Department of Family Medicine, Employee and Community Health, Mayo Clinic, USA.
Department of Nursing, Mayo Clinic, USA.
J Telemed Telecare. 2023 Jul;29(6):492-497. doi: 10.1177/1357633X21990999. Epub 2021 Feb 3.
Acute sore throat is a common complaint traditionally completed with an in-person visit. However, non-face-to-face telemedicine visits offer greater access at reduced cost. We evaluated patient/caregiver asynchronous text-based electronic visits (eVisits) for acute sore throat and whether there was concordance for individual components and total McIsaac score compared to a clinician's assessment. eVisits were completed by patients and/or their caregivers via a secure patient portal.
In this retrospective study, we manually reviewed charts between February 2017 and July 2019 of patients who had an eVisit, in-person visit and group A streptococcal (GAS) test performed on the same day for an acute sore throat. We calculated a McIsaac score for eVisits and in-person visits, and compared each component and total score using Cohen's kappa agreement statistic.
There were 320 instances of patients who had an eVisit, in-person visit and GAS testing done on the same day. Approximately a third of eVisits were missing at least one McIsaac component, with the physical examination elements missing most commonly. Individual score congruence was moderate for cough (0.41), fair for fever (0.34) and slight for tonsillar swelling/exudate and lymphadenopathy (0.17 and 0.08, respectively), with total congruence being slight to fair (0.09-0.37). A McIsaac score of ≤1 showed moderate agreement (0.44). Visits with complete individual score components demonstrated improved congruence: substantial for cough (0.64), moderate for fever (0.57), fair for tonsillar swelling (0.3) and slight for lymphadenopathy (0.13).
Overall agreement for individual score components was better for symptoms than it was for examination components, and was improved when data were complete. A McIsaac score of 1 or 0 had moderate agreement and thus could reasonably be safely used to exclude patients from GAS testing.
急性咽痛是一种常见的病症，传统上需要进行面对面的就诊。然而，非面对面的远程医疗就诊提供了更大的就诊机会，同时降低了成本。我们评估了患者/照顾者异步的基于文本的电子就诊（eVisits）在急性咽痛方面的应用，以及与临床医生的评估相比，其在各个部分和总 McIsaac 评分方面的一致性。eVisits 通过安全的患者门户由患者及其照顾者完成。
在这项回顾性研究中，我们手动查阅了 2017 年 2 月至 2019 年 7 月期间，在同一天因急性咽痛接受 eVisit、面对面就诊和 A 组链球菌（GAS）检测的患者的病历。我们为 eVisits 和面对面就诊计算了 McIsaac 评分，并使用 Cohen's kappa 一致性统计量比较了每个部分和总分。
有 320 例患者同一天接受了 eVisit、面对面就诊和 GAS 检测。大约三分之一的 eVisits 至少缺少一个 McIsaac 成分，其中最常见的是体检项目缺失。咳嗽的个体评分一致性为中度（0.41），发热的个体评分一致性为一般（0.34），扁桃体肿胀/渗出和淋巴结病的个体评分一致性为轻度到一般（0.17 和 0.08，分别），总评分一致性为轻度到一般（0.09-0.37）。McIsaac 评分≤1 显示出中度一致性（0.44）。具有完整个体评分成分的就诊显示出更好的一致性：咳嗽为显著（0.64），发热为中度（0.57），扁桃体肿胀为中度（0.3），淋巴结病为轻度（0.13）。
单个评分成分的总体一致性在症状方面优于体检成分，并且在数据完整时得到改善。McIsaac 评分 1 或 0 具有中度一致性，因此可以合理地用于安全排除 GAS 检测的患者。
