Division of Pediatric Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd., Wilmington, DE, 19803, USA.
Division of Pediatric Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd., Wilmington, DE, 19803, USA; Department of Otolaryngology - Head and Neck Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA.
Int J Pediatr Otorhinolaryngol. 2021 Jun;145:110712. doi: 10.1016/j.ijporl.2021.110712. Epub 2021 Apr 19.
The objective of this study was to evaluate the feasibility of telehealth visits and compare office-based visits for pediatric patients undergoing evaluation of recurrent acute otitis media or sleep-disordered breathing.
A retrospective cohort study compared telehealth patients with matched controls seen in the office. The feasibility of a thorough patient evaluation in a single telehealth visit without a follow-up office visit was assessed. Both groups were also compared for completeness of physical exam, management, follow-up recommendations, and correlation of physical exam findings with intraoperative findings.
100 children [mean age (SD) = 20.7 (15.6) months] with a chief complaint of recurrent acute otitis media and 128 children [5.4 (3.2) years] with a chief complaint of sleep-disordered breathing were evaluated. Recommendations for surgery, additional studies, or routine follow-up were similar between telehealth and office-based groups. Physical exam feasibility was significantly different for the nasal cavity, oropharynx, and middle ear (P < .001). Patients who underwent office-based consultation were much more likely to have findings of middle ear fluid at the time of tympanostomy tube placement (79.3% vs 39.3%, P = .002). There was no significant difference between preoperative and intraoperative tonsil size discrepancies (P = .749).
Telehealth can be used successfully for the evaluation of pediatric patients with sleep-disordered breathing; however, reliance on history alone may result in unnecessary tympanostomy tube placement in patients with recurrent acute otitis media. Physical examination of the oropharynx, nasal cavity, and middle ear via telehealth presents a unique challenge in pediatric otolaryngology.
本研究旨在评估远程医疗就诊的可行性，并比较儿童复发性急性中耳炎或睡眠呼吸障碍患者的门诊就诊。
回顾性队列研究比较了远程医疗患者和在门诊就诊的匹配对照组。评估了在单次远程医疗就诊中不进行后续门诊就诊即可全面评估患者的可行性。还比较了两组体格检查的完整性、管理、随访建议以及体格检查结果与术中发现的相关性。
评估了 100 例（平均年龄（SD）= 20.7（15.6）个月）主诉复发性急性中耳炎和 128 例（5.4（3.2）岁）主诉睡眠呼吸障碍的儿童。手术、额外检查或常规随访的建议在远程医疗和门诊就诊组之间相似。鼻腔、口咽和中耳的体格检查可行性差异有统计学意义（P<0.001）。接受门诊咨询的患者在鼓膜切开术置管时更有可能发现中耳积液（79.3% vs 39.3%，P=0.002）。术前和术中扁桃体大小差异无统计学意义（P=0.749）。
远程医疗可成功用于评估患有睡眠呼吸障碍的儿科患者；然而，仅依靠病史可能导致复发性急性中耳炎患者不必要的鼓膜切开术置管。通过远程医疗进行的口咽、鼻腔和中耳的体格检查在儿科耳鼻喉科中提出了独特的挑战。
