PMID- 35514061 OWN - NLM STAT- MEDLINE DCOM- 20221004 LR - 20231102 IS - 1469-8749 (Electronic) IS - 0012-1622 (Print) IS - 0012-1622 (Linking) VI - 64 IP - 11 DP - 2022 Nov TI - Visits of concern in child neurology telemedicine. PG - 1351-1358 LID - 10.1111/dmcn.15256 [doi] AB - AIM: To characterize child neurology telemedicine visits flagged as requiring in-person evaluation during the COVID-19 pandemic. METHOD: We analyzed 7130 audio-video telemedicine visits between March and November 2020. Visits of concern (VOCs) were defined as telemedicine visits where the clinical scenario necessitated in-person follow-up evaluation sooner than if the visit had been conducted in-person. RESULTS: VOCs occurred in 5% (333/7130) of visits for 292 individuals (148 females, 144 males). Providers noted technical challenges more often in VOCs (40%; 133/333) than visits without concern (non-VOCs) (28%; 1922/6797) (p < 0.05). The median age was younger in VOCs (9 years 3 months, interquartile range [IQR] 2 years 0 months-14 years 3 months) than non-VOCs (11 years 3 months, IQR 5 years 10 months-15 years 10 months) (p < 0.05). Median household income was lower for patients with VOCs ($74 K, IQR $55 K-$97 K) compared to non-VOCs ($80 K, IQR $61 K-$100 K) (p < 0.05). Compared with all other race categories, families who self-identified as Black were more likely to have a VOC (odds ratio 1.53, 95% confidence interval 1.21-2.06). Epilepsy and headache represented the highest percentages of VOCs, while neuromuscular disorders and developmental delay had a higher proportion of VOCs than other neurological disorders. INTERPRETATION: These findings suggest that telemedicine is an effective platform for most child neurology visits. Younger children and those with neuromuscular disorders or developmental delays are more likely to require in-person evaluation. WHAT THIS PAPER ADDS: It is possible to successfully flag patients who need in-person assessment. Providers can manage issues arising during telemedicine in 95% of visits. Visits flagged as concerning were likely unrelated to modality of patient care. Provider concern was independent of technical difficulties for most telehealth visits. Younger age may be correlated with need for in-person assessment. CI - (c) 2022 Mac Keith Press. FAU - Prelack, Marisa AU - Prelack M AD - Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA. AD - Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA. FAU - Fridinger, Sara AU - Fridinger S AD - Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA. AD - Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA. FAU - Gonzalez, Alexander K AU - Gonzalez AK AD - Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA. AD - Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA. AD - The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA. FAU - Kaufman, Michael C AU - Kaufman MC AUID- ORCID: 0000-0003-2718-296X AD - Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA. AD - Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA. AD - The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA. FAU - Xian, Julie AU - Xian J AD - Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA. AD - Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA. AD - The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA. FAU - Galer, Peter D AU - Galer PD AD - Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA. AD - Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA. AD - The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA. FAU - Craig, Sansanee AU - Craig S AD - Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA. FAU - Abend, Nicholas S AU - Abend NS AD - Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA. AD - Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA. AD - The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA. AD - Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. AD - Department of Anesthesia & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. FAU - Helbig, Ingo AU - Helbig I AUID- ORCID: 0000-0001-8486-0558 AD - Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA. AD - Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA. AD - Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA. AD - The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA. CN - CHOP Neuroscience Center - VOC Research Group* LA - eng GR - U54 NS108874/NS/NINDS NIH HHS/United States GR - K02 NS112600/NS/NINDS NIH HHS/United States GR - K23 NS102521/NS/NINDS NIH HHS/United States GR - U54 HD086984/HD/NICHD NIH HHS/United States GR - UL1TR001878/ITMAT/ GR - U24 NS120854/NS/NINDS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20220505 PL - England TA - Dev Med Child Neurol JT - Developmental medicine and child neurology JID - 0006761 SB - IM CIN - Dev Med Child Neurol. 2022 Nov;64(11):1315-1316. PMID: 35957497 MH - *COVID-19/epidemiology MH - Child MH - Female MH - Humans MH - Infant MH - Male MH - *Neurology MH - Pandemics MH - Retrospective Studies MH - *Telemedicine PMC - PMC9998265 MID - NIHMS1873129 EDAT- 2022/05/07 06:00 MHDA- 2022/10/05 06:00 PMCR- 2023/11/01 CRDT- 2022/05/06 00:53 PHST- 2022/03/25 00:00 [revised] PHST- 2021/08/19 00:00 [received] PHST- 2022/03/30 00:00 [accepted] PHST- 2022/05/07 06:00 [pubmed] PHST- 2022/10/05 06:00 [medline] PHST- 2022/05/06 00:53 [entrez] PHST- 2023/11/01 00:00 [pmc-release] AID - 10.1111/dmcn.15256 [doi] PST - ppublish SO - Dev Med Child Neurol. 2022 Nov;64(11):1351-1358. doi: 10.1111/dmcn.15256. Epub 2022 May 5.