Reliability of Telemedicine in the Assessment of Seriously Ill Children

Lawrence Siew, MD, Allen Hsiao, MD, Paul McCarthy, MD, Anup Agarwal, MBBS, Eric Lee, BS, Lei Chen, MD.
Pediatrics, 2015
Links   PubMed   Pediatrics  pdf

The Bottom Line

Telemedicine can offer a reliable way to assess children with fever and respiratory distress when compared with the bedside examination.

What They Did

  • A convenience sample of 2 to 36 month olds with fever were evaluated with the Yale Observation Score and 2 to 18 year olds with respiratory symptoms were assessed via a visual signs only respiratory score  score by both bedside assessment and via FaceTime on an iPad
  • The primary objective of the present study was to determine the reliability of telemedicine observations, compared with bedside observations as assessed by Pearson’s correlation coefficient. A strong agreement is generally κ >0.8.
  • 132 febrile infants were assessed with overall κ=0.81 between the live and FaceTime examiner
  • 145 patients with respiratory symptoms were assessed and κ=0.85 for “impression of respiratory distress” and κ>0.6 for the majority of the remaining components, with intercostal retractions having the lowest agreement.

What You Can Do

  • Recognize that telemedicine is a solution to providing care to locations with limited access
  • Many of you already have it available to you and don’t even know it – current applications I have used include video interpreter services, remote consultant with critical care medicine and mental health evaluations in the ED.
  • Know that it doesn’t replace the initial bedside assessment, but with the fidelity of current video devices as well as the improving availability of broadband internet it is easier than ever to connect with a colleague in another part of the country. You need to communicate what you are seeing, and know that the telemedicine interaction is only as good as the data the patient relays to you.