Teleconsultation in primary ophthalmic emergencies during the COVID-19 lockdown in Paris: Experience with 500 patients in March and April 2020
Teleconsultation in primary ophthalmic emergencies during the COVID-19 lockdown in Paris: Experience with 500 patients in March and April 2020
复制标题
DOI：
10.1016/j.jfo.2020.05.005
复制
发表时间：
2020-09-01
影响因子：
1.2
通讯作者：
N'Kosi, L.
中科院分区：
文献类型：
--
作者：
Bourdon, H.;Jaillant, R.;N'Kosi, L.
这项前瞻性观察队列研究基于 2020 年 3 月 20 日至 4 月 10 日期间法国巴黎 COVID-19 封锁初期请求紧急远程会诊的前 500 名患者。这是第一项评估紧急远程眼科实用性的研究，通过简单的智能手机应用程序或网络浏览器和网络摄像头来管理眼科医生突然受限的人群的紧急眼科护理。在这项研究中，每位要求在巴黎一家专业中心（“SOS CEit”）进行眼科紧急会诊的患者首先必须接受远程会诊预约，以评估进行身体会诊的适应症，以保持封锁。仅根据医疗建议，一天之内进行了体检（如有必要）。该研究的目的是描述人群和诊断并评估主要判断标准，定义为“远程会诊正确指示身体会诊以在眼科紧急情况下进行公平诊断和治疗的能力”。该组织允许医生和患者保持社交距离，同时避免每人进行 3 或 4 次体检。值得注意的是，27% 的远程咨询随后进行了现场预约。症状出现和就诊之间的平均延迟时间为 4.12 天，而外伤、浅表角膜异物和神经眼科紧急情况的延迟时间不到 1 天。正确评估体检指征的敏感性为 96%，特异性为 95%，只有 1.0% 的误诊导致护理延迟。因此，远程会诊为患有严重眼科疾病的患者提供了令人满意的医疗服务，同时保持了社交距离和卫生预防措施。因此，可以认真考虑远程会诊作为有效管理眼科紧急情况的一种方法，特别是对于无法接触专科医生的患者。 (C) 2020 Elsevier Masson SAS。版权所有。
This prospective observational cohort study is based on the first 500 patients who requested emergency teleconsultation during the initial days of the COVID-19 lockdown in Paris, France between 20 March and 10 April 2020. It is the first study to assess the utility of emergency teleophthalmology with a simple smartphone application or web browser and a webcam to manage emergency eye care in a population with sudden restricted access to ophthalmologists. In this study, every patient who asked for an ophthalmic emergency consultation in a single specialized center in Paris ('SOS CEit') first had to undergo a teleconsultation appointment to evaluate the indication for a physical consultation to preserve lockdown. Under medical advice only, a physical appointment was given within a day (if necessary). The aim of the study was to describe the population and diagnoses and evaluate the main judgment criteria, defined as the 'ability of teleconsultation to properly indicate a physical consultation for fair diagnosis and treatment in eye emergencies'. This organization has permitted physicians and patients to preserve social distancing while avoiding 3 or 4 physical consultations per person. Notably, 27% of teleconsultations were followed by a physical appointment. There was a mean 4.12-day delay between symptom apparition and consultation, and less than 1 day for traumas, superficial corneal foreign body and neuro-ophthalmological emergencies. There was a 96% sensitivity and 95% specificity to properly evaluate the indication of a physical consultation and only 1.0% misdiagnoses that lead to delayed care. Hence, teleconsultation maintained satisfactory healthcare access to patients with severe ophthalmological disorders while preserving social distancing and sanitary precautions. Therefore, teleconsultation may be seriously considered as a way to efficiently regulate ophthalmic emergencies, especially for patients with limited access to a specialist. (C) 2020 Elsevier Masson SAS. All rights reserved.