ABSTRACT
Background and aims: The COVID-19 pandemic has broadened the use of teleneurology, how this compares to face-to-face (F2F) clinics is unclear. This study compared virtual with F2F new neurological consultations. Methods: We retrospectively evaluated new outpatient consultations in neurology clinics in Aberdeen Royal Infirmary. We compared sociodemographic data, time to consultation, time to diagnosis, the need for reassessment and re-investigation between traditional F2F and virtual clinics using the web-based video platform (Near Me) or telephone into patients own homes (or chosen location) without a trained assistant. We calculated the relative risk of the need for reassessment and re-investigation over sixmonth periods by the suspected neurological diagnosis. Results: 73% of consultations were virtual (Near Me or telephone) between June and October 2020, this was almost non-existent (<0.1%) in June-October 2019. We analysed 352 F2F (June-July 2019) and 225 virtual consultations (June-July 2020). Compared to F2F clinics, virtual clinics had a longer time to diagnosis (p=0.019), were more likely to be re-assessed (RR: 2.2, 95% CI: 1.5-3.2;p<0.0001) and re-investigated (RR: 1.50, 95% CI: 0.88-2.54;p=0.133), this was likelier in those aged ≥60 years. Patients with headaches and suspected seizures were less likely to need reassessment or re-investigation following virtual clinics than multiple sclerosis & neuroinflammatory disorders, spinal cord disorders and functional neurological disorders. Conclusion: This study demonstrates that virtual clinics have higher rates of reassessment and re-investigation than F2F clinics. As virtual clinics become a potential consultation alternative, this study should instruct the selection of patients for either consultation type.
ABSTRACT
Purpose: A government funded;interactive cloud storage platform (www.vcreate.tv/neuro) allowing patients and carers to upload video and linked metadata for neurological diagnosis was established during the Covid-19 pandemic. We describe the utility for epilepsy and paroxysmal disorders in 16 centres with the first centre active from 01/05/2020. Method: Users are invited to register and utilise a password and passcode for access. Videos are uploaded with a structured history. The clinician classifies seizure type, syndrome, aetiology or other diagnosis using drop-down menus. Users and clinicians complete online evaluations. Postcode allows linkage to user index of deprivation score. Consents for teaching by the local clinical team and research within a national neurology video research database with research ethics approval are optional. All data, except the video file, transfer to the electronic patient record. Result: To 24/03/2021, 4582 video uploads (4024 paediatric, 558 adult), 1889 patients (1594 paediatric, 295 adult). 400-600 new videos per month. 323 physician and nurse users. Deprivation scores indicate equitable use across socio-economic groups. Paediatric classification: non-epileptic 55%, epileptic (36.5%), unknown (8.5%). Adult: non-epileptic 73.5% (34% dissociative, 41% movement disorders), epileptic 11%, unknown 15.5%. Paediatric seizure types include: focal impaired awareness (19%), generalised tonic clonic (18%), focal clonic (17%), epileptic spasms (13%). Non-epileptic events: tics (13%), normal behaviour (12%), sleep myoclonus (10%) gratification (8%), dissociative (5%). >95% carers ranked the system positively. Clinicians report video prevented face-to-face review in 57%, investigations in 44% and reduced time to diagnosis in 97%. Median time to review video and classify was 5 minutes. Conclusions: Remote care is facilitated, investigations prevented or prioritised, with rapid diagnosis and efficiencies in the patient pathway. A rapidly growing teaching resource and research database for semiology and machine learning diagnostics for paroxysmal disorders has been established. We plan to establish the system in low-income countries without cost.