Advances in Telemedicine: Remote Vs. Conventional Physical Examination

Abstract

Abstract Importance: The accuracy of novel devices enabling remote physical examination (PE) of patients has not been clinically established. Objective: In this study we sought to evaluate the performance of a remote-based diagnostic tool enabling PE as compared to the standard PE. Design: A prospective study of a convenience sample. Setting: The emergency department (ED) of a university affiliated, tertiary, pediatric facility between July 2016 and January 2017. Participants: Children aged 2-18 years referred to the ED. Intervention: Eligible patients underwent PE of the heart, lungs, ears and throat by a single physician using a remote device (RD), and data captured got stored on a cloud-based server and later interpreted by a single EDA physician. Upon completion of the RD examination, a standard PE was held by an ED attending (EDA) physician and results were documented in the hospital electronic medical records. All physicians were blinded to each other PEs. The quality of the data retrieved, user satisfaction and RD adverse events were also recorded. Outcome measures: The agreement between the RD and standard PE results served as the main outcome measure. Secondary outcome measures were the quality of the data retrieved and user satisfaction of the RD. Results: The cohort included 138 children (59% male) of mean age 8.1±5 years. Analysis of the agreement between the remote device and conventional examinations yielded the following kappa values: heart, 0.674; right lung, 1.000; left lung 1.000; right ear, 0.467; left ear, 0.725; and throat 0.796. The average scores for quality of the data were as follows: heart, 4.94; right lung, 4.35; left lung, 4.31; right ear, 3.93; left ear, 4.00; and throat, 4.93. The corresponding average scores for user satisfaction with the remote device experience were 4.95, 3.92, 4.10, 4.64, 4.76 and 4.77. No adverse events were recorded. Conclusions and Relevance: Remote device assisted PE of children presenting to the ED appears to be efficient and safe, with overall good agreement of the results with the standard PE. Further research is required to establish its role as part of a routine telehealth visit and its performance when used by non-professional persons. Keywords Pediatrics; Children; Emergency medicine; Medical service; Physical examination; Telemedicine; Telehealth; Remote device; Tele-examination; COVID-19 Abbreviations ED: Emergency Department; EDA: Emergency Department Attending; PE: Physical Examination; RD: Remote Device