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Telemedicine and Utilization of Chest X-Rays in Pediatric Community-Acquired Pneumonia: Lessons from the COVID-19
Sophia Eilat-Tsanani1,2, Moti Almog1,3, Vered Levy1,2
1Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
Insights
Telehealth use surged during COVID-19 lockdowns, yet chest X-ray use for pediatric community-acquired pneumonia (CAP) remained stable. This suggests telemedicine can support judicious diagnostic imaging in children with pneumonia.
Area of Science:
- Pediatrics
- Infectious Diseases
- Health Services Research
Background:
- Community-acquired pneumonia (CAP) is a significant childhood illness, with guidelines prioritizing clinical assessment over routine imaging.
- The COVID-19 pandemic rapidly advanced the adoption of telehealth in healthcare settings.
- The impact of increased telehealth on the diagnosis and management of pediatric CAP requires investigation.
Purpose of the Study:
- To evaluate the effect of COVID-19 lockdown periods on chest X-ray utilization for pediatric CAP diagnoses in primary care.
- To compare imaging trends during pandemic lockdowns with pre-pandemic periods.
- To identify factors influencing diagnostic imaging decisions in pediatric CAP during different healthcare contexts.
Main Methods:
- Retrospective database study analyzing children aged 1-14 years diagnosed with CAP.
- Comparison of data from three lockdown periods (2020-2021) against corresponding pre-pandemic periods (2018-2019).
- Analysis of remote consultation rates, chest X-ray referrals, and antibiotic prescribing patterns.
Main Results:
- Remote consultations increased significantly from 1.7% to 11.6% during lockdown periods (p < 0.001).
- Chest X-ray referrals and antibiotic use for pediatric CAP remained consistent across pre-pandemic and lockdown periods.
- Predictors for imaging shifted, with socioeconomic status becoming a significant factor during lockdown, replacing age and travel distance.
Conclusions:
- Telemedicine adoption did not lead to increased chest X-ray use for pediatric CAP during lockdowns.
- Clinical judgment and established guidelines for imaging appear to have been maintained despite increased remote consultations.
- Future strategies can leverage telemedicine to enhance diagnostic confidence and promote "choosing wisely" principles in pediatric pneumonia care.
Abstract:
Community-acquired pneumonia (CAP) is a leading infectious disease in children, with management guidelines emphasizing clinical judgment over routine imaging. The COVID-19 pandemic accelerated telehealth adoption, raising questions about its impact on pediatric CAP care. We conducted a retrospective database study within primary care, comparing chest X-ray use for CAP diagnosis during three lockdown periods (2020-2021) with corresponding pre-pandemic periods (2018-2019). Children aged 1-14 years with CAP diagnoses were included (n = 3,499 pre-pandemic; n = 438 during lockdown). Remote consultations increased significantly (1.7% vs. 11.6%, p < 0.001), while chest X-ray referrals remained stable, and antibiotic use also stayed consistent. Predictors for imaging shifted: pre-pandemic, older age and longer travel distance were significant factors, whereas during lockdown, only higher socioeconomic status was associated. The ongoing use of telemedicine after COVID-19 offers an opportunity to develop strategies that improve diagnostic confidence and encourage "choosing wisely" in pediatric pneumonia diagnosis.
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