Stanford University School of Medicine, Stanford, California, USA.
Flushing Hospital Medical Center, Flushing, New York, USA.
Low Urin Tract Symptoms. 2023 Sep;15(5):200-205. doi: 10.1111/luts.12496. Epub 2023 Jul 13.
Telemedicine for pediatric lower urinary tract symptoms (pLUTS) is a relatively new mode of delivering bladder health education with scant evidence supporting current practice. We aim to examine the safety of pLUTS-related telemedicine visits surrounding the COVID-19 pandemic.
We conducted a retrospective cohort study of new pLUTS referral diagnoses to our institution's pediatric urology clinics. Demographics, wait times, and referral diagnoses were captured and compared before and after March 2020 using χ /Fisher exact tests and t-tests. A retrospective chart review was performed for an initial telemedicine visit followed by an in-person visit to identify missed radiology, lab, or physical exam findings.
Six hundred twelve patients were included from September 2018 to August 2021. Most were 5-10 years old (62.3%), female (56.2%), English speaking (86.5%), White (39.4%), and had private insurance (67.2%). Wait times were shorter for telemedicine versus in-person visits (t = -3.56, p < .001). After March 2020, patients with a urinary tract infection (UTI) and females utilized in-person visits more often (p < .001). After chart review (11 patients, mean = 10.4 years), 9 (81.8%) had comorbid conditions and/or family history of lower urinary tract symptoms. None had missed clinical findings that changed management.
pLUTS care can be delivered via telemedicine without a significant change in patient volume and population, though additional investigations will clarify the needs of patients with specific referral diagnoses and comorbid conditions. The in-person exam can be omitted safely with proper clinical history taking, supporting future virtual programs that address delays in care within local communities.
儿科下尿路症状（pLUTS）的远程医疗是一种提供膀胱健康教育培训的新模式，目前的实践几乎没有证据支持。我们旨在研究 COVID-19 大流行期间与 pLUTS 相关的远程医疗访问的安全性。
我们对我院小儿泌尿科诊所新的 pLUTS 转诊诊断进行了回顾性队列研究。使用 χ2/Fisher 确切检验和 t 检验比较 2020 年 3 月前后的人口统计学、等待时间和转诊诊断。对首次远程医疗就诊进行回顾性病历复查，然后进行面对面就诊，以确定是否漏诊放射学、实验室或体格检查结果。
从 2018 年 9 月至 2021 年 8 月，共纳入 612 例患者。他们大多 5-10 岁（62.3%），女性（56.2%），讲英语（86.5%），白人（39.4%），有私人保险（67.2%）。与面对面就诊相比，远程医疗的等待时间更短（t =-3.56，p<.001）。2020 年 3 月后，患有尿路感染（UTI）的患者和女性更常使用面对面就诊（p<.001）。在病历复查后（11 例，平均年龄 10.4 岁），9 例（81.8%）有合并症和/或下尿路症状的家族史。无一例有改变管理的漏诊临床发现。
pLUTS 护理可以通过远程医疗提供，而不会对患者数量和人群产生重大影响，尽管进一步的研究将阐明具有特定转诊诊断和合并症的患者的需求。在适当的临床病史采集下，可以安全省略体格检查，支持未来的虚拟项目，以解决当地社区的护理延迟问题。
