Bowman R J C, Kennedy C, Kirwan J F, Sze P, Murdoch I E
Moorfields Eye Hospital City Rd, London EC1V 2PD UK.
Eye (Lond). 2003 Aug;17(6):743-6. doi: 10.1038/sj.eye.6700489.
To assess the accuracy and efficiency of telemedicine in diagnosing and managing eye problems presenting to accident and emergency departments.
A controlled trial with a face-to-face and telemedicine phases, each involving 40 patients undergoing two consecutive consultations. In the face-to-face phase, both consultations were in person; in the telemedicine phase, observer 1 used videoconferencing technology at 384 kbit/s (separate nonslit lamp-torchlight and slit lamp examinations) and observer 2 saw the patient face to face. Setting The accident and emergency department at Moorfields Eye Hospital.Participants In total, 80 consenting new patients presenting to the department.
(1) Agreement levels between the two observers for each phase (judged by an independent masked investigator), (2) length of consultation, and (3) number of unnecessary recalls.
Agreement rates were as follows. Face-to-face phase: total agreement (30/40=75%), trivial disagreement (8/40=20%), clinically important disagreement (2/40=5%). Telemedicine phase (torchlight): complete agreement (16/40=40%), trivial disagreement (20/40=50%), clinically important disagreement (4/40=10%). Telemedicine phase (slit lamp): total agreement (23/40=58%), trivial disagreement (15/40=37%), clinically important disagreement (2/40=5%). Agreement levels in the telemedicine phase with torchlight examination were significantly lower (chi(2)=10.07, P=0.007) for any disagreement. Telemedicine consultations erred on the side of clinical caution and were no slower than face-to-face consultations (mean 6 min for observer 1 in both phases). Recalls were more likely (chi(2)=5.16, P=0.02) after telemedicine consultations with torchlight only (9/40) compared with face-to-face consultations (2/40). Although there were more significant disagreements using the telemedicine, in each case the telemedicine diagnosis and management erred on the side of safety; hence, no patient would have suffered by wrong management because of the consultation using telemedicine.
Telemedicine was found to be an accurate, safe, and efficient method of diagnosing and managing these patients, especially if slit lamp images were used. Advice using telemedicine erred on the side of caution, which resulted in more recalls.
评估远程医疗在诊断和处理急诊科就诊的眼部问题时的准确性和效率。
一项对照试验，分为面对面和远程医疗两个阶段，每个阶段有40名患者接受连续两次会诊。在面对面阶段，两次会诊均为亲自进行；在远程医疗阶段，观察者1使用384 kbit/s的视频会议技术（分别进行非裂隙灯手电筒检查和裂隙灯检查），观察者2面对面检查患者。地点：摩尔菲尔德眼科医院急诊科。参与者：共有80名同意参与的新患者到该科室就诊。
（1）两个阶段中两位观察者之间的一致程度（由独立的盲态研究者判断），（2）会诊时长，（3）不必要召回的次数。
一致率如下。面对面阶段：完全一致（30/40 = 75%），轻微不一致（8/40 = 20%），具有临床重要意义的不一致（2/40 = 5%）。远程医疗阶段（手电筒检查）：完全一致（16/40 = 40%），轻微不一致（20/40 = 50%），具有临床重要意义的不一致（4/40 = 10%）。远程医疗阶段（裂隙灯检查）：完全一致（23/40 = 58%），轻微不一致（15/40 = 37%），具有临床重要意义的不一致（2/40 = 5%）。在远程医疗阶段，手电筒检查时任何不一致的一致程度显著更低（χ² = 10.07，P = 0.007）。远程医疗会诊在临床谨慎方面有误判，且不比面对面会诊慢（两个阶段观察者1的平均时间均为6分钟）。与面对面会诊（2/40）相比，仅使用手电筒进行远程医疗会诊后召回的可能性更大（χ² = 5.16，P = 0.02）（9/40）。尽管使用远程医疗时存在更多显著的不一致，但在每种情况下，远程医疗的诊断和处理都偏向安全；因此，不会有患者因远程医疗会诊导致的错误处理而受到伤害。
发现远程医疗是诊断和处理这些患者的准确、安全且有效的方法，尤其是使用裂隙灯图像时。使用远程医疗的建议偏向谨慎，这导致了更多的召回。
