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Related Concept Videos

Data Collection III01:05

Data Collection III

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The physical assessment examines the patient for objective data that defines the patient's condition, and aids in formulating the nursing care plan. The purpose of physical assessment is a health status appraisal, which includes identifying health problems, and establishing a database for nursing intervention.
The principles to begin the physical assessment include conducting a comprehensive or problem-related history in a quiet, well-lit room, emphasizing privacy and comfort for the...
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Virtual Compared With In-Person Neurologic Examination Study.

Lauren Hophing1, Tiffany Tse1, Nicole Naimer1

  • 1Division of Neurology (LH, MM, AI, HK, CDK, SBM), Department of Medicine; Neurology Quality and Innovation Lab (LH, TT, NN, HK, CDK, SBM); Division of Neurology (MM, AI, HK, SBM), Department of Medicine, Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (MM, SSM, HK, SBM), University of Toronto, Ontario, Canada; Division of Neurology (CDK), Department of Medicine; Li Ka Shing Knowledge Institute (CDK), St. Michael's Hospital; Department of Psychiatry (SBM), Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; and Azrieli Brian Medicine Fellowship Program (SBM), Toronto, Ontario, Canada.

Neurology. Clinical Practice
|August 26, 2024
PubMed
Summary
This summary is machine-generated.

The virtual neurologic examination (VNE) showed fair agreement with in-person exams, particularly for gait. While useful for initial consultations, a normal VNE warrants in-person follow-up due to lower sensitivity.

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Area of Science:

  • Neurology
  • Telemedicine
  • Clinical Assessment

Background:

  • The COVID-19 pandemic accelerated the adoption of virtual care in neurology.
  • The diagnostic validity of virtual neurologic examinations (VNE) compared to in-person neurologic examinations (IPNE) remains under-investigated.

Purpose of the Study:

  • To assess the utility of VNE in achieving accurate localization and diagnosis compared to IPNE.
  • To compare the accuracy, localization, and diagnostic capabilities of VNE versus IPNE in an outpatient neurology setting.

Main Methods:

  • Retrospective chart review of 81 patients from general neurology and neuromuscular clinics.
  • Comparison of VNE and IPNE results using Cohen kappa coefficient and descriptive statistics.
  • Analysis of agreement for localization and diagnosis between virtual and in-person assessments.

Main Results:

  • Fair overall agreement (64%) between VNE and IPNE; substantial agreement for gait abnormalities.
  • VNE demonstrated 86% specificity and 56% sensitivity compared to IPNE.
  • Consistent localization (44%) and diagnosis (57%) were found in some cases, with modifications in others.

Conclusions:

  • VNE shows potential validity for initial consultations in specific scenarios, especially for gait abnormalities.
  • The lower sensitivity of VNE necessitates in-person follow-up for normal virtual exams, particularly with concerning histories.
  • IPNE remains superior for detecting subtle abnormalities, supporting a low threshold for in-person visits when VNE is normal.