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
