Development and evaluation of a clinical guideline for a paediatric telemedicine service in a low-resource setting

• Published in: BMJ paediatrics open Vol. 8; no. 1; p. e002164
• Main Authors: Klarman, Molly B, Chi, Xiaofei, Cajusma, Youseline, Flaherty, Katelyn E, Capois, Anne Carine, Dofiné, Michel Daryl Vladimir, Exantus, Lerby, Friesen, Jason, Beau de Rochars, Valery Madsen, Becker, Torben K, Baril, Chantale, Gurka, Matthew J, Nelson, Eric J
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 08.01.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Call Centers; Child; Clinical practice guidelines; Cohort analysis; Consent; Dehydration - diagnosis; Dehydration - therapy; Families & family life; General Paediatrics; Health services research; Humans; Illnesses; Pandemics; Pediatrics; Performance evaluation; Prospective Studies; Resource-Limited Settings; Telemedicine; Haiti; Health services research
• ISSN: 2399-9772; 2399-9772
• DOI: 10.1136/bmjpo-2023-002164

ObjectiveTo develop and evaluate a guideline for a paediatric telemedicine and medication delivery service (TMDS).MethodsA clinical guideline for paediatric telemedicine was derived from the World Health (WHO) Organization Integrated Management of Childhood Illness (IMCI) Handbook. The guideline was deployed at a TMDS in Haiti and evaluated through a prospective cohort study; children ≤10 years were enrolled. For non-severe cases, paired virtual and in-person examinations were conducted at the call centre and household; severe cases were referred to the hospital. The performance of virtual examination components were evaluated by comparison with the paired in-person examination findings (reference).ResultsA total of 391 cases were enrolled. Among the 320 cases with paired examinations, no general WHO danger signs were identified during in-person examinations; 5 cases (2%) required hospital referral due to problem-specific danger signs or other reasons for escalation. Cohen’s kappa for the virtual designation of mild cases was 0.78 (95% CI: 0.69 to 0.87). The sensitivity and specificity of a virtually reported fever were 91% (95% CI: 87% to 96%) and 69% (95% CI: 62% to 76%), respectively; the sensitivity and specificity of virtually reported ‘fast breathing’ were 47% (95% CI: 21% to 72%) and 89% (95% CI: 85% to 94%), respectively. Kappa for ‘no’ and ‘some’ dehydration indicated moderate congruence between virtual and in-person examinations (0.69; 95% CI: 0.41 to 0.98). At 10 days, 273 (95%) of the 287 cases reached by phone were better/recovered.ConclusionCritical components of the virtual examination (triage, danger signs and dehydration assessment) performed well despite varied performance among the problem-specific components. The study and associated resources represents formative steps towards an evidence-based paediatric telemedicine guideline built on WHO clinical principles. In-person examinations for select cases were important to address limitations with virtual examinations and identify cases for escalation.Trial registration numberNCT03943654.