Assessment of patients with acute respiratory symptoms during the COVID-19 pandemic by Telemedicine: clinical features and impact on referral

Abstract

Objective: To characterize variables associated with referral to the emergency department following Telemedicine consultation during the COVID-19 pandemic. Methods: Cross-sectional retrospective study conducted between March and May 2020, with a sample of 500 adult patients. The inclusion criterion was the manifestation of respiratory symptoms, regardless of type. Results: The mean age of patients was 34.7±10.5 years, and 59% were women. Most patients (62.6%) perceived their own health status as malaise and some (41.4%) self-diagnosed COVID-19. Cough (74.4%), rhinorrhea (65.6%), sore throat (38.6%) and sneezing (20.6%) were the most common infection-related symptoms. Overall, 29.4% and 16% of patients reported dyspnea and chest pain, respectively. The Roth score was calculated for a sizeable number of patients (67.6%) and was normal, moderately altered or severely altered in 83.5%, 10.7% and 5.6% of patients, respectively. The percentage of suspected COVID-19 cases was 67.6%. Of these, 75% were managed remotely and only one quarter referred for emergency assessment. Conclusion: Telemedicine assessment is associated with reclassification of patient's subjective impression, better inspection of coronavirus disease 2019 and identification of risk patients. Referral is therefore optimized to avoid inappropriate in-person assessment, and low-risk patients can be properly guided. Telemedicine should be implemented in the health care system as a cost-effective strategy for initial assessment of acute patients.

Telemedicine diagnosis of acute respiratory tract infection patients is not inferior to face-to-face consultation: a randomized trial

“…(12) This study estimated a 90%, diagnostic accuracy of RTI by TM, based on the low proportion of critically ill patients with acute respiratory complaints, high diagnostic capacity by anamnesis for virus infection, and the observed low referral rate by TM in the service. (9,13) Sample size was obtained to demonstrate the non-inferiority of the TM diagnosis accuracy with a clinically acceptable variation of up to 20% less in the estimated accuracy (non-inferiority margin of 20%). The enrollment of 37 patients per group would provide approximately 85% chance to detect a non-inferiority margin in the primary analysis, with a unilateral significance level of 2.5%.…”

“…(7) Regarding patients with suspected RTI, TM can help oligosymptomatic patients follow the correct guidelines at home and improve adequate referral. (8,9) Nonetheless, direct-toconsumer TM diagnostic accuracy of RTI is still not well studied and time spent on evaluation, test ordering, and general guidance provided.…”

Análise dos atendimentos realizados pelo telessaúde-COVID em um município de Minas Gerais

“…No referido estudo, os pacientes buscaram o serviço de telemedicina, em média, 4,67 ± 4,82 dias após o aparecimento dos sintomas. Inferiu-se que a procura precoce dos pacientes pelo serviço pudesse estar associada à ampla disseminação publicitária feita pelo município acerca da oferta do serviço de telessaúde, com o intuito de manejar precocemente os casos positivos ou sintomáticos e, desse modo, evitar a sobrecarga hospitalar 17 . Os sinais e sintomas mais frequentes no presente estudo foram cefaleia (41,8%), tosse (33,3%) e coriza (30,0%).…”

“…O supracitado trabalho realizado em São Paulo evidenciou a tosse em 74,4% dos pacientes, seguida da rinorreia (65,6%). A dor de garganta e o espirro foram menos prevalentes, ocorrendo em 38,6% e 20,6% dos casos, respectivamente 17 . Como observado na presente investigação, a febre não esteve entre os sintomas mais comuns, ocorrendo em apenas 25,3% dos casos.…”

“…Dessa forma, o encaminhamento é otimizado ao evitar a avaliação presencial inadequada e permitir que os pacientes de baixo risco sejam orientados de maneira apropriada. Com isso, o Telessaúde-COVID pode ser considerado uma estratégia eficiente para a avaliação inicial acompanhamento de pacientes agudos 17 .…”