WhatsApp Use In The Evaluation of Hematuria

https://doi.org/10.1016/j.ijmedinf.2017.12.011Get rights and content

Highlights

  • WhatsApp is a great help in clinical practice in all fields of medicine.

  • Evaluation of hematuria remotely is possible with WhatsApp.

  • Tertiary hospitals where urologist isn’t present can benefit from WhatsApp.

  • The ubiquity of WhatsApp provides effective communication in clinical practice.

  • The main limitation of the study is the limited number of patients.

Abstract

Introduction

The advancements in telemedicine provide the possibility to send photos of hematuria cases to professionals for further evaluation. We aimed to evaluate the inter-rater reliability of WhatsApp use in the evaluation of hematuria.

Materials and methods

Between December 2014 and April 2016, 212 patients were evaluated prospectively for hematuria by 2 groups of urologists; Group A: in direct contact with patients for evaluation; Group B: “blind” urologist who had no access to the patients’ data but received pictures via WhatsApp. Two photos of voided urine in a sterile container were taken and sent using WhatsApp. The opinions of Group A and B about the grade of hematuria were evaluated. Shapiro-Wilk test and Fleiss’ kappa statistics were used for statistical analyses.

Results

The median age of patients was 71 (min 22, max 96). The Group A urologists were in accordance in 96.22% of cases. Group B urologists had common opinions in 99.5% (n = 203) and there was almost perfect agreement between 2 groups (λ = 0.992). The number of common opinions among “blind” urologists is more than the number of common opinions among the consultants. When further classification is performed as serious and non-serious hematuria, the rate of misdiagnosing serious cases is approximately 6.5–7%. However, using WhatsApp, the urologists can differentiate normal urine and any form of hematuria with 100% accuracy.

Conclusion

It is possible to evaluate hematuria remotely and also reduce unnecessary costs of services for hematuria of mild clinical significance by using telemedicine. WhatsApp can provide valuable aid to tertiary hospitals where the urologist is not always present as well as in rural areas.

Introduction

The presence of red blood cells in urine is termed hematuria. Gross hematuria is the visible presence of blood in the urine and represents between 4 and 20% of all urological consultations and hospitalizations [1]. Hematuria isn’t always easy to assess and patients often go to emergency care due to false hematuria diagnoses that requires no active treatment. This situation leads to over-treatment and further increases complications as well as health care expenses.

With the advancements in mobile phone technology and related applications, it is possible to send messages, photos, and videos [2]. By now, it is estimated that WhatsApp has over 10 million users and more than 3 billion messages are sent via WhatsApp around the world every day [3,4]. WhatsApp can provide rapid communication in challenging scenarios whenever the party in need of a second opinion is even miles away from the consulting party. This is actually called “Telemedicine” and is frequently used by various specialties to exchange opinions over medical images, recordings of CT or MRI images or any kind of medical data.

We suggest that the use of WhatsApp can be used to send photos of cases of hematuria to medical professionals in order to determine the severity of cases, and thereby discriminate whether active treatment is necessary or not. The main target population of this study is the health professionals, general practitioners who may need a urology consultation where a urologist is not present, and urologists in doubt that may need a second opinion about their patients. So, the objective of this study was to evaluate the reliability of WhatsApp in the evaluation of hematuria through inter-rater agreement and to see the reliability of telemedicine communication via WhatsApp upon making critical clinical decisions.

Section snippets

Materials and methods

This study has been planned as a prospective evaluation of patients presenting with hematuria in an academic center. Between December 2014 and April 2016, a total of 212 patients were referred for our consultation for hematuria. As standard protocol of the university hospital in which the study was carried out, each patient was informed about the procedure upon admission and signed an informed consent agreement allowing data collection for research purposes. The study design is in accordance

Sample characteristics

The total number of patients evaluated for WhatsApp telemedicine communication outcome was 212. There were 26 (12.3%) female and 186 (86.7%) male patients. The median age of patients was 71 (29–78). The most common cause of hematuria was bladder cancer with 39 patients. The causes of hematuria are given in Table 2.

Evaluation of the total cohort for inter-observer agreement

The 2 consultants had different opinions in 8 cases, so these patients were excluded from the analyses in order to have a patient cohort where diagnosis is based upon the common

Discussion

Hematuria isn’t always easy to assess and still remains a clinical problem for the patient and for the urologist. Patients often go to emergency care due to false hematuria diagnoses requiring no active treatment. This situation adds excessive costs to public health and frequently creates overcrowding of emergency rooms and urology clinics.

The exchange of medical data from via electronic communication is referred to as “Telemedicine (TM)” and the idea behind this is to provide the transmission

Conclusion

It is possible to evaluate hematuria cases remotely and also reduce unnecessary costs of services for hematuria of mild clinical significance by using telemedicine. WhatsApp can provide a valuable aid to tertiary hospitals where the urologist is not always present as well as in rural areas. Also, the absence of compromise in photo quality, the easy use of WhatsApp are the major advantages that provide usefulness of the application in clinical practice.

This study demonstrates that patients

Disclosure

None of the authors have any financial interest to declare and no financial support was taken for the study.

Author contributions

Concept and design: Salvatore Butticè, Christopher Netsch, Rosa Pappalardo

Acquisition of data: Salvatore Butticè, Bahadir Sahin, Laurian Dragos, Rosa Pappalardo

Analysis and interpretation of data: Tarik Emre Sener, Salvatore Butticè, Bahadir Sahin,

Drafting the article Tarik Emre Sener, Salvatore Butticè, Bahadir Sahin, Laurian Dragos, Rosa Pappalardo

Revising the article for important intellectual content: Tarik Emre Sener, Salvatore Butticè, Carlo Magno

Summary points

What was already known:

Acknowledgements

We would like to thank the native speakers Selin Sakarcan, DPM Candidate, Temple University, School of Podiatric Medicine, Pennsylvania and Abdullah Sakarcan, MD, Pediatric Nephrologist in AACP (All About Children Pediatric Partners), Reading, Pennsylvania, USA for their contributions in language revision of the manuscript.

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The authors contributed equally to the manuscript.

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