A Validation Pilot Study Comparing Telemedicine Images to a Face-to-Face Airway Exam for Conducting the Anesthesia Preoperative Airway Evaluation

Kavya Reddy,Alex Bekker,George Tewfik,Dennis Grech,Yash M Shah,Kwame Awuku,Ming Xiong,Evan Spivack

doi:10.4236/ojanes.2021.117020

Kavya Reddy, Alex Bekker + Show 6 more

Open Access

https://doi.org/10.4236/ojanes.2021.117020

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Abstract

Telemedicine is a branch of healthcare that uses communication technology to deliver medical information and services between patients and healthcare providers. The applicability of telemedicine is vast and increasingly relevant. There is a lack of research on utilizing telemedicine for remote evaluation of the airway. The primary aim of this pilot study was to validate a telemedical airway exam as a viable alternative to an in-person evaluation. Three anesthesiologists evaluated 48 volunteers by telemedicine and live examination. The telemedical exam consisted of transmitting still images of four established, predictive parameters of difficult airways: Mallampati score; neck extension; ability to prognath; and thyromental distance. Each subject’s telemedical and face-to-face scores were compared to determine their degree of correlation. Still images were taken using standardized positioning with four pictures of mouth opening, neck extension, prognath, and thyromental distance. Data were analyzed using Wilcoxon signed-rank tests and free-marginal multirater kappa analysis. Average respective scores for live versus telemedicine examination were as follows: Mallampati scores were 1.73 versus 2.54; neck extension scores were 3.77 versus 3.60; thyromental distance (measured in finger breadths) was 2.95 versus 2.92; and prognath scores were 0.97 versus 0.94. There was no difference in grading of thyromental distance or prognathy ability between live and telemedical exams, and interrater reliability was very good for both parameters. This study supports telemedicine as a reliable tool for preoperative anesthesia airway exams to identify airway difficulties. This may be especially useful as an alternative in patients with COVID-19 undergoing urgent surgery.

Highlights

Telemedicine is a branch of healthcare that uses communication technology to deliver medical information and services between patients and healthcare providers
Telemedicine is a branch of healthcare that uses communication technology, such as smartphones, video conferencing, and photographs, to provide patients and healthcare providers with medical information and services [1] [2]
Telemedicine’s growing role and potential future in anesthesia as a form of expert consultations in emergent situations has been discussed with the growth of technology through newer smartphones, tablets, and 5G networks to ensure seamlessness in communication between patients and providers [11]

Summary

Introduction

Telemedicine is a branch of healthcare that uses communication technology, such as smartphones, video conferencing, and photographs, to provide patients and healthcare providers with medical information and services [1] [2]. Studies have even shown increased patient and provider satisfaction, after inclusion of still images into the electronic medical record to supplement the in-person airway exam, in lieu of the traditional written assessment of patients’ airway exams [16]. Despite this burgeoning growth in technology, there is little statistical evidence to date that supports the use of telemedicine as a reliable substitute for an inperson preoperative airway exam using objective parameters

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