ABSTRACT
Aim: To determine the long-term impact of telemedicine in child neurology care during the COVID-19 pandemic and with the reopening of outpatient clinics. Method(s): We performed an observational cohort study of 34 837 in-person visits and 14 820 telemedicine outpatient visits across 26 399 individuals. We assessed differences in care across visit types, time-period observed, time between follow-ups, patient portal activation rates, and demographic factors. Result(s): We observed a higher proportion of telemedicine for epilepsy (International Classification of Diseases, 10th Revision G40: odds ratio [OR] 1.4, 95% confidence interval [CI] 1.3-1.5) and a lower proportion for movement disorders (G25: OR 0.7, 95% CI 0.6-0.8;R25: OR 0.7, 95% CI 0.6-0.9) relative to in-person visits. Infants were more likely to be seen in-person after reopening clinics than by telemedicine (OR 1.6, 95% CI 1.5-1.8) as were individuals with neuromuscular disorders (OR 1.6, 95% CI 1.5-1.7). Self-reported racial and ethnic minority populations and those with highest social vulnerability had lower telemedicine participation rates (OR 0.8, 95% CI 0.8-0.8;OR 0.7, 95% CI 0.7-0.8). Interpretation(s): Telemedicine continued to be utilized even once in-person clinics were available. Pediatric epilepsy care can often be performed using telemedicine while young patients with neuromuscular disorders often require in-person assessment. Prominent barriers for socially vulnerable families and racial and ethnic minorities persist.Copyright © 2022 Mac Keith Press.
ABSTRACT
LAY SUMMARY Traumatic injury is the most common cause of death among young people. Most victims of trauma die alone before medical response is possible. Typical causes of death are not overly complex to fix if access to standard hospital interventions is feasible. Dying victims are often connected to smartphone-supporting informatic communication technologies, which make available a worldwide network of experts who can potentially reassure and remotely diagnose victims and provide life-saving advice. TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) researchers have focused on empowering point-of-care providers to perform outside their scope and deliver life-saving interventions. With the recognition that coronavirus disease 2019 (COVID-19) has profoundly isolated many people, solutions to respect COVID-19 isolation policies have stimulated the TMUSMI group to appreciate the potential for informatic technologies' effect on the ability to care for oneself in cases of catastrophic injury. Most traumatic death occurs pre-hospital, before a victim ever encounters a health care provider, whether in military or in civilian settings. Many of these deaths have been accepted as unpreventable, especially when severe injuries occur to isolated victims, with no possibility of rescuers responding. A double paradox is that dying individuals often have anatomically simple wounds with complex physiology. These individuals are physically dying alone while virtually connected via smartphone to a potential worldwide network of life-saving mentors - many of whom have the comprehensive library of human resuscitative science at their virtual fingertips. If a seriously injured victim is not immediately incapacitated, then many techniques to empower point-of-care self-resuscitation exist, including both remotely telementored and video-modelled diagnostic, resuscitative, and interventional procedures. This article discusses a small but evolving database and proposes developmental pathways to attempt to ensure that no conscious, dying victim ever dies alone without at least trying to save themselves or receiving comforting words through virtual expert help.