Utility of Smartphone Telemedical Consultations for Peritonsillar Abscess Diagnosis and Triage

Abstract

IMPORTANCETelemedicine is rapidly gaining traction as a way to reduce costs and connect patients with medical experts outside their local communities. Peritonsillar abscess (PTA) is a logical pathologic condition to evaluate for effectiveness of remote diagnosis given its prevalence and the paucity of on-site otolaryngologists at many institutions.OBJECTIVE To explore the potential of otolaryngology telemedical consultation in triaging and diagnosing patients with suspected PTA. DESIGN, SETTING, AND PARTICIPANTSA comparative effectiveness research study was conducted from January 1 to June 30, 2018, at 3 tertiary care hospitals among 31 consecutive patients aged 18 to 85 years for whom the otolaryngology department was consulted to assess for PTA. Statistical analysis was conducted from July 1 to September 30, 2018.INTERVENTIONS Telemedical evaluation of suspected PTA by 5 attending otolaryngologists blinded to patients' history aside from the chief report of odynophagia. Otolaryngologists rated each patient video on whether they believed the patient had a PTA and whether the case warranted prompt evaluation by an otolaryngologist. Predictions were compared with the criterion standard of drainage or negative needle aspiration. Otolaryngologists additionally assessed video quality. MAIN OUTCOMES AND MEASURESRates of accurate diagnosis and triage of PTA based on otolaryngologists' review of oropharyngeal examinations recorded using standard smartphone cameras, as well as percentage of videos of oropharyngeal examinations using standard smartphone cameras deemed of sufficiently high quality for clinical decisionmaking.RESULTS A total of 31 patients (16 women [51.6%]; mean age, 31.9 years [range, 18-62 years]) were recruited, and 16 patients (51.6%) had a PTA. Comparing otolaryngologists' predictions with PTA status by the criterion standard, the prediction was consistent with that of the criterion standard 81% of the time averaged across otolaryngologists (mean diagnostic accuracy, 0.81). Similarly, the mean diagnostic accuracy was 0.83 when comparing the otolaryngologist's suggestion for a prompt in-person evaluation with actual PTA status by the criterion standard. Comparing patients who were deemed to require prompt otolaryngology evaluation and those with PTA by the criterion standard, mean sensitivity was 90%. Videos were rated as of sufficiently high quality to make a diagnosis in 154 of 155 videos (99.4%). CONCLUSIONS AND RELEVANCEThis study suggests that telemedical consultation is a viable, cost-conscious, efficient, and safe approach to PTA management. Despite having some difficulty diagnosing PTAs based on "history concerning for PTA" and oropharyngeal video alone, otolaryngologists are able to determine, with high sensitivity, which patients require prompt otolaryngology evaluation. The recording of consistently high-quality video using a standard smartphone camera is achievable without formal training.

Utility of Telemedicine for Diagnosis and Management of Laryngology‐Related Complaints during COVID‐19

“…This is the first study to investigate the diagnosis and management concordance rates between the pre‐laryngoscopy telemedicine visits and post‐laryngoscopy in‐person visits for laryngology‐related complaints. Previous studies have assessed the accuracy of diagnosis based on history and specific exam findings available via telemedicine on various otolaryngological complaints ranging from otologic conditions (based on video‐otoscopy images), 15 , 16 , 18 , 19 , 20 , 29 , 30 , 31 , 32 , 33 peritonsillar abscess (based on phone captured intraoral images), 21 nasal fracture (based on phone captured face images), 14 , 34 and dysphonia (based on telephone voice) 35 , 36 and other general otolaryngology consults from general practitioners. 17 , 22 , 37 , 38 , 39 The diagnostic concordance rates from these studies were overall high between 64% and 100%.…”

“…High reliability and accuracy of diagnosis have been reported in patients with various otolaryngological complaints including otologic conditions, rhinosinusitis, peritonsillar abscess, and nasal fracture. [13][14][15][16][17][18][19][20][21][22][23] In terms of management provided through telemedicine, one study found that telemedicine was associated with a lower rate of outpatient antibiotic treatment for acute rhinosinusitis compared with the previous year, and another study found that there is high sensitivity between otolaryngologists in the ability to determine which patients presenting with peritonsillar abscess would require prompt in-person evaluation. 21,23 While laryngoscopy can likely be safely delayed in the majority of patients, little is known about the utility of telemedicine for initial diagnosis and management of new patients presenting with laryngology-related complaints.…”

“…[13][14][15][16][17][18][19][20][21][22][23] In terms of management provided through telemedicine, one study found that telemedicine was associated with a lower rate of outpatient antibiotic treatment for acute rhinosinusitis compared with the previous year, and another study found that there is high sensitivity between otolaryngologists in the ability to determine which patients presenting with peritonsillar abscess would require prompt in-person evaluation. 21,23 While laryngoscopy can likely be safely delayed in the majority of patients, little is known about the utility of telemedicine for initial diagnosis and management of new patients presenting with laryngology-related complaints. [24][25][26] In this study, we aim to investigate the concordance in diagnosis and management provided during the initial telemedicine visit and subsequent in-person visit with laryngoscopy at a tertiary care center laryngology clinic.…”

COVID-19 and the resurgence of telehealth in otolaryngology

“…In rhinology, telemedicine has been used to evaluate patients with anosmia with the aid of at-home objective smell testing. 30 Other effective telemedicine interventions have included evaluation of dysphonia, 31 , 32 vertigo, 33 , 34 peritonsillar abscess, 35 nasal bone fracture, 36 and home management of positive pressure ventilation in children. 37 Video and photo documentation appear useful in these clinical scenarios.…”

Assessing the Views and Needs of People at High Risk of Gestational Diabetes Mellitus for the Development of Mobile Health Apps: Descriptive Qualitative Study

“…Mobile information technology can bridge the communication between medical service providers and users, helping doctors understand the health status of users and providing clinical decision support, so as to achieve remote diagnosis and treatment. At the same time, users’ needs for self-management support can be met to improve their compliance and self-management behaviors [ 12 - 14 ]. In addition, mobile information technology can greatly save users’ time and transportation costs, relieve the burden of medical treatment faced by hospitals and community health service institutions, and make the limited medical service resources the most effective.…”