title: Telemedicine: A Reliable Tool to Assess the Severity of Respiratory Distress in Children.
abstract: OBJECTIVE
  Remote assessment of respiratory distress using telemedicine enabled audio-video conferencing (TM) is of value for medical decision-making. Our goal was to evaluate the interobserver reliability (IOR) of TM compared with face-to-face (FTF) assessment of respiratory distress in children.
  
  
  METHODS
  A prospective, cohort study was performed in pediatric emergency department from July 2012 to February 2013. Children (aged 0-18 years) who presented with signs of respiratory distress were included in the study. The respiratory score is a 4-item, 12-point scale (respiratory rate [1-3], retractions [0-3], dyspnea [0-3], and wheezing [0-3]) that assesses the severity of a child's respiratory distress. Each child was evaluated by a pair of observers from a pool of 25 observers. The first observer evaluated the patient FTF, and the second observer simultaneously and independently evaluated remotely via TM. The overall respiratory distress severity is based on the respiratory scale and reported as nonsevere (≤8) and severe (≥9) respiratory distress. The IOR reliability between FTF and TM assessment was measured using a 2-way mixed model, absolute agreement and average measure intraclass correlation coefficient (ICC).
  
  
  RESULTS
  Forty-eight patients and 135 paired observations were recorded. IOR between the FTF and TM groups for total respiratory score had an ICC of 0.95 (confidence interval 0.93-0.96) and for subscores, the ICC range was as follows: respiratory rate = 0.92, retractions = 0.85, dyspnea = 0.94, and wheezing = 0.77.
  
  
  CONCLUSIONS
  TM is a reliable tool to assess the severity of respiratory distress in children.
authors.affiliation: Division of Pediatric Emergency Medicine and rgattu@peds.umaryland.edu.
authors.forename: Rajender
authors.initials: R
authors.lastname: Gattu
authors.affiliation: Division of Pediatric Emergency Medicine and.
authors.forename: Joey
authors.initials: J
authors.lastname: Scollan
authors.affiliation: Department of Pediatrics, University of Maryland Medical Center; and.
authors.forename: Amita
authors.initials: A
authors.lastname: DeSouza
authors.affiliation: Department of Pediatrics, Division of Neonatology, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Danielle
authors.initials: D
authors.lastname: Devereaux
authors.affiliation: Division of Pediatric Emergency Medicine and.
authors.forename: Holli
authors.initials: H
authors.lastname: Weaver
authors.affiliation: Department of Pediatrics, Division of Neonatology, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Agthe
mesh_terms: D000293:Adolescent; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D012107:Research Design; D012131:Respiratory Insufficiency / Q000175:diagnosis*; D012720:Severity of Illness Index; D063189:Symptom Assessment / Q000379:methods*; D017216:Telemedicine / Q000379:methods*; D014481:United States