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Study: Telemedicine Works Fine in Diagnosing Sick Children

When compared to having a doctor at the bedside, a video consult proves just as good in assessing fevers and respiratory distress.

By Eric Wicklund

- A new study has found that telemedicine can be used to assess the severity of a child’s illness as well as an in-person examination.

Supported by the American Academy of Pediatrics and published in the Feb. 5 issue of Pediatrics, the Yale University study compared in-person examinations of 132 patients between two and 36 months old to exams done with a FaceTime application on an iPad. The findings “showed excellent agreement between bedside and telemedicine observers across all scores,” the researchers reported.

The study addresses two key pain points in healthcare: the shortage of pediatric clinicians and the viability of telemedicine for ER diagnoses. And while noting there were several limitations to the study and calling for more testing on the reliability of telemedicine, the researchers said this is a good start in proving that clinicians can use video consults to make certain diagnoses.

 “The importance of determining whether observations made via telemedicine are similar enough to observations made in person underlie the important application of telemedicine: to make clinical assessments and treatment plans for patients being evaluated with telemedicine when bedside evaluation is not possible,” wrote Lawrence Siew, MD, of the Yale University School of Medicine’s Department of Pediatrics-Pediatric Emergency Medicine, one of six listed researchers.

The clinicians involved in the study used what’s known as the Yale Observation Scale, measuring each patient’s response to parent simulation, color, hydration status, crying, response to social overtures and ability to be aroused. As well, 30 of the patients were assessed at the same time by two clinicians at the bedside and two remote clinicians.

In another part of the study, 145 children between the ages of two months and 18 years were evaluated via the Respiratory Observation Checklist, which uses visual analysis of respiratory distress to diagnose age-appropriate tachypnea, perioral cyanosis, nasal flaring, tripoding, thoracoabdominal asynchrony, supraclavicular, substernal and intercostal retractions and mental status.

"We found the highest degree of agreement between bedside and telemedicine observers with the clinical impression of respiratory distress,” the researchers wrote. “Such strong agreement by observers that a subject was in respiratory distress suggests that clinical impressions or 'gestalt' is not lost with telemedicine.”

For their study, the researchers said they wanted to focus on challenging illnesses related to fevers and respiratory distress, reasoning that those patients – and their healthcare providers – would benefit the most from telemedicine access. 

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