Silva Mauricio, Delfosse Erin M, Aceves-Martin Bianka, Scaduto Anthony A, Ebramzadeh Edward
Orthopaedic Institute for Children.
Department of Orthopaedics, David Geffen School of Medicine, UCLA/Orthopaedic Hospital, University of California, Los Angeles, California, USA.
J Pediatr Orthop B. 2019 Nov;28(6):542-548. doi: 10.1097/BPB.0000000000000576.
Telehealth has seldom been used in the field of pediatric orthopaedics. The purpose of this study is to assess the efficacy of telehealth as a tool for the follow-up of children with nondisplaced elbow fractures. We hypothesize that patients treated via telehealth will have comparable clinical outcomes as those treated at our institution, with increased patient satisfaction. We conducted a randomized trial, which included 52 children with type I supracondylar humeral fractures, or occult elbow injuries, divided in two groups, based on the type of care provided during the fourth-week follow-up appointment: cast removal at our institution (group A) or cast removal at home via telehealth appointment (group B). The time duration and professional fees for this week 4 follow-up were calculated. Patients in both groups returned to our institution for a final follow-up in week 8. We measured the amount of fracture displacement, range of motion, pain, and patient satisfaction. There was no statistically significant difference in fracture displacement, range of motion, or pain scores between groups. The mean length of the fourth-week clinical encounter was higher in group A than group B (47.2 vs. 17.6 min, respectively; P < 0.001). Initially, the mean patient satisfaction scores were nearly identical in both groups (97%) until patients in group A were made aware of this difference in time duration, at which their mean satisfaction score decreased to 76.4% (P = 0.05). The use of telehealth as a tool in the treatment of nondisplaced pediatric elbow fractures is appealing. Patients managed via telehealth had higher satisfaction rates and spent only a third of the time for their clinical encounter.
远程医疗在小儿骨科领域很少被使用。本研究的目的是评估远程医疗作为无移位肘部骨折患儿随访工具的疗效。我们假设通过远程医疗治疗的患者将获得与在我们机构接受治疗的患者相当的临床结果，同时患者满意度会提高。我们进行了一项随机试验，该试验纳入了52例肱骨髁上I型骨折或隐匿性肘部损伤的儿童，根据第四周随访预约期间提供的护理类型分为两组：在我们机构拆除石膏（A组）或通过远程医疗预约在家中拆除石膏（B组）。计算了第四周随访的时长和专业费用。两组患者均在第8周返回我们机构进行最终随访。我们测量了骨折移位量、活动范围、疼痛程度和患者满意度。两组之间在骨折移位、活动范围或疼痛评分方面没有统计学上的显著差异。A组第四周临床问诊的平均时长高于B组（分别为47.2分钟和17.6分钟；P<0.001）。最初，两组患者的平均满意度评分几乎相同（97%），直到A组患者意识到时长差异，此时他们的平均满意度评分降至76.4%（P=0.05）。将远程医疗作为治疗无移位小儿肘部骨折的工具很有吸引力。通过远程医疗管理的患者满意度更高，且临床问诊时间仅为原来的三分之一。
