting surgical foot and ankle disorders were addressed to the experts. The surgical problem involved the forefoot (46%), the mid foot (16%), the hind foot (7%) and the ankle (31%). Mean delay to response was 11 days. The index of diagnostic agreement was 3.2/4 and the index of therapeutic agreement was 2.6/4. This study was designed to analyze the operating procedures involved (respective responsibility of the requesting surgeon and the regional experts, remuneration due to the different participants) and the potential patient benefit. The appropriateness of the email transmission system was also examined. For this type of study, email transmission was indicated because of the low cost, easy use, and image quality. This work illustrated the very good diagnostic and therapeutic concordance between experts in foot and ankle surgery and thus demonstrated the potential usefulness of long-distance expert systems. Furthermore, implication of several experts provided greater precision and complementary information facilitating management of difficult cases.