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Telemedicine reliably assesses children's respiratory distress levels
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Telemedicine provided significant interobserver reliability during clinical assessments of children in respiratory distress compared with face-to-face evaluations, according to recently published study findings.
“Respiratory status evaluation is complex, involving auscultation of chest and interaction with the child,” Rajender Gattu, MD, director of the telemedicine program at the University of Maryland School of Medicine, and colleagues wrote. “[Telemedicine (TM)]-enabled high-definition audio-video conferencing allows interactive discussion and relays clinical findings. The addition of peripheral devices, such as an electronic stethoscope, allows a comprehensive clinical evaluation that entails auscultation of the chest for breath and heart sounds.”
Gattu and colleagues conducted an observational, prospective, cohort study to compare interobserver reliability (IOR) evaluations between TM and face-to-face (FTF) techniques. The study included 48 children aged younger than 18 years who presented to a pediatric ED with respiratory distress during a 7-month period. Two observers from a pool of 25 observers examined each patient to denote respiratory scores; the first observer evaluated the patient FTF via a mobile video unit (GlobalMed Caretone Telephonic Stethoscope and Transmitter, Rubbermaid Healthcare), and the second observer evaluated using TM remotely and independently via mobile unit and desktop unit (GlobalMed Caretone Receiver, GlobalMed). Comparisons were drawn from respiratory scores that assessed respiratory rate, retractions, dyspnea and wheezing to determine a child’s distress severity.
One hundred thirty-five paired observations were recorded. TM and FTF displayed highly compatible rates of IOR, with total respiratory scores showing an intraclass correlation coefficient of 0.95 (95% CI, 0.93-0.96). Respiratory rate was scored at 0.92 (95% CI, 0.89-0.94), retractions at 0.85 (95% CI, 0.79-0.89), dyspnea at 0.94 (95% CI, 0.92-0.96) and wheezing at 0.77 (95% CI, 0.68-0.83).
“The TM may be used in many ways, but its purpose in this study is to reliably identify children in severe respiratory distress from a remote location, and it may assist in management decisions,” the researchers wrote. “TM evaluations in this regard may influence the decision on disposition by predicting a need for transfer and may even prevent unnecessary transfer.
“TM-based assessment may even prevent unnecessary transfer. TM-based assessment of respiratory status could also be used by subspecialists doing inpatient TM consults at remote hospitals.” – by Kate Sherrer
Disclosure: The researchers report no relevant financial disclosures.
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