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Anesthesia TeleConsultation for Pediatric preoperative assessment: a large national prospective multicentric study in
Delphine Kern1, Nada Sabourdin2, Nathalie Bourdaud3
1Department of Anesthesia and Intensive Care, Children Hospital, University Hospital of Toulouse, Toulouse, France.
Background:
While interest in pediatric anesthesia teleconsultation is growing, published data remain scarce. This study evaluated the feasibility of anesthesia teleconsultation in children, providing a comprehensive analysis of failure, quality, dedicated time and satisfaction.
Methods:
This prospective observational study was performed in 11 major French hospitals. The primary outcome was anesthesia teleconsultation feasibility. Feasibility was defined as the rate of successful anesthesia teleconsultations, i.e. those performed in presence of both child and parent, exclusively via the dedicated secure audiovisual platform, and not requiring a complementary in-person appointment.Secondary outcomes included: causes and consequences of failure; factors associated with failure; quality of anesthetic preparation, medical time dedicated to preoperative assessment; analysis of parents and anesthetist satisfaction.
Results:
A total of 830 children aged 6.7 [3.5-12.2] years were included. Feasibility of anesthesia teleconsultation was 73%. Failure was due to technical (91%), organizational (9%), and medical (1%) issues. Three anesthesia teleconsultations (0.4%) were converted to in-person consultations. Factors associated with technical failure included the use of tablets or smartphones rather than computers ((OR, 95%CI): 2.44, 1.40 to 4.26, p=0.002), the absence of a pre-connection test ((OR, 95%CI): 6.21, 3.05 to 12.66, p<0.001) and several sociodemographic characteristics. On the day of surgery, no procedure was cancelled, one was postponed, one anesthetic strategy was modified. Medical time dedicated to preoperative evaluation was 28 [18,33] minutes. Parental satisfaction was high, 93% would choose teleconsultation for a future procedure. Anesthetist's satisfaction was high: 96% with medical aspects, 90% with the suitability for the case, 72% with the quality of information delivered. Technical failure consistently impacted all components of anesthetist satisfaction.
Conclusion:
This national audit highlights that addressing technical and organizational issues appears essential to transform anesthesia teleconsultations from a mere tool into a robust clinical process, ensuring its reliability and clinical utility in pediatric anesthesia.