Abstract
The use of telemedicine in ICUs has grown and is becoming increasingly recognized. However, its impact on PICUs remains unclear. This systematic review and meta-analysis aimed to evaluate whether telemedicine in the PICU has the potential to improve clinical and non-clinical outcomes. PubMed, Scopus, LILACS, and CINAHL electronic databases were searched to identify studies that assessed the impact of telemedicine on clinical outcomes, with no publication date restrictions. The reference lists of the selected articles were hand-searched for additional studies that had not been identified by the initial electronic search. Studies were included if they had a cohort design, used telemedicine, were conducted in PICUs or specialized PICUs, and were published in Portuguese, English, or Spanish. Two groups of reviewers independently screened titles and abstracts for inclusion. The same group of reviewers independently assessed the full-text articles for eligibility and extracted the following information: telecommunication method, intervention characteristics, patient characteristics, sample size, and main results. Studies were meta-analyzed using a random-effects model to estimate the pooled prevalence of PICU mortality and length of PICU stay. Risk of bias was assessed using the Newcastle-Ottawa Scale. Of 2703 studies initially identified, 2226 had their titles and abstracts screened. Of these, 53 were selected for full-text reading, of which 10 were included and analyzed. The main results of interest were length of PICU stay, number of deaths or mortality rate, and satisfaction of health professionals and family members. The results of meta-analysis show that the mortality rate reduced by 34% with an increase of the length of PICU stay in the PICUs with the use of telemedicine. Family members and health professionals were satisfied with the use of telemedicine. Telemedicine has the potential to improve PICU outcomes, such as mortality rate and family and staff satisfaction. However, it extended length of PICU stay in the studies included in this systematic review.
Highlights
Telemedicine has become an option to overcome access barriers to health services due to its ability to overcome geographical barriers and to bridge health care gaps
Even the lower number of studies included in the meta-analysis, we follow the guidelines of Viechtbauer et al, indicating that the effects do not depend on a single study, to exclude the outliers or influential cases may be an error, once small or large effects could be a result of chance alone [31]
Based on the analysis of satisfaction, both family members and health professionals were satisfied with the use of telemedicine in the pediatric ICUs (PICUs) (Tables 1 and 2)
Summary
The keywords required for our searches were identified using the participants, interventions, comparators, outcomes, and study design (PICOS) approach [12, 13] in order to guide the search and obtain the specific studies that would best serve our review. A search strategy was developed for each database using specific search terms (S1 File). We performed the search of the following databases through April 16, 2021: MEDLINE (via PubMed), Scopus, Latina American and Caribbean Health Sciences Literature (LILACS), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) electronic databases. The reference lists of the selected articles were hand-searched for additional studies that had not been identified by the initial electronic search. The literature search was performed under the guidance of a librarian with experience in database searches
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