Gunasekeran Dinesh Visva, Liu Zhenghong, Tan Win Jim, Koh Joshua, Cheong Chiu Peng, Tan Lay Hong, Lau Chee Siang, Phuah Gaik Kheng, Manuel Newsie Donnah A, Chia Che Chong, Seng Gek Siang, Tong Nancy, Huin May Hang, Dulce Suzette Villaluna, Yap Susan, Ponampalam Kishanti, Ying Hao, Ong Marcus Eng Hock, Ponampalam R
Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
J Med Internet Res. 2020 Jun 15;22(6):e17417. doi: 10.2196/17417.
The benefits of telemedicine include cost savings and decentralized care. Video consultation is one form that enables early detection of deteriorating patients and promotion of self-efficacy in patients who are well but anxious. Abdominal pain is a common symptom presented by patients in emergency departments. These patients could benefit from video consultation, as it enables remote follow-up of patients who do not require admission and facilitates early discharge of patients from overcrowded hospitals.
The study aimed to evaluate the safety and efficacy of the use of digital telereview in patients presenting with undifferentiated acute abdominal pain.
The SAVED study was a prospective randomized controlled trial in which follow-up using existing telephone-based telereview (control) was compared with digital telereview (intervention). Patients with undifferentiated acute abdominal pain discharged from the emergency department observation ward were studied based on intention-to-treat. The control arm received routine, provider-scheduled telereview with missed reviews actively coordinated and rescheduled by emergency department staff. The intervention arm received access to a platform for digital telereview (asynchronous and synchronous format) that enabled patient-led appointment rescheduling. Patients were followed-up for 2 weeks for outcomes of service utilization, efficacy (compliance with their disposition plan), and safety (re-presentation for the same condition).
A total of 70 patients participated, with patients randomly assigned to each arm (1:1 ratio). Patients were a mean age of 40.0 (SD 13.8; range 22-71) years, predominantly female (47/70, 67%), and predominantly of Chinese ethnicity (39/70, 56%). The telereview service was used by 32 patients in the control arm (32/35, 91%) and 18 patients in the intervention arm (18/35, 51%). Most patients in control (33/35, 94%; 95% CI 79.5%-99.0%) and intervention (34/35, 97%; 95% CI 83.4%-99.9%) arms were compliant with their final disposition. There was a low rate of re-presentation at 72 hours and 2 weeks for both control (72 hours: 2/35, 6%; 95% CI 1.0%-20.5%; 2 weeks: 2/35, 6%, 95% CI 1.0%-20.5%) and intervention (72 hours: 2/35, 6%; 95% CI 1.0%-20.5%; 2 weeks: 3/35, 9%, 95% CI 2.2%-24.2%) arms. There were no significant differences in safety (P>.99) and efficacy (P>.99) between the two groups.
The application of digital telereview for the follow-up of patients with abdominal pain may be safe and effective. Future studies are needed to evaluate its cost-effectiveness and usefulness for broader clinical application.
ISRCTN Registry ISRCTN28468556; http://www.isrctn.com/ISRCTN28468556.
远程医疗的益处包括节省成本和分散式医疗。视频会诊是一种形式，能够早期发现病情恶化的患者，并提高健康但焦虑患者的自我效能感。腹痛是急诊科患者常见的症状。这些患者可从视频会诊中受益，因为它能对无需住院的患者进行远程随访，并有助于将患者从人满为患的医院尽早出院。
本研究旨在评估对未分化急性腹痛患者使用数字远程复查的安全性和有效性。
SAVED研究是一项前瞻性随机对照试验，将使用现有的基于电话的远程复查（对照组）进行随访与数字远程复查（干预组）进行比较。对从急诊科观察病房出院的未分化急性腹痛患者进行意向性治疗研究。对照组接受常规的、由医护人员安排的远程复查，急诊科工作人员积极协调并重新安排错过的复查。干预组可使用一个数字远程复查平台（异步和同步形式），该平台允许患者自主重新安排预约。对患者进行为期2周的随访，观察服务利用情况、有效性（遵守其处置计划情况）和安全性（因相同病情再次就诊情况）等结果。
共有70名患者参与，患者被随机分配到每组（比例为1:1）。患者的平均年龄为40.0（标准差13.8；范围22 - 71）岁，以女性为主（47/70，67%），以华裔为主（39/70，56%）。对照组32名患者（32/35，91%）和干预组18名患者（18/35，51%）使用了远程复查服务。对照组大多数患者（33/35，94%；95%置信区间79.5% - 99.0%）和干预组大多数患者（34/35，97%；95%置信区间83.4% - 99.9%）都遵守了其最终处置方案。对照组和干预组在72小时和2周时的再次就诊率都很低（72小时：对照组2/35，6%；95%置信区间1.0% - 20.5%；干预组2/35，6%；95%置信区间1.0% - 20.5%；2周：对照组2/35，6%，95%置信区间1.0% - 20.5%；干预组3/35，9%，95%置信区间2.2% - 24.2%）。两组在安全性（P>.99）和有效性（P>.99）方面无显著差异。
对腹痛患者应用数字远程复查进行随访可能是安全有效的。未来需要开展研究评估其成本效益以及在更广泛临床应用中的实用性。
ISRCTN注册库ISRCTN28468556；http://www.isrctn.com/ISRCTN28468556 。
