Development and evaluation of a clinical guideline for a paediatric telemedicine service in a low-resource setting.
Development and evaluation of a clinical guideline for a paediatric telemedicine service in a low-resource setting.
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在低资源环境中针对儿科远程医疗服务的临床指南的开发和评估。
DOI：
10.1136/bmjpo-2023-002164
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发表时间：
2024-01-08
影响因子：
2.6
通讯作者：
中科院分区：
文献类型：
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作者：
制定和评价儿科远程医疗和药物递送服务（TMDS）指南。儿科远程医疗临床指南源自世界卫生组织（世卫组织）《儿童疾病综合管理手册》。该指南在海地的TMDS中部署，并通过前瞻性队列研究进行评价;招募了≤10岁的儿童。对于非严重病例，在呼叫中心和家庭进行了配对的虚拟和面对面检查;严重病例被转诊到医院。通过与成对的面对面检查结果（参考）进行比较来评估虚拟检查组件的性能。共入组391例病例。在进行配对检查的320例病例中，在现场检查期间未发现一般的WHO危险体征; 5例病例（2%）由于特定问题的危险体征或其他升级原因需要转诊。轻度病例虚拟指定的Cohen kappa值为0.78（95% CI：0.69 - 0.87）。虚拟报告的发热的敏感性和特异性分别为91%（95% CI：87%至96%）和69%（95% CI：62%至76%）;虚拟报告的“呼吸急促”的敏感性和特异性分别为47%（95% CI：21%至72%）和89%（95% CI：85%至94%）。“无”和“一些”脱水的Kappa值表明虚拟检查和现场检查之间存在中度一致性（0.69; 95% CI：0.41至0.98）。在第10天，通过电话联系的287例病例中有273例（95%）好转/康复。尽管特定问题组件的表现各不相同，但虚拟检查的关键组件（分诊、危险迹象和脱水评估）表现良好。这项研究和相关资源代表了在世卫组织临床原则基础上制定循证儿科远程医疗指南的形成步骤。对选定病例进行当面检查对于解决虚拟检查的局限性和确定需要上报的病例非常重要。NCT 03943654。
To develop and evaluate a guideline for a paediatric telemedicine and medication delivery service (TMDS). A clinical guideline for paediatric telemedicine was derived from the World Health (WHO) Organization Integrated Management of Childhood Illness (IMCI) Handbook. The guideline was deployed at a TMDS in Haiti and evaluated through a prospective cohort study; children ≤10 years were enrolled. For non-severe cases, paired virtual and in-person examinations were conducted at the call centre and household; severe cases were referred to the hospital. The performance of virtual examination components were evaluated by comparison with the paired in-person examination findings (reference). A total of 391 cases were enrolled. Among the 320 cases with paired examinations, no general WHO danger signs were identified during in-person examinations; 5 cases (2%) required hospital referral due to problem-specific danger signs or other reasons for escalation. Cohen’s kappa for the virtual designation of mild cases was 0.78 (95% CI: 0.69 to 0.87). The sensitivity and specificity of a virtually reported fever were 91% (95% CI: 87% to 96%) and 69% (95% CI: 62% to 76%), respectively; the sensitivity and specificity of virtually reported ‘fast breathing’ were 47% (95% CI: 21% to 72%) and 89% (95% CI: 85% to 94%), respectively. Kappa for ‘no’ and ‘some’ dehydration indicated moderate congruence between virtual and in-person examinations (0.69; 95% CI: 0.41 to 0.98). At 10 days, 273 (95%) of the 287 cases reached by phone were better/recovered. Critical components of the virtual examination (triage, danger signs and dehydration assessment) performed well despite varied performance among the problem-specific components. The study and associated resources represents formative steps towards an evidence-based paediatric telemedicine guideline built on WHO clinical principles. In-person examinations for select cases were important to address limitations with virtual examinations and identify cases for escalation. NCT03943654.
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DOI：
10.1016/s0140-6736(20)30750-9
发表时间：
2020-10-17
期刊：
Lancet (London, England)
影响因子：
--
作者：
GBD 2019 Universal Health Coverage Collaborators
通讯作者：
GBD 2019 Universal Health Coverage Collaborators
影响因子：
1.9
作者：
Galagali PM;Ghosh S;Bhargav H
通讯作者：
Bhargav H
影响因子：
2.9
作者：
Klarman M;Schon J;Cajusma Y;Maples S;Beau de Rochars VEM;Baril C;Nelson EJ
通讯作者：
Nelson EJ
影响因子：
3.6
作者：
Vinekar, Kavita;Schaad, Nicolas;Tohme, Rania A.
通讯作者：
Tohme, Rania A.
影响因子：
4.3
作者：
Kane-Gill, Sandra L.;Rincon, Fred
通讯作者：
Rincon, Fred