Telemedicine in pediatric respiratory distress: a pilot study

Children with respiratory symptoms are frequently seen in the emergency rooms
across the Netherlands. In Rijnstate Hospital around 1000 emergency room
consultations by pediatric patients with respiratory symptoms are performed.
There is a distinct pattern throughout the year with more patients in the first
and last quarter, with a peakincidence in January and February (RIVM, 2013).
Children with respiratory symptoms usually spend between 2-4 hours in our
emergency rooms. Around 50% of these patients are admitted, the others are
discharged home. These numbers are most likely similar in other hospitals in
the Netherlands.

The patients who are discharged have a significant strain by having to travel
to the hospital while being ill, waiting in our emergency room before being
discharged home. This time- and travelstrain might well be reduced by using
telemedicine.

It is hypothesized that telemedicine applications and software allow for a
reliable examination of the child in respiratory distress. By examining the
patient through telemedicine the pediatrician can make a quatlity judgement
whether the patient needs to be seen in the emergency room or can be safely
discharged home with advice on when to reconnect with their general
practitioner. Also, the patients who are referred to our emergencyroom have
been examined before and will be able to go through our clinical examination in
a shorter period of time. We expect that patients and their parents will need
to get used to the idea of telemedicine, but will be pleased in the end because
of less travel and waiting time.

1. Are telemedicine and FTF-evaluation similar?
2. Are TM-evaluation from a general practitioners office and FTF-evaluation
similar?
3. How do parents/patients value the TM evaluation?
4. How do general practitioners and paediatricians value the TM evaluation?

Part 1:
Determining the safety and applicability of the software.
Children with respiratory distress who are already referred to our emergency
room will receive an extra physical examination by telemedicine and by a
face-to-face examination by the same doctor while they are waiting in the
emergency room. If the examination in real life and the telemedicine
examination are congruent part 2 of the study will commence.

Part 2:
Determining wether telemedicine works over long-distance connection with
general practitioner offices.
Children with respiratory symptoms whom the general practitioner was going to
refer to our emergency room will first be examined using telemedicine after
which they will be seen in real life on our emergency room to study whether
both physical examinations coincide.

Burden of the study consists of 1-2 extra physical examinations of which one
will be via telemedicine.
Additionally patients/parents will receive a questionnaire for evaluating the
telemedicine.


Participation may result in a delay of customary examination and therefore
treatment of approximately 15-30 minutes.
The risks associated with this delay are judged as minimal because the patient
is accompanied by a physician throughout the delay. Should the patients
condition deteriorate the general practitioner will continue to have the
opportunity to request for an ambulance.

Should the paediatrician examining the patient judge the respiratory distress
to be significant, the paediatrician can advice for an ambulance to be called
to transfer the patient to the hospital and thereby shortening the
transportation significantly.

A child with respiratory symptoms can suddenly develop to respiratory
insufficiency. However this is particularly the case in children younger than 2
months whom are not included in the study. Older children can potentially
deteriorate quickly however it is easier to determine their rate of respiratory
distress and it is expected that a delay of 15-30 minutes will not lead to
significant risk.