Telemedicine diagnosis of acute respiratory tract infection patients is not inferior to face-to-face consultation: a randomized trial

Tarso Augusto Duenhas Accorsi, Flavio Tocci Moreira, Carlos Henrique Sartorato Pedrotti, Karine De Amicis, Renata Farias Vidigal Correia, Renata Albaladejo Morbeck, Fernanda Ferreira Medeiros, José Leão de Souza Jr, Eduardo Cordioli, Tarso Augusto Duenhas Accorsi, Flavio Tocci Moreira, Carlos Henrique Sartorato Pedrotti, Karine De Amicis, Renata Farias Vidigal Correia, Renata Albaladejo Morbeck, Fernanda Ferreira Medeiros, José Leão de Souza Jr, Eduardo Cordioli

Abstract

Objective: To analyze telemedicine diagnostic accuracy in patients with respiratory infections during COVID-19 pandemic compared to face-to-face evaluation in the emergency department.

Methods: Randomized, unicentric study between September 2020 and November 2020 in patients with any respiratory symptom (exclusion criteria: age >65 years, chronic heart or lung diseases, immunosuppressed). Patients were randomized 1:1 for brief telemedicine followed by face-to-face consultation or direct face-to-face evaluation. The primary endpoint was the International Classification of Diseases code. The secondary analysis comprised length of stay, diagnostic test ordering, medical prescription, and proposed destination.

Results: Ninety-eight patients were enrolled. The mean age was 36.3±9.7 years old, 57.1% were women, and 81.6% had diagnostic test ordered. Mean grouped by International Classification of Diseases code for upper respiratory tract infection, pharyngotonsillitis, and sinusitis showed no difference between study groups or secondary endpoints. The Telemedicine Group was representative of the population usually evaluated in this center. In the Telemedicine Group (n=48), 18.7% patients would be referred for evaluation at the emergency department. The distribution of diagnoses by telemedicine was 67.4% for upper respiratory tract infection, 2.3% for pharyngotonsillitis, and 0% for sinusitis, being statistically similar to the subsequent face-to-face assessment, respectively: 72.1%, 11.6% and 7% (Kappa 0.386 [95%CI: 0.112-0.66]; p=0.536). Telemedicine ordered COVID-19 molecular (RT-PCR) tests in 76.5% versus 79.4% in face-to-face evaluation (Kappa 0.715 [95%CI: 0.413-1]; p>0.999).

Conclusion: Diagnostic telemedicine consultation of low-risk patients with acute respiratory symptoms is not inferior to face-to-face evaluation at emergency department. Telemedicine is to be reinforced in the health care system as a strategy for the initial assessment of acute patients. ClinicalTrials.gov Identifier: NCT04806477.

Conflict of interest statement

Conflict of interest: none.

Figures

Figure 1. Participants flow diagram
Figure 1. Participants flow diagram

References

    1. .Hollander JE, Carr BG. Virtually perfect? Telemedicine for Covid-19. N Engl J Med. 2020;382(18):1679-81.
    1. .Hersh W, Helfand M, Wallace J, Kraemer D, Patterson P, Shapiro S, et al. A systematic review of the efficacy of telemedicine for making diagnostic and management decisions. J Telemed Telecare. 2002;8(4):197-209. Review.
    1. .Ekeland AG, Bowes A, Flottorp S. Effectiveness of telemedicine: a systematic review of reviews. Int J Med Inform. 2010;79(11):736-71. Review.
    1. .Irwin RS, French CL, Chang AB, Altman KW; CHEST Expert Cough Panel*. Classification of cough as a symptom in adults and management algorithms: CHEST Guideline and Expert Panel Report. Chest. 2018;153(1):196-209.
    1. .Bond K, Ospina MB, Blitz S, Afilalo M, Campbell SG, Bullard M, et al. Frequency, determinants, and impact of overcrowding in emergency departments in Canada: a national survey. Healthc Q. 2007;10(4):32-40.
    1. .Morley C, Unwin M, Peterson GM, Stankovich J, Kinsman L. Emergency department crowding: a systematic review of causes, consequences, and solutions. PLoS One. 2018;13(8):e0203316.
    1. .Dolton P, Pathania V. Can increased primary care access reduce demand for emergency care? Evidence from England’s 7-day GP opening. J Health Econ. 2016;49:193-208.
    1. .Portnoy J, Waller M, Elliott T. Telemedicine in the era of COVID-19. J Allergy Clin Immunol Pract. 2020;8(5):1489-91.
    1. .Accorsi TA, De Amicis K, Brígido AR, Belfort DS, Habrum FC, Scarpanti FG, et al. Assessment of patients with acute respiratory symptoms during the COVID-19 pandemic by telemedicine: clinical features and impact on referral. einstein (São Paulo). 2020;18:eAO6106.
    1. . Birkmeyer JD, Barnato A, Birkmeyer N, Bessler R, Skinner J. The impact of the COVID-19 pandemic on hospital admissions in the United States. Health Aff (Millwood). 2020;39(11):2010-17.
    1. .Struyf T, Deeks JJ, Dinnes J, Takwoingi Y, Davenport C, Leeflang MM, Spijker R, Hooft L, Emperador D, Dittrich S, Domen J, Horn SR, Van den Bruel A; Cochrane COVID-19 Diagnostic Test Accuracy Group. Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19 disease. Cochrane Database Syst Rev. 2020;7(7):CD013665. Update in: Cochrane Database Syst Rev. 2021;2:CD013665.
    1. .Fatehi F, Martin-Khan M, Gray LC, Russell AW. Design of a randomized, non-inferiority trial to evaluate the reliability of videoconferencing for remote consultation of diabetes. BMC Med Inform Decis Mak. 2014;14:11.
    1. .Singal BM, Hedges JR, Radack KL. Decision rules and clinical prediction of pneumonia: evaluation of low-yield criteria. Ann Emerg Med. 1989;18(1):13-20.
    1. .Hooker EA, Mallow PJ, Oglesby MM. Characteristics and trends of Emergency Department visits in the United States (2010-2014). J Emerg Med. 2019; 56(3):344-51.
    1. .Fendrick AM, Saint S, Brook I, Jacobs MR, Pelton S, Sethi S. Diagnosis and treatment of upper respiratory tract infections in the primary care setting. Clin Ther. 2001;23(10):1683-706. Review.
    1. .Shah SN, Bachur RG, Simel DL, Neuman MI. Does this child have pneumonia? the rational clinical examination systematic review. JAMA. 2017;318(13): 462-71. Review.
    1. .West JV. Acute upper airway infections. Br Med Bull. 2002;61(1):215-30. Review.
    1. .Malesker MA, Callahan-Lyon P, Ireland B, Irwin RS; CHEST Expert Cough Panel. Pharmacologic and nonpharmacologic treatment for acute cough associated with the common cold: chest expert panel report. Chest. 2017;152(5):1021-37. Review.
    1. .Shih J, Portnoy J. Tips for seeing patients via telemedicine. Curr Allergy Asthma Rep. 2018;18(10):50. Review.
    1. .Sociedade Brasileira de Pneumologia e Tisiologia. Diretrizes para Pneumonias Adqüiridas na Comunidade (PAC) em Adultos Imunocompetentes. J Bras Pneumol. 2004;30:S1-S24.
    1. .Parshall MB, Schwartzstein RM, Adams L, Banzett RB, Manning HL, Bourbeau J, Calverley PM, Gift AG, Harver A, Lareau SC, Mahler DA, Meek PM, O’Donnell DE; American Thoracic Society Committee on Dyspnea. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med. 2012;185(4):435-52.
    1. .Fernández Mondéjar E. Considerations on the low adherence to clinical practice guidelines. Med Intensiva. 2017;41(5):265-6. Spanish.
    1. .Ebell MH, Chupp H, Cai X, Bentivegna M, Kearney M. Accuracy of signs and symptoms for the diagnosis of community-acquired pneumonia: a meta-analysis. Acad Emerg Med. 2020;27(7):541-53.
    1. .Pedrotti CH, Accorsi TA, De Amicis K, Serpa Neto A, Lira MT, Morbeck RA, et al. Antibiotic stewardship in direct-to-consumer telemedicine consultations lead to high adherence to best practice guidelines and a low prescription rate. Int J Infect Dis. 2021;105:130-4.
    1. .Monaghesh E, Hajizadeh A. The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence. BMC Public Health. 2020; 20(1):1193.
    1. .Ribeira R, Shen S, Callagy P, Newberry J, Strehlow M, Quinn J. Telemedicine to decrease personal protective equipment use and protect Healthcare workers. West J Emerg Med. 2020;21(6):61-2.
    1. .Budd J, Miller BS, Manning EM, Lampos V, Zhuang M, Edelstein M, et al. Digital technologies in the public-health response to COVID-19. Nat Med. 2020;26(8):1183-92. Review.
    1. .Hong Z, Li N, Li D, Li J, Li B, Xiong W, et al. Telemedicine during the COVID-19 pandemic: experiences from western China. J Med Internet Res. 2020;22(5):e19577.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe