Gulati Sheffali, Shruthi N M, Panda Prateek Kumar, Sharawat Indar Kumar, Josey Mable, Pandey Ravindra M
Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
Seizure. 2020 Dec;83:98-103. doi: 10.1016/j.seizure.2020.10.002. Epub 2020 Oct 6.
Childhood epilepsy forms a significant burden on the health-care delivery system. Only a few pediatric neurologists available in most of the developing countries and caregivers face a lot of financial and logistic hardships, apart from a long waiting period for initial and follow up visits. Telemedicine is a proposed effective alternative in overcoming this burden.
Telephonic consultation by a pediatric neurology fellow was compared with that of a specialty nurse; both against face-to-face consultation (gold standard). Care-givers of children 4 months-18 years with epilepsy were telephonically consulted 24-48 hours before their scheduled hospital appointment by one specialty nurse and one pediatric neurology fellow at least 24 h apart in a random sequence. During the hospital visit, another pediatric neurology fellow blinded to the telephonic consultation, documented the same after Face-to-Face interview.
In 141 children with epilepsy, 504 critical clinical events were identified. Telephonic consultation by pediatric neurology fellow had a sensitivity of 99 %, 97 %, and 100 % and specificity of 100 % each in detecting whether the child had any breakthrough seizure, any adverse event and whether the drug compliance was adequate or poor respectively, as compared to face-to-face consultation. Telephonic consultation by specialty nurse had a sensitivity of 91 %, 84 %, and 98 % and specificity of 97 %, 99 %, and 81 % in detecting whether the child had any breakthrough seizure, adverse event and whether the drug compliance was adequate or poor respectively. But the specialty nurses fared poorly in identifying atypical seizure semiologies like atonic and myoclonic seizures and documenting an exact number of breakthrough seizures, as well as few subjective adverse effects like behavioral abnormality and scholastic worsening, which was performed excellently by the pediatric neurology fellow.
Telephonic consultation in childhood epilepsy by pediatric neurology fellow has excellent sensitivity and specificity. A specialty nurse has also acceptable sensitivity and specificity in comparison with a face-to-face consultation.
儿童癫痫给医疗保健系统带来了沉重负担。在大多数发展中国家，儿科神经科医生数量稀少，除了初诊和复诊等待时间长外，照顾者还面临诸多经济和后勤方面的困难。远程医疗被认为是克服这一负担的有效替代方案。
将儿科神经科住院医师的电话咨询与专科护士的电话咨询进行比较，两者均与面对面咨询（金标准）进行对比。在预定的医院预约前24 - 48小时，由一名专科护士和一名儿科神经科住院医师以随机顺序，至少间隔24小时，对4个月至18岁癫痫患儿的照顾者进行电话咨询。在医院就诊期间，另一名对电话咨询不知情的儿科神经科住院医师在面对面访谈后进行记录。
在141例癫痫患儿中，共识别出504个关键临床事件。与面对面咨询相比，儿科神经科住院医师的电话咨询在检测患儿是否有任何突破性癫痫发作、任何不良事件以及药物依从性是否良好方面，敏感性分别为99%、97%和100%，特异性均为100%。专科护士的电话咨询在检测患儿是否有任何突破性癫痫发作、不良事件以及药物依从性是否良好方面，敏感性分别为91%、84%和98%，特异性分别为97%、99%和81%。但专科护士在识别非典型癫痫发作形式如失张力和肌阵挛发作以及记录突破性癫痫发作的确切数量方面表现不佳，在记录一些主观不良影响如行为异常和学业成绩下降方面也表现欠佳，而儿科神经科住院医师在这些方面表现出色。
儿科神经科住院医师对儿童癫痫进行电话咨询具有出色的敏感性和特异性。与面对面咨询相比，专科护士的敏感性和特异性也可接受。
