Diagnostic Accuracy Comparison Between Telemedicine and Face-to-face Consultations in Respiratory Infection Patients.

Hospital Israelita Albert Einstein98 enrolled

Overview

This is a randomized study that sought to analyze the diagnostic accuracy of the telemedicine consultation of patients suspected of respiratory tract infections during COVID-19 pandemic in comparison with the face-to-face evaluation at the emergency department.

Unicentric, prospective and randomized study performed between September and November 2020 with adult patients who sought care at emergency department. The inclusion criterion was the exhibition of any tract respiratory symptom. Patients older than 65 years, with chronic heart or lung diseases or immunosuppressed were excluded. Eligible patients were randomized 1:1 for a brief telemedicine consultation, blinded to subsequent face-to-face evaluation or direct face-to-face evaluation.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

DIAGNOSTIC

Masking

NONE

Enrollment

Conditions

Respiratory Tract Infections

Interventions

Telemedicine ConsultationOTHER

Brief telemedicine consultation, blinded to subsequent face-to-face evaluation.

Face-to-face ConsultationOTHER

Direct face-to-face evaluation (without telemedicine consultation before).

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients with at least one acute symptom compatible with RTI (sore throat, nasal obstruction, coryza, new or growing cough, sputum, hoarseness, dyspnea) in presence or absence of symptoms related to the infection (fever ≥ 38oC, chills, sweating, myalgia) that motivated spontaneously face-to-face evaluation at the ED. Exclusion Criteria: * Patients with diagnosis of chronic respiratory diseases (chronic obstructive pulmonary disease, asthma and interstitial lung disease) * Patients with previous diagnosis of congestive heart failure, * Patients with HIV / AIDS * Patients with active cancer * Patients with type I diabetes mellitus * Patients in use of any immunosuppressant * Patients with chronic cough * Patiets that referral to emergency room after nursing triage.

Locations (1)

Hospital Israelita Abert Einstein

São Paulo, São Paulo, Brazil

Outcomes

Primary Outcomes

Number of final evaluation ICD 10-code diagnosis.

All institutional Emergency Department or Telemedicine assessments involve filling out the final diagnosis on an International Classification of Diseases (ICD-10)-code basis in the electronic medical record before discharge to home or admission. For aggregation of most prevalent RTI with similar pathophysiologic characteristics, three diagnostic groups were defined, based on ICD 10 codes: RTI, including COVID-19 (B34.2, B34.9, B97.2, J00, J04, J06, J11, J20, J30, J39, U07.1); PT - Acute Pharyngotonsillitis (J02-J03.9) and AS - Acute Sinusitis (J01-J01.9).

Time frame: up to 10 months

Secondary Outcomes

Time of medical care

Comparison of time (minutes) of medical care between telemedicine and face-to-face consultation.

Time frame: up to 10 months

Rate of indication for complementary exams

Comparison of rate (percentage) of indication for complementary exams between telemedicine and face-to-face consultation.

Time frame: up to 10 months

Type of requested exams

Comparison of type of requested exams (porcentage) between telemedicine and face-to-face consultation.

Time frame: up to 10 months

Type of Medical prescription

Comparison of type of medical prescription after completion of the service between telemedicine and face-to-face consultation

Time frame: up to 10 months

Type of proposed destination after completion of the service

Comparison of proposed destination (percentage of discharge or hospitalization) after completion of the service between telemedicine and face-to-face consultation.

Data from ClinicalTrials.gov

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