title: Reliability of circulatory and neurologic examination by telemedicine in a pediatric intensive care unit.
abstract: OBJECTIVE
  To test the hypothesis that telemedicine can reliably be used for many aspects of circulatory and neurologic examinations of children admitted to a pediatric intensive care unit (PICU).
  
  
  METHODS
  A prospective, randomized study in a 14-bed PICU in a tertiary care, academic-affiliated institution. Eligible patients were >2 months or <19 years of age, not involved in a concurrent study, had parents/guardian able to sign an informed consent form, were not at end-of-life, and had an attending who not only deemed them medically stable, but also felt that the study would not interrupt their care. Other than the Principal Investigator, 6 pediatric intensivists and 7 pediatric critical care fellows were eligible study providers. Two physician providers were randomly assigned to perform circulatory and neurologic examinations according to the American Heart Association/Pediatric Advanced Life Support guidelines in-person and via telemedicine. Findings were recorded on a standardized data collection form and compared.
  
  
  RESULTS
  One hundred ten data collection forms were completed. For many aspects of the circulatory and neurologic examinations, outcomes showed substantial to perfect agreement between the in-person and telemedical care providers (kappa = 0.64-1.00). However, assessments of muscle tone had a kappa = 0.23, with a kappa = 0.37 for skin color.
  
  
  CONCLUSIONS
  Telemedicine can reliably identify normal and abnormal findings of many aspects of circulatory and neurologic examinations in PICU patients. This finding opens the door to further studies on the use of telemedicine across other disciplines.
authors.affiliation: Massachusetts General Hospital, Boston, MA.
authors.forename: Phoebe H
authors.initials: PH
authors.lastname: Yager
authors.affiliation: Massachusetts General Hospital, Boston, MA.
authors.forename: Maureen E
authors.initials: ME
authors.lastname: Clark
authors.affiliation: Maimonides Medical Center, Brooklyn, NY.
authors.forename: Heda R
authors.initials: HR
authors.lastname: Dapul
authors.affiliation: Massachusetts General Hospital, Boston, MA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Murphy
authors.affiliation: Massachusetts General Hospital, Boston, MA.
authors.forename: Hui
authors.initials: H
authors.lastname: Zheng
authors.affiliation: Massachusetts General Hospital, Boston, MA. Electronic address: nnoviski@partners.org.
authors.forename: Natan
authors.initials: N
authors.lastname: Noviski
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D009460:Neurologic Examination / Q000379:methods*; D015588:Observer Variation; D010808:Physical Examination / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017216:Telemedicine / Q000379:methods*