Telemedicine can be a feasible means of guiding untrained general practitioners to perform point-of-care ultrasound in life-threatening situations: the case of a field hospital during the COVID-19 pandemic.

Objective: To evaluate the feasibility of telemedicine using a standardized multiorgan ultrasound assessment protocol to guide untrained on-site general practitioners at a field hospital during a life-threatening crisis. Materials and Methods: We evaluated 11 inpatients with shock, with or without acute dyspnea, for whom general practitioners spontaneously requested remote evaluation by a specialist. Results: All of the general practitioners accepted the protocol and were able to position the transducer correctly, thus obtaining key images of the internal jugular vein, lungs, and inferior vena cava when guided remotely by a telemedicine physician, who interpreted all of the findings. However, only four (36%) of the on-site general practitioners obtained the appropriate key image of the heart in the left parasternal long-axis view, and only three (27%) received an immediate interpretation of an image from the remote physician. The mean evaluation time was 22.7 ± 12 min (range, 7-42 min). Conclusion: Even in life-threatening situations, untrained general practitioners may be correctly guided by telemedicine specialists to perform multiorgan point-of-care ultrasound in order to improve bedside diagnostic evaluation.

Objetivo: Avaliar a viabilidade da orientação por telemedicina de médicos in situ não treinados na avaliação ultrassonográfica de múltiplos órgãos mediante protocolo padronizado, durante uma situação de risco de vida em hospital de campanha. Materiais e Métodos: Avaliamos 11 pacientes com choque e/ou dispneia de manifestação aguda durante a internação, cujos clínicos gerais solicitaram auxílio de especialista a distância. Resultados: Todos os médicos aceitaram o protocolo e, posicionando o transdutor, obtiveram imagens-chave da veia jugular interna, pulmão e veia cava inferior, quando guiados por um médico via telemedicina, que interpretou os achados desses órgãos. No entanto, apenas quatro (36%) médicos in situ obtiveram a imagem-chave apropriada do coração na janela paraesternal do eixo longo esquerdo e três (27%) tiveram imagem remotamente interpretada imediatamente. O tempo de avaliação variou de 7-42 minutos (média de 22,7 ± 12 minutos). Conclusão: Em situação de risco de vida, os clínicos gerais não treinados podem ser corretamente orientados por especialistas em telemedicina para realizar ultrassonografia multiórgãos in situ, melhorando o diagnóstico beira do leito.

Telemedicine can be a feasible means of guiding untrained general practitioners to perform point-of-care ultrasound in life-threatening situations: the case of a field hospital during the COVID-19 pandemic O ultrassom guiado por telemedicina realizado por clínicos gerais não treinados pode ser viável em uma situação de risco de vida: o caso de um hospital de campanha durante a pandemia de COVID-19

Objective To evaluate the feasibility of telemedicine using a standardized multiorgan ultrasound assessment protocol to guide untrained on-site general practitioners at a field hospital during a life-threatening crisis. Materials and Methods We evaluated 11 inpatients with shock, with or without acute dyspnea, for whom general practitioners spontaneously requested remote evaluation by a specialist. Results All of the general practitioners accepted the protocol and were able to position the transducer correctly, thus obtaining key images of the internal jugular vein, lungs, and inferior vena cava when guided remotely by a telemedicine physician, who interpreted all of the findings. However, only four (36%) of the on-site general practitioners obtained the appropriate key image of the heart in the left parasternal long-axis view, and only three (27%) received an immediate interpretation of an image from the remote physician. The mean evaluation time was 22.7 ± 12 min (range, 7-42 min). Conclusion Even in life-threatening situations, untrained general practitioners may be correctly guided by telemedicine specialists to perform multiorgan point-of-care ultrasound in order to improve bedside diagnostic evaluation.

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

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.

Assessment of patients with acute respiratory symptoms during the COVID-19 pandemic by Telemedicine: clinical features and impact on referral

ABSTRACT Objective: To characterize variables associated with referral to the emergency department following Telemedicine consultation during the COVID-19 pandemic. Methods: Cross-sectional retrospective study conducted between March and May 2020, with a sample of 500 adult patients. The inclusion criterion was the manifestation of respiratory symptoms, regardless of type. Results: The mean age of patients was 34.7±10.5 years, and 59% were women. Most patients (62.6%) perceived their own health status as malaise and some (41.4%) self-diagnosed COVID-19. Cough (74.4%), rhinorrhea (65.6%), sore throat (38.6%) and sneezing (20.6%) were the most common infection-related symptoms. Overall, 29.4% and 16% of patients reported dyspnea and chest pain, respectively. The Roth score was calculated for a sizeable number of patients (67.6%) and was normal, moderately altered or severely altered in 83.5%, 10.7% and 5.6% of patients, respectively. The percentage of suspected COVID-19 cases was 67.6%. Of these, 75% were managed remotely and only one quarter referred for emergency assessment. Conclusion: Telemedicine assessment is associated with reclassification of patient's subjective impression, better inspection of coronavirus disease 2019 and identification of risk patients. Referral is therefore optimized to avoid inappropriate in-person assessment, and low-risk patients can be properly guided. Telemedicine should be implemented in the health care system as a cost-effective strategy for initial assessment of acute patients. RESUMO Objetivo: Caracterizar as variáveis associadas ao encaminhamento à emergência após consulta de Telemedicina durante a pandemia de COVID-19. Métodos: Estudo transversal e retrospectivo, realizado entre março e maio de 2020, com amostra de 500 pacientes adultos. O critério de inclusão foi apresentação de sintomas respiratórios, independente do tipo. Resultados: A média de idade dos pacientes foi de 34,7±10,5 anos, e 59% eram do sexo feminino. A maioria dos pacientes (62,6%) se classificou subjetivamente como tendo um mal-estar, e alguns (41,4%) autodiagnosticaram COVID-19. Tosse (74,4%), rinorreia (65,6%), dor de garganta (38,6%) e espirros (20,6%) foram os sintomas mais comuns relacionados à infecção. Dispneia e dor torácica foram relatados por 29,4% e 16% dos pacientes, respectivamente. Foi calculado o escore de Roth de um número considerável de pacientes (67,6%), obtendo resultado normal em 83,5%, moderadamente alterado em 10,7% e grave em 5,6%. A percentagem de casos suspeitos de COVID-19 foi de 67,6%, e 75% desses foram gerenciados remotamente, com apenas um quarto sendo encaminhado para avaliação imediata na emergência. Conclusão: A avaliação da Telemedicina está associada à reclassificação da impressão subjetiva do paciente, melhor inspeção da COVI-19 e identificação de pacientes de risco. O encaminhamento é otimizado, para evitar avaliação presencial inadequada, e permite que os pacientes de baixo risco sejam orientados de forma apropriada. A Telemedicina deve ser implementada no sistema de saúde como estratégia com boa relação custo-efetividade para a avaliação inicial de pacientes agudos.

Assessment of patients with acute respiratory symptoms during the COVID-19 pandemic by Telemedicine: clinical features and impact on referral

ABSTRACT Objective: To characterize variables associated with referral to the emergency department following Telemedicine consultation during the COVID-19 pandemic. Methods: Cross-sectional retrospective study conducted between March and May 2020, with a sample of 500 adult patients. The inclusion criterion was the manifestation of respiratory symptoms, regardless of type. Results: The mean age of patients was 34.7±10.5 years, and 59% were women. Most patients (62.6%) perceived their own health status as malaise and some (41.4%) self-diagnosed COVID-19. Cough (74.4%), rhinorrhea (65.6%), sore throat (38.6%) and sneezing (20.6%) were the most common infection-related symptoms. Overall, 29.4% and 16% of patients reported dyspnea and chest pain, respectively. The Roth score was calculated for a sizeable number of patients (67.6%) and was normal, moderately altered or severely altered in 83.5%, 10.7% and 5.6% of patients, respectively. The percentage of suspected COVID-19 cases was 67.6%. Of these, 75% were managed remotely and only one quarter referred for emergency assessment. Conclusion: Telemedicine assessment is associated with reclassification of patient's subjective impression, better inspection of coronavirus disease 2019 and identification of risk patients. Referral is therefore optimized to avoid inappropriate in-person assessment, and low-risk patients can be properly guided. Telemedicine should be implemented in the health care system as a cost-effective strategy for initial assessment of acute patients. RESUMO Objetivo: Caracterizar as variáveis associadas ao encaminhamento à emergência após consulta de Telemedicina durante a pandemia de COVID-19. Métodos: Estudo transversal e retrospectivo, realizado entre março e maio de 2020, com amostra de 500 pacientes adultos. O critério de inclusão foi apresentação de sintomas respiratórios, independente do tipo. Resultados: A média de idade dos pacientes foi de 34,7±10,5 anos, e 59% eram do sexo feminino. A maioria dos pacientes (62,6%) se classificou subjetivamente como tendo um mal-estar, e alguns (41,4%) autodiagnosticaram COVID-19. Tosse (74,4%), rinorreia (65,6%), dor de garganta (38,6%) e espirros (20,6%) foram os sintomas mais comuns relacionados à infecção. Dispneia e dor torácica foram relatados por 29,4% e 16% dos pacientes, respectivamente. Foi calculado o escore de Roth de um número considerável de pacientes (67,6%), obtendo resultado normal em 83,5%, moderadamente alterado em 10,7% e grave em 5,6%. A percentagem de casos suspeitos de COVID-19 foi de 67,6%, e 75% desses foram gerenciados remotamente, com apenas um quarto sendo encaminhado para avaliação imediata na emergência. Conclusão: A avaliação da Telemedicina está associada à reclassificação da impressão subjetiva do paciente, melhor inspeção da COVI-19 e identificação de pacientes de risco. O encaminhamento é otimizado, para evitar avaliação presencial inadequada, e permite que os pacientes de baixo risco sejam orientados de forma apropriada. A Telemedicina deve ser implementada no sistema de saúde como estratégia com boa relação custo-efetividade para a avaliação inicial de pacientes agudos.

Telemedicine: Is It a Tool for Orthopedics?

PURPOSE OF REVIEW: The purpose of this paper is to illustrate how telemedicine can be beneficial in many areas of orthopedic clinical practice through a literature narrative review. In addition, we discuss advantages, barriers, and enablers of such technology. RECENT FINDINGS: Telemedicine in orthopedics was initially described to discuss simple cases among non-specialist doctors through videoconferencing. Recently, it evolved to postoperative follow-up on selected cases, physical examination, and even teleconsultations direct to patients. Studies have reported that consultation can be offered safely to selected patients. Although this topic is already being addressed for a long time, recent studies have reported that there is still resistance among many orthopedic surgeons. Telemedicine for orthopedics has safely expanded its operations. It can be used in postoperative follow-up of selected cases, fracture follow-up, and even in pediatric cases. Remote diagnosis of fractures is done successfully on an outpatient basis in many countries. Protocols and methods to standardize the virtual orthopedic examination for common musculoskeletal conditions have been developed. Satisfaction with teleconsultations as well as cost-effectiveness of remote care orthopedics were already well reported by some studies. We believe that remote care will be expanded in several hospitals around the world due to its huge potential. This fact is explained by natural technological development and by change and obliteration of habits accelerated exponentially after COVID-19 crisis.