Video Based Assessment of Treatment Urgency in Outpatient Orthopaedic and Trauma Patients - a Pilot Trial

Abstract

Introduction When consulting a specialist in orthopaedics and trauma surgery, personal assessment and manual clinical examination by the doctor on site are essential. Nevertheless, implementation of video consultation hours has been made legally easier in Germany. The present pilot study examines the possibility of video-based assessment of the urgency of treatment in outpatient orthopaedic and trauma patients.

Materials and Methods Within an ex ante study design, 40 patients with an orthopaedic clinical picture for trauma surgery with elective, urgent or emergency indication were selected from consultation hours. A short questionnaire was filled in based on the information provided and a medical colleague simulated a movement sequence based on the patient information. After modification to the “red flags” and “yellow flags” established in spinal orthopaedics, nine short questions were recorded, which inquire about the urgency of a medical consultation. The video-based movement sequence is based on a 60 s long instruction video in which motor tests and movement sequences are demonstrated: Cervical spine movement in all levels, elevation of the upper extremity, test of the finger-floor distance when “bending forward over-bending”, possibility of crouching from standing and getting up again, standing on heels and toes.

Results In 91.1% (n = 328) of the cases, the diagnosis was associated with the same joint or the same pathological entity. In 37.5% (n = 135) of the cases an emergency indication was seen, in 10.8% (n = 39) of the cases an urgent indication and in 51.6% (n = 186) of the cases it was seen to offer an elective indication. 12.5% (n = 45) of the cases were evaluated as “false positives” with regard to an emergency or urgent presentation. This means that the test persons were classified as “emergency” or “urgent”, although there was no preventable dangerous course or medical emergency. 18 cases (5%) were evaluated as “false negative”.

Discussion The screening questionnaire presented and the short video assessment are technically feasible and practicable method for the initial evaluation in video-based online medical consultation. In addition, the questionnaire presented in combination with the short video assessment was suitable as an instrument for assessing the urgency of the consultation and selecting preventable dangerous processes and acute emergencies.

Conclusion The questionnaire, in combination with the short video assessment, is a suitable method for the social distancing requirements during limited accessibility of the medical system. Nevertheless, a false negative rate of 5% is too high to implement the questionnaire presented into daily clinics without further optimisation.

Keywords

online - urgency - outpatient - Emergency - Teleconsultation

Publikationsverlauf

Eingereicht: 27. Januar 2021

Angenommen nach Revision: 11. November 2021

Artikel online veröffentlicht:
31. Mai 2022

• Literatur

• 1 Bini SA, Schilling PL, Patel SP. et al. Digital Orthopaedics: A Glimpse Into the Future in the Midst of a Pandemic. J Arthroplasty 2020; 35(7S): S68-S73
• 2 Nesbitt TS, Hilty DM, Kuenneth CA. et al. Development of a telemedicine program: a review of 1,000 videoconferencing consultations. West J Med 2000; 173: 169-174
• 3 Henry TW, Fletcher D, Vaccaro AR. et al. Evaluating Patient Interest in Orthopedic Telehealth Services Beyond the COVID-19 Pandemic. Cureus 2021; 13: e16523
• 4 Bundesregierung. Entwurf eines Gesetzes für eine bessere Versorgung durch Digitalisierung und Innovation (Digitale-Versorgung-Gesetz – DVG). Zugriff am 24. Mai 2020 unter: https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/3_Downloads/Gesetze_und_Verordnungen/GuV/D/Digitale-Versorgung-Gesetz_DVG_Kabinett.pdf
• 5 Nguyen OT, Watson AK, Motwani K. et al. Patient-Level Factors Associated with Utilization of Telemedicine Services from a Free Clinic During COVID-19. Telemed J E Health 2021;
• 6 Reitzle L, Schmidt C, Färber F. et al. Perceived Access to Health Care Services and Relevance of Telemedicine during the COVID-19 Pandemic in Germany. Int J Environ Res Public Health 2021; 18: 7661
• 7 Hurley ET, Haskel JD, Bloom DA. et al. The Use and Acceptance of Telemedicine in Orthopedic Surgery During the COVID-19 Pandemic. Telemed J E Health 2021; 27: 657-662
• 8 Graf von Stillfried D, Czihal T, Meer A. Sachstandsbericht: Strukturierte medizinische Ersteinschätzung in Deutschland (SmED). Notfall Rettungsmed 2019; 22: 578-588
• 9 Downie A, Williams CM, Henschke N. et al. Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ 2013; 347: f7095
• 10 Scott J, Huskisson EC. Graphic representation of pain. Pain 1976; 2: 175-184
• 11 Welle K, Täger S, Hackenberg RK. et al. Examining the Hand in the Video Consultation. Z Orthop Unfall 2021; 159: 202-208
• 12 Wootton R, Darkins A. Telemedicine and the doctor-patient relationship. J R Coll Physicians Lond 1997; 31: 598-599
• 13 Daentzer D. Video Consultations and Their Utilization by Orthopedic and Trauma Surgeons During the COVID-19 Pandemic. A Go-To Technology in the Future or Just a Stopgap?. Z Orthop Unfall 2021;
• 14 Buvik A, Bergmo TS, Bugge E. et al. Cost-Effectiveness of Telemedicine in Remote Orthopedic Consultations: Randomized Controlled Trial. J Med Internet Res 2019; 21: e11330