1 Department of Emergency Medicine, University of Iowa Carver College of Medicine , Iowa City, Iowa.
2 Department of Epidemiology, University of Iowa College of Public Health , Iowa City, Iowa.
Telemed J E Health. 2018 Oct;24(10):790-796. doi: 10.1089/tmj.2017.0240. Epub 2018 Feb 22.
Telemedicine allows patients to connect with healthcare providers remotely. It has recently expanded to evaluate low-acuity illnesses such as pharyngitis by using patients' personal communication devices. The purpose of our study was to compare the telemedicine-facilitated physical examination with an in-person examination in emergency department (ED) patients with sore throat.
This was a prospective, observational, blinded diagnostic concordance study of patients being seen for sore throat in a 60,000-visit Midwestern academic ED. A telemedicine and a face-to-face examination were performed independently by two advanced practice providers (APP), blinded to the results of the other evaluator. The primary outcome was agreement on pharyngeal redness between the evaluators, with secondary outcomes of agreement and inter-rater reliability on 14 other aspects of the pharyngeal physical examination. We also conducted a survey of patients and providers to evaluate perceptions and preferences for sore throat evaluation using telemedicine.
Sixty-two patients were enrolled, with a median tonsil size of 1.0. Inter-rater agreement (kappa) for tonsil size was 0.394, which was worse than our predetermined concordance threshold. Other kappa values ranged from 0 to 0.434, and telemedicine was best for detecting abnormal coloration of the palate and tender superficial cervical lymph nodes (anterior structures), but poor for detecting abnormal submandibular lymph nodes or asymmetry of the posterior pharynx (posterior structures). In survey responses, telemedicine was judged easier to use and more comfortable for providers than patients; however, neither patients nor providers preferred in-person to telemedicine evaluation.
Telemedicine exhibited poor agreement with the in-person physical examination on the primary outcome of tonsil size, but exhibited moderate agreement on coloration of the palate and cervical lymphadenopathy. Future work should better characterize the importance of the physical examination in treatment decisions for patients with sore throat and the use of telemedicine in avoiding in-person healthcare visits.
远程医疗使患者能够与医疗保健提供者远程联系。最近，它已经扩展到通过使用患者的个人通讯设备来评估咽炎等低危疾病。我们研究的目的是比较远程医疗辅助的体检与急诊科（ED）咽痛患者的面对面检查。
这是一项针对在中西部学术 ED 就诊的咽痛患者的前瞻性、观察性、盲法诊断一致性研究。由两名高级执业医师（APP）独立进行远程医疗和面对面检查，对另一名评估者的结果均不知情。主要结局是评估者之间在咽部发红方面的一致性，次要结局是 14 个其他咽部体检方面的一致性和评价者间可靠性。我们还对患者和提供者进行了调查，以评估使用远程医疗评估咽痛的看法和偏好。
共纳入 62 例患者，扁桃体大小中位数为 1.0。扁桃体大小的评价者间一致性（kappa）为 0.394，低于我们预先设定的一致性阈值。其他 kappa 值范围为 0 至 0.434，远程医疗最适合检测 palate 异常着色和 tender superficial cervical lymph nodes（前结构），但对检测异常 submandibular lymph nodes 或后咽部（后结构）的不对称性较差。在调查回应中，远程医疗被认为比患者更容易使用，对提供者更舒适；然而，无论是患者还是提供者都不希望面对面评估优于远程医疗评估。
远程医疗在扁桃体大小的主要结局上与面对面体检的一致性较差，但在 palate 着色和颈淋巴结病方面的一致性较好。未来的工作应更好地描述体检在治疗决策中的重要性以及远程医疗在避免面对面医疗访问方面的应用。
