Telemedicine diagnosis of acute respiratory tract infection patients is not inferior to face-to-face consultation: a randomized trial

Abstract

Objective To analyze telemedicine diagnostic accuracy in patients with respiratory infections during COVID-19 pandemic compared to face-to-face evaluation in the emergency department. Methods Randomized, unicentric study between September 2020 and November 2020 in patients with any respiratory symptom (exclusion criteria: age >65 years, chronic heart or lung diseases, immunosuppressed). Patients were randomized 1:1 for brief telemedicine followed by face-to-face consultation or direct face-to-face evaluation. The primary endpoint was the International Classification of Diseases code. The secondary analysis comprised length of stay, diagnostic test ordering, medical prescription, and proposed destination. Results Ninety-eight patients were enrolled. The mean age was 36.3±9.7 years old, 57.1% were women, and 81.6% had diagnostic test ordered. Mean grouped by International Classification of Diseases code for upper respiratory tract infection, pharyngotonsillitis, and sinusitis showed no difference between study groups or secondary endpoints. The Telemedicine Group was representative of the population usually evaluated in this center. In the Telemedicine Group (n=48), 18.7% patients would be referred for evaluation at the emergency department. The distribution of diagnoses by telemedicine was 67.4% for upper respiratory tract infection, 2.3% for pharyngotonsillitis, and 0% for sinusitis, being statistically similar to the subsequent face-to-face assessment, respectively: 72.1%, 11.6% and 7% (Kappa 0.386 [95%CI: 0.112-0.66]; p=0.536). Telemedicine ordered COVID-19 molecular (RT-PCR) tests in 76.5% versus 79.4% in face-to-face evaluation (Kappa 0.715 [95%CI: 0.413-1]; p>0.999). Conclusion Diagnostic telemedicine consultation of low-risk patients with acute respiratory symptoms is not inferior to face-to-face evaluation at emergency department. Telemedicine is to be reinforced in the health care system as a strategy for the initial assessment of acute patients. ClinicalTrials.gov Identifier: NCT04806477

Digital Innovations in Pneumonia Care: A Mini Review

“…Telephone interviews were rapid (5 minutes and 30 seconds on average), and patients received appropriate treatment based on drug testing. 19 There were no significant differences between the telemedicine and control groups in final diagnoses, orders, ED visit times, or prescriptions.…”

“…This study was conducted by Accorsi et al 19 conducted a comparative trial comparing ubiquitous face-to-face telemedicine evaluation of patients with respiratory tract infection (RTI) during the COVID-19 pandemic. The trial was conducted between September and November 2020 and included 98 low-risk patients evaluated in the emergency department (ED) with symptoms of acute IRI.…”

Telemedicine in Primary Practice in the Age of the COVID-19 Pandemic—Review

“…Most studies were conducted in Europe (n = 7), and the remaining papers originated from Asia (n = 7), North America (n = 6), Australia (n = 1), and South America (n = 1). The most articles about telehealth covering various types of teleconsultations was published in Europe [ 13 , 14 , 15 ] and one work in North America [ 16 ] and South America [ 12 ]. In Asia, all publications concerned AI techniques and remote patient monitoring.…”

“…Telephone history taking in primary health care was effective in detecting pneumonia in patients diagnosed with mild SARS-CoV-2 [ 16 ]. Accorsi et al, in their randomized trial, showed that teleconsultation is comparable to an in-patient consultation for patients with a low risk of progressing to a severe course of COVID-19 infection who developed symptoms of acute respiratory tract infection [ 12 ].…”

Internet hospital response to the COVID-19 pandemic in a tertiary hospital in China: Perspectives based on a mixed-methods

“…The current Internet-based medical practice of the respiratory medicine department has produced favorable results in the management of chronic respiratory diseases and in the diagnosis of low-risk patients with acute respiratory symptoms. 37 , 38 Therefore, during departmental development, while continuing to promote efficient personalized consultation, the quality of medical services may also be improved in terms of the management of chronic diseases through the organization and analysis of diagnosis and treatment data of patients with chronic diseases. Moreover, introducing common symptoms and treatment plans to the general public may help patients to self-evaluate their conditions to improve the overall efficiency of medical services.…”