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Development and evaluation of a clinical guideline for a paediatric telemedicine service in a low-resource setting
Molly B Klarman1, Xiaofei Chi2, Youseline Cajusma1
1Department of Pediatrics, University of Florida, Gainesville, Florida, USA.
Insights
This study developed a paediatric telemedicine guideline for medication delivery. The guideline showed critical virtual examination components performed well, improving child healthcare access.
Area of Science:
- Global Health
- Digital Health
- Pediatric Medicine
Background:
- Paediatric telemedicine and medication delivery services (TMDS) can improve healthcare access in underserved regions.
- Existing clinical guidelines need adaptation for effective telemedicine implementation in paediatrics.
Purpose of the Study:
- To develop and evaluate a clinical guideline for a paediatric telemedicine and medication delivery service (TMDS).
- To assess the performance of virtual examinations against in-person examinations for paediatric cases.
Main Methods:
- A guideline was derived from the WHO Integrated Management of Childhood Illness (IMCI) Handbook.
- A prospective cohort study evaluated the guideline in Haiti, enrolling children ≤10 years.
- Paired virtual and in-person examinations were conducted for non-severe cases; severe cases were referred to hospitals.
Main Results:
- 391 cases were enrolled; 320 had paired examinations.
- Virtual triage and danger sign assessments showed good performance (Kappa 0.78 for mild cases).
- Sensitivity for virtual fever reporting was 91%; specificity for fast breathing was 89%.
Conclusions:
- Critical virtual examination components performed well, supporting an evidence-based paediatric telemedicine guideline.
- In-person examinations remain crucial for addressing virtual limitations and identifying severe cases.
- The study represents a formative step in establishing WHO-aligned paediatric telemedicine services.
Objective:
To develop and evaluate a guideline for a paediatric telemedicine and medication delivery service (TMDS).
Methods:
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).
Results:
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.
Conclusion:
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.
Trial Registration Number:
NCT03943654.
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