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Abstract

Introduction: Telemedicine has become popular as a means to support clinical care at a distance, yet few limited studies have measured the reliability of the physical assessment obtained via telemedicine. Hypothesis: We hypothesized that many aspects of the circulatory, neurologic and respiratory examinations of patients admitted to a pediatric intensive care unit can be reliably obtained via telemedicine. Methods: We designed a prospective, randomized study comparing telemedicine versus face-to-face assessments of 55 pediatric intensive care unit patients. Study providers included six pediatric intensivists and seven critical care fellows. For each study patient, two providers were randomly assigned to perform an examination in-person or via telemedicine. Findings were recorded on a standardized data collection form and compared. Results: One hundred and ten data collection forms were completed. There was good agreement between the in-person and telemedicine care provider for most elements of the circulatory and neurologic examinations (kappa = 0.61-1.00). Regarding the pulmonary assessment, there was excellent agreement on determination of airway patency (kappa = 1.00) though less on other elements (kappa = -0.02-0.34). Providers identified equipment-related difficulties and environmental influences that limited their ability to obtain a reliable pulmonary assessment via telemedicine. Conclusions: Telemedicine is a powerful tool to aid in the assessment of critically ill patients. It can be used to reliably identify normal and abnormal findings on many aspects of the circulatory, neurologic and pulmonary examinations. However, one needs to be aware of certain limitations of telemedicine related to the pulmonary physical assessment for its optimal use.