Foni Noel Oizerovici, Accorsi Tarso Augusto Duenhas, Correia Renata Farias Vidigal, Moreira Flavio Tocci, Lima Karine De Amicis, Morbeck Renata Albaladejo, Souza Jose Leão de, Pedrotti Carlos Henrique Sartorato, Wolosker Nelson
Emergency Department, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Telemedicine Department, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Telemed J E Health. 2024 Dec;30(12):2859-2869. doi: 10.1089/tmj.2024.0312. Epub 2024 Aug 21.
There is a lack of randomized controlled trials focusing on orthopedic telemedicine (TM). The objective of this research was to compare the diagnostic accuracy and pattern of TM consultations of low-risk orthopedic patients performed by general practitioners (GPs) with those of face-to-face evaluations by orthopedists at an emergency department (ED). This randomized, single-center study was conducted between October 2021 and November 2022 on patients at an ED. Inclusion criteria were age >18 years, low back pain, extremity contusion, ankle sprain, or neck pain. Eligible patients were randomized 1:1 for TM consultations by generalist physicians with subsequent face-to-face orthopedic evaluations (TM-ED group) or face-to-face evaluations by orthopedic physicians (ED group). Primary outcomes were syndromic diagnosis, physical examination, and tests ordered. Secondary analysis included a satisfaction survey. A total of 99 patients were enrolled; mean age was 41 ± 10.1 years, and 62.6% were female. The most common conditions were foot contusion (28.3%), ankle sprain (27.3%), hand contusion (19.2%), low back pain (19.2%), and neck pain (6.1%). Syndromic diagnosis showed no difference between groups ( = 0.231). In the TM-ED group ( = 51), self-examination demonstrated moderate to good agreement with face-to-face evaluations in several areas. Both groups showed similar tests practices. Patient satisfaction was higher in the TM-ED group across multiple measures. TM consultations for low-risk orthopedic patients by GPs are not inferior to face-to-face specialist evaluations at the ED. Virtual assessments are associated with higher patient satisfaction. Clinical Trial Identifier: NCT04981002.
目前缺乏针对骨科远程医疗（TM）的随机对照试验。本研究的目的是比较全科医生（GPs）对低风险骨科患者进行的TM会诊的诊断准确性和模式，与急诊科（ED）骨科医生进行的面对面评估的诊断准确性和模式。这项随机、单中心研究于2021年10月至2022年11月在一家急诊科对患者进行。纳入标准为年龄>18岁、腰痛、肢体挫伤、踝关节扭伤或颈部疼痛。符合条件的患者按1:1随机分组，由全科医生进行TM会诊，随后进行面对面的骨科评估（TM-ED组）或由骨科医生进行面对面评估（ED组）。主要结局指标为症状诊断、体格检查和所开的检查。次要分析包括满意度调查。共纳入99例患者；平均年龄为41±10.1岁，62.6%为女性。最常见的病症为足部挫伤（28.3%）、踝关节扭伤（27.3%）、手部挫伤（19.2%）、腰痛（19.2%）和颈部疼痛（6.1%）。症状诊断在两组之间无差异（ = 0.231）。在TM-ED组（ = 51）中，自我检查在几个方面与面对面评估显示出中度至良好的一致性。两组的检查操作相似。在多项指标上，TM-ED组的患者满意度更高。全科医生对低风险骨科患者进行的TM会诊并不逊于急诊科的面对面专科评估。虚拟评估与更高的患者满意度相关。临床试验标识符：NCT04981002。
