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Evaluation of the use of telemedicine in pediatric intensive care units: a cluster-randomized trial
Gabriela de Oliveira Laguna Silva1, Emanuele König Klever1, Jacqueline Castro da Rocha1
1Responsabilidade Social, Hospital Moinhos de Vento, Porto Alegre, Brasil.
Insights
Telemedicine did not significantly improve clinical care indicators in Brazilian pediatric intensive care units (PICUs). Further research is needed to overcome implementation challenges and optimize its role in pediatric critical care.
Area of Science:
- Critical Care Medicine
- Health Services Research
- Pediatrics
Background:
- Telemedicine offers potential for remote specialist care but lacks robust evidence for effectiveness.
- Implementation in public health systems presents challenges.
- Pediatric intensive care units (PICUs) are a key area for evaluating telemedicine's impact.
Purpose of the Study:
- To evaluate the impact of telemedicine on clinical care indicators in PICUs within the Brazilian public health system.
- To compare outcomes between PICUs receiving telemedicine support and those receiving usual care.
Main Methods:
- An open-label cluster-randomized trial (CRT) involving 16 PICUs in Brazil.
- Comparison of telemedicine intervention group versus usual care control group.
- Primary outcome: PICU length of stay; Secondary outcomes: mortality rate, ventilator-free days.
Main Results:
- 1393 participants included (657 control, 736 intervention).
- No significant differences observed in PICU length of stay, mortality rate, or ventilator-free days between groups.
- Mean PICU length of stay: 10.42 days (control) vs. 11.52 days (intervention).
Conclusions:
- Telemedicine did not demonstrate a significant impact on key clinical indicators in this Brazilian PICU trial.
- Challenges in effective telemedicine implementation persist within the public health system.
- Continued investigation is crucial to enhance telemedicine's role in pediatric critical care.
Introduction:
Telemedicine has shown promising results, allowing specialists to provide rapid and effective care in remote locations. However, to our knowledge, current evidence is not robust enough to prove the effectiveness of this tool. This cluster-randomized trial (CRT) aimed to evaluate the impact of telemedicine on clinical care indicators in pediatric intensive care units (PICUs).
Methods:
An open-label CRT was conducted in 16 PICUs within the Brazilian public health system. The trial took place from August 2022 to December 2023 and compared an intervention group, which received telemedicine support, with a control group, which received usual PICU care. The primary outcome was the PICU length of stay. The main secondary outcomes were mortality rate and ventilator-free days.
Results:
A total of 1393 participants were included, 657 in the control group and 736 in the intervention group. The mean PICU length of stay was 10.42 (SD, 10.71) days for the control group and 11.52 (SD, 10.80) days for the intervention group. The overall mean of ventilator-free days was 6.82 (SD, 7.71) days. Regarding mortality, 7.54% of participants died in total. No significant difference was found in the outcomes between the groups.
Conclusion:
Despite the potential benefits of telemedicine, its effective implementation in the Brazilian public health system faces considerable challenges, highlighting the continued importance of investigating and improving the role of telemedicine in pediatric critical care.
Clinical Trial Registration:
ClinicalTrials.gov NCT05260710 and ReBEC - RBR-7×j4wyp.
