Telemedicine for Pediatric Emergency Care

No longer recruiting at 1 trial location

Overseen By Tehnaz Boyle, MD PhD

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: Boston Medical Center

Disqualifiers: Non-respiratory complaints, Life-threatening illness, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if video calls connecting doctors with paramedics can improve emergency care for children with breathing issues during ambulance transport. The focus is on ensuring that this technology, known as teleconsultation, functions effectively and gains acceptance from doctors and paramedics. The trial targets children in New England who are stable but require additional care, such as oxygen or medication, en route to the hospital. As an unphased trial, this study provides an opportunity to contribute to innovative solutions that could enhance emergency care for children.

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What prior data suggests that teleconsultation is safe for pediatric emergency care?

Research has shown that teleconsultation, which uses video technology to connect doctors with patients, is generally safe and well-liked in children's emergency care. Studies have found that telehealth can quickly connect children with specialists, which is important for managing both everyday and urgent health issues in kids.

In controlled environments, researchers successfully tested teleconsultation using baby simulators, suggesting it could be safe in real-life situations too. Additionally, telemedicine has helped doctors make better decisions and reduce unnecessary emergency trips.

While concerns exist about accurately judging the urgency of situations, teleconsultation overall appears to be a safe and promising way to improve emergency care for children. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about teleconsultation for pediatric emergency care because it introduces a new way to deliver medical expertise directly to the scene via telemedicine. Unlike traditional emergency care, which relies solely on on-site paramedics, teleconsultation connects paramedic teams with specialists in real-time. This approach has the potential to improve decision-making and treatment speed for children in emergency situations, especially when immediate access to a hospital isn't possible. By leveraging technology to bridge the gap between emergency responders and pediatric experts, teleconsultation could enhance care quality and outcomes for young patients.

What evidence suggests that teleconsultation is effective for pediatric emergency care?

Research has shown that teleconsultation, which uses video calls to connect with expert doctors remotely, can aid in emergency care for children. Studies have found that telemedicine shortens hospital stays and helps doctors make better decisions during emergencies. This approach is often used for treating injuries and moderate cases, as it provides quick access to specialists. Additionally, telemedicine may reduce unnecessary hospital visits by improving decision-making. In this trial, researchers will explore the effectiveness of teleconsultation in prehospital situations, such as with paramedics in ambulances. While these findings suggest potential benefits, more research is needed to confirm its effectiveness in these settings. ^{1 3 6 7 8}

Who Is on the Research Team?

Tehnaz Boyle, MD PhD

Principal Investigator

Boston Medical Center

Are You a Good Fit for This Trial?

This trial is for children in New England with respiratory illnesses who are stable enough for transport by Boston Children's Hospital. They must need things like extra oxygen, medications, or be stable on a ventilator. Kids can't join if their parents don't speak English, they have non-respiratory issues, or are too sick and might need emergency care during the ride.

Inclusion Criteria

I am stable enough for travel, even if I need help like oxygen or medication.

Children in New England who were taken to Boston Children's Hospital for any respiratory illness.

Exclusion Criteria

Non-English speaking parents/guardians

My child has health issues not related to breathing.

Children whose condition is expected to be very serious and needing urgent medical care during transportation.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Teleconsultation

Transport providers initiate a video-call from the ambulance to a medical control physician for remote respiratory assessment of children

6 months

Ongoing during each transport

Follow-up

Participants are monitored for acceptability and feasibility of the teleconsultation platform using a validated questionnaire

6 months

What Are the Treatments Tested in This Trial?

Interventions

• Teleconsultation

Trial Overview

The study tests if doctors can use video calls to check on kids with breathing problems during ambulance rides. It checks whether this teleconsultation is doable and okay with everyone involved—like the medical staff and families—in real-life situations outside of hospitals.

How Is the Trial Designed?

Group I: Teleconsultation group Experimental Treatment 1 Intervention

Eligible children managed by urban paramedic teams responding to 911 calls in the prehospital setting to support a future trial of clinical efficacy.

Who Is Running the Clinical Trial?

Boston Medical Center

Lead Sponsor

Trials

410

Recruited

890,000+

National Heart, Lung, and Blood Institute (NHLBI)

Collaborator

Trials

3,987

Recruited

47,860,000+

Published Research Related to This Trial

The pediatric telemedicine service demonstrated high levels of diagnosis appropriateness (98.5%) and decision reasonableness (92%), indicating that online physicians are making accurate assessments in most cases.

Despite the overall high safety levels, with low false-positive (2.65%) and false-negative (5.3%) rates, there is a need for ongoing improvements to enhance diagnostic accuracy and treatment quality in tele-triage settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessing patient safety in a pediatric telemedicine setting: a multi-methods study. Haimi, M., Brammli-Greenberg, S., Baron-Epel, O., et al.[2020]

A qualitative study involving 16 healthcare professionals revealed that addressing biases against telemedicine is crucial for increasing its adoption in pediatric emergency care.

Telemedicine enhances collaboration among healthcare providers and families, but to improve its use, processes must adapt to include various technologies and allow more healthcare staff, like nurses, to participate in consultations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acceptability, Usability, and Effectiveness: A Qualitative Study Evaluating a Pediatric Telemedicine Program. Sauers-Ford, HS., Hamline, MY., Gosdin, MM., et al.[2020]

In a study of 138 acutely ill and injured children in rural emergency departments, those receiving telemedicine consultations had a significantly lower hospital admission rate (59.5%) compared to those receiving telephone consultations (87.5%), suggesting that telemedicine may lead to more appropriate care.

Despite the lower admission rate with telemedicine, the observed-to-expected admission ratios were not statistically different between the two groups, indicating that both consultation methods provided similar levels of care quality, which supports the use of telemedicine in pediatric emergency settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Appropriateness of disposition following telemedicine consultations in rural emergency departments. Yang, NH., Dharmar, M., Kuppermann, N., et al.[2022]

Children admitted to the PICU from emergency departments with access to pediatric telemedicine were younger and less severely ill compared to those from departments without telemedicine, indicating that telemedicine may help in better managing critical cases before transfer.

After implementing telemedicine, the severity of illness in children transferred from emergency departments significantly decreased, suggesting that telemedicine programs can improve initial care and potentially lead to better clinical outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of Telemedicine on Severity of Illness and Outcomes Among Children Transferred From Referring Emergency Departments to a Children's Hospital PICU. Dayal, P., Hojman, NM., Kissee, JL., et al.[2019]

General emergency department providers see potential in pediatric telemedicine for improving care, particularly in guiding diagnoses and managing low-frequency, high-stakes situations, based on interviews with 18 providers.

However, they also noted limitations such as infrequent need for telemedicine and barriers to implementation, suggesting that further research is needed to evaluate its effectiveness and cost before widespread use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Qualitative Analysis of General Emergency Medicine Providers' Perceptions on Pediatric Emergency Telemedicine. Kim, JW., Tiyyagura, G., Langhan, M.[2020]

A survey of 25 respondents from 20 pediatric emergency telemedicine programs revealed that while reimbursement is less of a barrier, challenges like cross-hospital credentialing and integration into existing workflows significantly hinder the widespread use of telemedicine in pediatric emergency care.

Successful implementation of pediatric emergency telemedicine relies on selecting hospitals that are receptive to the program and having local clinical champions to promote its use, highlighting the importance of local support and adaptability in overcoming barriers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Barriers and facilitators to pediatric emergency telemedicine in the United States. Uscher-Pines, L., Kahn, JM.[2021]

Telemedicine shows promise in pediatric emergency medicine by enabling real-time decision-making, which could enhance the quality of care for children.

However, there are logistical and legal challenges to its implementation, and further research is needed to determine its impact on clinical outcomes and to address practical issues like training and resource allocation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Telemedicine Applications for the Pediatric Emergency Medicine: A Review of the Current Literature. Gattu, R., Teshome, G., Lichenstein, R.[2016]

In a study of 320 critically ill children in rural emergency departments, telemedicine consultations provided the highest quality of care compared to telephone consultations and no consultations, as rated by pediatric emergency medicine physicians.

Parents reported significantly higher satisfaction and perceived quality of care when telemedicine was used, and telemedicine led to more frequent changes in diagnosis and treatment by referring physicians compared to telephone consultations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of critical care telemedicine consultations on children in rural emergency departments. Dharmar, M., Romano, PS., Kuppermann, N., et al.[2022]

Synchronous telemedicine in pediatric acute care settings has been associated with improved quality of care, reduced transfer rates (by 31-87.5%), and shorter hospital stays (averaging 8.2 days compared to 15.1 days).

Despite these positive outcomes, the overall quality of the studies reviewed was weak, indicating a need for more robust research to confirm the clinical effectiveness of telemedicine in these settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of Synchronous Telemedicine Models on Clinical Outcomes in Pediatric Acute Care Settings: A Systematic Review. Nadar, M., Jouvet, P., Tucci, M., et al.[2023]

A pilot study evaluating a telemedicine program for critically ill pediatric patients in the emergency department showed positive perceptions from both parents and physicians, highlighting its effectiveness in providing rapid access to specialized care.

The program facilitated better communication between local and remote physicians, although the study faced limitations related to sample size and response rate, indicating a need for further research to validate these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Examining perceptions of a telemedicine network for pediatric emergency medicine: a mixed-methods pilot study. Mateus, LA., Law, MP., Khowaja, AR., et al.[2023]

During a 6-month study period, the pediatric emergency department received an average of 2.15 calls per day, with common concerns including fever (27%), digestive issues (22%), and trauma (14%), indicating a significant demand for telephone advice in pediatric care.

About 30% of the calls did not require medical advice, suggesting that many parents were seeking general orientation rather than urgent care, highlighting the need for improved protocols to address common inquiries effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Pediatric telephone advice in the emergency department]. Dufour, D., Paon, JC., Marshall, B., et al.[2006]

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