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This is a randomized study that sought to analyze the diagnostic accuracy of the telemedicine consultation of patients suspected of respiratory tract infections during COVID-19 pandemic in comparison with the face-to-face evaluation at the emergency department.
Unicentric, prospective and randomized study performed between September and November 2020 with adult patients who sought care at emergency department. The inclusion criterion was the exhibition of any tract respiratory symptom. Patients older than 65 years, with chronic heart or lung diseases or immunosuppressed were excluded. Eligible patients were randomized 1:1 for a brief telemedicine consultation, blinded to subsequent face-to-face evaluation or direct face-to-face evaluation.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Adult patients with respiratory tract symptom - telemedicine before face-to-face evaluation | Active Comparator | We included adults (≥18 years of age) who had at least one acute symptom compatible with Respiratory Tract Infection (sore throat, nasal obstruction, coryza, new or growing cough, sputum, hoarseness, dyspnea) with or without symptoms related to the infection (fever ≥ 38oC, chills, sweating, myalgia) who have undergone telemedicine consultation before face-to-face evaluation |
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| Adult patients with respiratory tract symptom - only face-to-face evaluation | Active Comparator | We included adults (≥18 years of age) who had at least one acute symptom compatible with Respiratory Tract Infection (sore throat, nasal obstruction, coryza, new or growing cough, sputum, hoarseness, dyspnea) with or without symptoms related to the infection (fever ≥ 38oC, chills, sweating, myalgia) who have undergone only face-to-face evaluation |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Telemedicine Consultation | Other | Brief telemedicine consultation, blinded to subsequent face-to-face evaluation. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Number of final evaluation ICD 10-code diagnosis. | All institutional Emergency Department or Telemedicine assessments involve filling out the final diagnosis on an International Classification of Diseases (ICD-10)-code basis in the electronic medical record before discharge to home or admission. For aggregation of most prevalent RTI with similar pathophysiologic characteristics, three diagnostic groups were defined, based on ICD 10 codes: RTI, including COVID-19 (B34.2, B34.9, B97.2, J00, J04, J06, J11, J20, J30, J39, U07.1); PT - Acute Pharyngotonsillitis (J02-J03.9) and AS - Acute Sinusitis (J01-J01.9). | up to 10 months |
| Measure | Description | Time Frame |
|---|---|---|
| Time of medical care | Comparison of time (minutes) of medical care between telemedicine and face-to-face consultation. | up to 10 months |
| Rate of indication for complementary exams | Comparison of rate (percentage) of indication for complementary exams between telemedicine and face-to-face consultation. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Eduardo HS Cordioli, MD | Telemedicine Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospital Israelita Abert Einstein | São Paulo | São Paulo | 05652-900 | Brazil |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 35649057 | Derived | Accorsi TAD, Moreira FT, Pedrotti CHS, Amicis K, Correia RFV, Morbeck RA, Medeiros FF, Souza JL Jr, Cordioli E. Telemedicine diagnosis of acute respiratory tract infection patients is not inferior to face-to-face consultation: a randomized trial. Einstein (Sao Paulo). 2022 May 27;20:eAO6800. doi: 10.31744/einstein_journal/2022AO6800. eCollection 2022. |
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| ID | Term |
|---|---|
| D012141 | Respiratory Tract Infections |
| D000086382 | COVID-19 |
| ID | Term |
|---|---|
| D007239 | Infections |
| D012140 | Respiratory Tract Diseases |
| D011024 | Pneumonia, Viral |
| D011014 | Pneumonia |
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| Face-to-face Consultation | Other | Direct face-to-face evaluation (without telemedicine consultation before). |
|
| up to 10 months |
| Type of requested exams | Comparison of type of requested exams (porcentage) between telemedicine and face-to-face consultation. | up to 10 months |
| Type of Medical prescription | Comparison of type of medical prescription after completion of the service between telemedicine and face-to-face consultation | up to 10 months |
| Type of proposed destination after completion of the service | Comparison of proposed destination (percentage of discharge or hospitalization) after completion of the service between telemedicine and face-to-face consultation. | up to 10 months |
| D014777 |
| Virus Diseases |
| D018352 | Coronavirus Infections |
| D003333 | Coronaviridae Infections |
| D030341 | Nidovirales Infections |
| D012327 | RNA Virus Infections |
| D008171 | Lung Diseases |