Telemedicine Department, Hospital Israelita Albert Einstein, Sāo Paulo, Brazil.
Telemedicine Department, Hospital Israelita Albert Einstein, Sāo Paulo, Brazil.
Int J Infect Dis. 2022 Aug;121:106-111. doi: 10.1016/j.ijid.2022.04.059. Epub 2022 Apr 30.
To analyze the effectiveness of telemedicine consultations during an outbreak in reducing the need for face-to-face consultations at a field hospital for patients with dengue.
We performed a retrospective unicentric study between April and May 2015 with 4626 patients (≥15 years old) who spontaneously sought care at an emergency field hospital (Sāo Paulo/Brazil). A nurse initially assessed all patients with dengue through rapid diagnostic testing, automated complete blood count, and risk stratification. During overcrowded situations, a video-based telemedicine consultation was provided as an option to all low-to-moderate risk patients who tested positive. The management was carried out according to current dengue guidelines. The primary end point was a referral to immediate face-to-face medical evaluation.
Of all patients suspected of dengue infection, 2003 presented positive testing, 1978 were classified as low-moderate risk, and 267 patients with dengue were evaluated by telemedicine. The mean age was 38.17 ± 13.7 years (54.6% female). Oral medications were recommended in 169 (63.3%), intravenous hydration or symptomatic drugs in 96 (36%), 252 (94.4%) were discharged after telemedicine assessment, and only 15 (5.6%) were referred to immediate face-to-face medical evaluation. No adverse events were recorded.
Telemedicine medical assessment of low-to-moderate risk patients with dengue previously screened by nursing triage is effective in replacing the face-to-face evaluation in a field hospital. Telemedicine may be reinforced in epidemiological outbreak scenarios as a cost-effective strategy for the initial assessment of acute patients.
分析在传染病爆发期间远程医疗咨询对减少登革热患者到野战医院进行面对面咨询的需求的效果。
我们进行了一项回顾性单中心研究，纳入 2015 年 4 月至 5 月期间在一个急诊野战医院（巴西圣保罗）就诊的 4626 例（≥15 岁）自行就诊的患者。一名护士通过快速诊断检测、自动化全血细胞计数和风险分层对所有登革热患者进行初步评估。在人满为患的情况下，为所有检测呈阳性且风险较低至中度的患者提供基于视频的远程医疗咨询作为一种选择。根据当前的登革热指南进行管理。主要终点是转诊至立即进行面对面医学评估。
所有疑似登革热感染的患者中，2003 例检测呈阳性，1978 例被分类为低中度风险，267 例登革热患者接受了远程医疗评估。患者的平均年龄为 38.17±13.7 岁（54.6%为女性）。169 例（63.3%）患者推荐口服药物，96 例（36%）患者推荐静脉补液或对症药物，252 例（94.4%）在远程医疗评估后出院，仅有 15 例（5.6%）患者被转诊至立即进行面对面医学评估。未记录到不良事件。
通过护理分诊初步筛选的低中度风险登革热患者进行远程医疗评估可有效替代野战医院的面对面评估。在传染病爆发期间，远程医疗可能作为一种具有成本效益的策略，用于对急性患者进行初始评估，因此可得到加强。
