Shah Sunny R, Munhall Christopher C, Nguyen Shaun A, O'Rourke Ashli K, Miccichi Kate, Meyer Ted A
Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
Department of IT Telemedicine, McLeod Health, Florence, SC, USA.
J Telemed Telecare. 2024 Oct;30(9):1386-1397. doi: 10.1177/1357633X231156207. Epub 2023 Mar 14.
COVID-19 has led to delays in providing healthcare in both emergency and non-emergency settings, especially in surgical subspecialties which rely heavily on referrals and in-person visits. Without an established telehealth infrastructure, many otorhinolaryngological departments experienced decreases in consultations. Telemedicine has attempted to bridge the gap between pre- and post-pandemic periods by creating a safe avenue of communication between otorhinolaryngologists and patients. This review hopes to address the accuracy of telemedicine in patient diagnosis and management.
Searches were conducted since study conception until June 30, 2022, on multiple databases including PubMed, SCOPUS, and CINAHL for this systematic review and meta-analysis. Diagnostic accuracy, management accuracy, kappa, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were meta-analyzed by comparing virtual visits to in-person visits (gold standard).
Nineteen studies were included in this review. A total of 1518 patients were included across all studies. When comparing virtual visits against in-person visits, accurate diagnosis was made in 86.2% [82.1,89.9, = 73.5%, < 0.0001] of patients and management accuracy was 91.5% [86.1,95.7, = 81.8%, < 0.0001] when treating patients. Kappa value determining interrater reliability was 0.8 [0.7,0.9, = 81.8%, < 0.0001].
Our data suggest that diagnostic and management concordance is above 80% when comparing diagnosis and management strategies in patients who underwent both telehealth and in-person visits with an otorhinolaryngologist. In uncomplicated patients, telehealth might be a reliable source for diagnosis and management however, in-person consultation is likely still required for pathologies in which physical exam, imaging or procedural elements represent a vital component of the work-up.
新型冠状病毒肺炎（COVID-19）导致了急诊和非急诊环境下医疗服务的延迟，尤其是在严重依赖转诊和面对面就诊的外科亚专业领域。由于缺乏成熟的远程医疗基础设施，许多耳鼻喉科部门的会诊量有所下降。远程医疗试图通过在耳鼻喉科医生和患者之间建立一条安全的沟通渠道，弥合疫情前和疫情后时期的差距。本综述旨在探讨远程医疗在患者诊断和管理中的准确性。
从研究构思开始至2022年6月30日，在多个数据库（包括PubMed、SCOPUS和CINAHL）中进行检索，以进行本系统评价和荟萃分析。通过将虚拟就诊与面对面就诊（金标准）进行比较，对诊断准确性、管理准确性、kappa值、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）进行荟萃分析。
本综述纳入了19项研究。所有研究共纳入1518例患者。将虚拟就诊与面对面就诊进行比较时，患者的准确诊断率为86.2%[82.1,89.9，I² = 73.5%，P < 0.0001]，治疗患者时的管理准确率为91.5%[86.1,95.7，I² = 81.8%，P < 0.0001]。确定评分者间可靠性的kappa值为0.8[0.7,0.9，I² = 81.8%，P < 0.0001]。
我们的数据表明，在对同时接受远程医疗和耳鼻喉科医生面对面就诊的患者进行诊断和管理策略比较时，诊断和管理的一致性超过80%。对于病情不复杂的患者，远程医疗可能是诊断和管理的可靠来源，然而，对于体格检查、影像学或手术操作是检查关键组成部分的疾病，可能仍需要面对面会诊。
