Konanki Ramesh, Gulati Sheffali, Prasad Kameshwar, Saini Lokesh, Pandey Ravindra Manohar, Paul Vinod Kumar
Division of Child Neurology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Epilepsy Res. 2018 Sep;145:110-115. doi: 10.1016/j.eplepsyres.2018.06.005. Epub 2018 Jun 12.
There is significant scarcity of specialists to provide care for children with epilepsy in many parts of the world. Telemedicine is a potential future option. This study was planned to estimate the diagnostic accuracy of telephone consultation to identify Critical Clinical Events (breakthrough seizures, drug non-compliance, drug adverse events, features of raised intracranial pressure, and other disease-related events),compared to the Face-to-Face consultation (gold standard), in children with Neurocysticercosis (NCC) and symptomatic seizures, following the completion of cysticidal therapy.
Children aged 2-15 years attending a tertiary health care facility with a diagnosis of NCC and symptomatic seizures were enrolled after completion of the cysticidal therapy. The parents were contacted by a Pediatric Neurology Resident on Telephone before the scheduled hospital visit. Subsequently, all the children were seen directly in hospital the next day by another Pediatric Neurology Resident. The information was noted on a structured questionnaire. The diagnostic accuracy of telephone consultation for identifying the Critical Clinical Events was estimated using Face-to-Face consultation as the gold standard.
A total of 1145 potential events were evaluated. Of these, the face-to-face consultation identified 56 events that would need hospital visit for detailed evaluation (breakthrough seizures in 19, drug non-compliance in 15, adverse drug events in 11, features of raised intracranial pressure in 8, and other disease-related events in 3), and 1089 events that did not require hospital consultation. The sensitivity, specificity, positive and negative predictive values of telephone consultation were 89.28% (78.12-95.96), 97.61% (96.52-98.43), 65.79% (54.01-76.30), and 99.43% (98.78-99.79) respectively. The likelihood ratios when telephone consultation was positive and negative were 37.3 and 0.11 respectively.
Telephone consultation is an acceptable mode of follow-up for children with mild Neurocysticercosis and symptomatic seizures after completion of cysticidal therapy.
在世界许多地区，为癫痫患儿提供护理的专科医生严重短缺。远程医疗是未来一种可能的选择。本研究旨在评估在接受杀囊治疗后，与面对面咨询（金标准）相比，电话咨询对神经囊尾蚴病（NCC）和症状性癫痫患儿识别关键临床事件（突破性癫痫发作、药物不依从、药物不良事件、颅内压升高特征及其他疾病相关事件）的诊断准确性。
对在三级医疗保健机构就诊、诊断为NCC和症状性癫痫且已完成杀囊治疗的2至15岁儿童进行研究。在预定的医院就诊前，儿科神经科住院医师通过电话联系患儿家长。随后，第二天另一名儿科神经科住院医师直接在医院对所有患儿进行检查。信息记录在结构化问卷上。以面对面咨询为金标准，评估电话咨询识别关键临床事件的诊断准确性。
共评估了1145个潜在事件。其中，面对面咨询确定有56个事件需要住院进行详细评估（19例突破性癫痫发作、15例药物不依从、11例药物不良事件、8例颅内压升高特征及3例其他疾病相关事件），1089个事件不需要住院咨询。电话咨询的敏感性、特异性、阳性预测值和阴性预测值分别为89.28%（78.12 - 95.96）、97.61%（96.52 - 98.43）、65.79%（54.01 - 76.30）和99.43%（98.78 - 99.79）。电话咨询阳性和阴性时的似然比分别为37.3和0.11。
对于轻度神经囊尾蚴病和症状性癫痫患儿，在完成杀囊治疗后，电话咨询是一种可接受的随访方式。
