Telemedicine follow-ups for COVID-19: Experience in a tertiary hospital

Abstract

Introduction: Telemedicine is an attractive option for the follow-up of paediatric patients with SARS-CoV-2 infection. The aim of this article is to describe the experience with telephone consultations in a tertiary hospital. Patients and methods: Retrospective descriptive study of children with confirmed or probable diagnosis of COVID-19 attended by telephone consultations in Hospital La Paz (Madrid) between March and June 2020. Patients were referred from the Emergency Department after being discharged from the hospital. Telephone consultations were made every 48 h until symptoms resolved, then weekly until completing 14 days without symptoms. Results: A total of 72 children were included, with median age of 83.5 months [IQR = 16.3−157.5]. Of those 46 (63.9%) were male, and 14 (19.4%) had comorbidities. There were 32 (44.4%) hospital admissions. COVID-19 diagnosis was confirmed in 33 children by RT-PCR, and in 7 by serology tests. The seroconversion rate was 67.7% in those patients with a positive RT-PCR. Other infections were found in 7 patients (5 Mycoplasma pneumoniae, 1 parvovirus, and 1 CMV). Median symptom duration was 25.5 days [IQR = 13.8−37], while median follow-up duration was 28 days [IQR = 21−39]. The median number of telephone consultations per patient was 6 [IQR = 4−8]. Clinical worsening was reported in 19 (26.4%) during follow-up, and 14 (19.4%) were re-evaluated in the Emergency Department. One patient required hospital admission, but he had a favourable outcome. Conclusions: Children with suspected SARS-CoV-2 infection should be followed-up due to prolonged duration of symptoms, and the risk of clinical deterioration. Telephone consultations are a useful and safe alternative for the follow-up of patients with mild symptoms, and for children discharged from the hospital. Resumen: Introducción: El seguimiento telefónico es una posible alternativa para la atención médica de niños con COVID-19. Nuestro objetivo es describir la experiencia del seguimiento telemático realizado en un hospital terciario. Pacientes y métodos: Estudio descriptivo retrospectivo de los niños con diagnóstico confirmado o probable de COVID-19 atendidos en la consulta de seguimiento del Hospital La Paz entre marzo y junio de 2020. Se realizaron llamadas cada 48 horas hasta desaparecer los síntomas y posteriormente semanales hasta estar 14 días asintomáticos. Resultados: Se incluyeron 72 niños con mediana de edad de 83,5 meses [RIC = 16,3-157,5]. 46 eran varones (63,9%) y 14 tenían comorbilidades (19,4%). 32 pacientes (44,4%) habían requerido ingreso hospitalario. Se confirmó diagnóstico de COVID-19 en 33 niños por PCR y en 7 por serología. De los confirmados por PCR seroconvirtieron el 67,7%. Se demostraron otras etiologías en 7 pacientes (5 Mycoplasma pneumoniae, 1 parvovirus y 1 CMV).La mediana de duración de síntomas fue 25,5 días [RIC = 13,8-37], con mediana de tiempo de seguimiento de 28 días [RIC = 21-39]. Se realizó una mediana de 6 llamadas [RIC = 4-8] por niño. 19 pacientes (26,4%) refirieron empeoramiento en el seguimiento, precisando 14 (19,4%) ser reevaluados en urgencias. Un niño necesitó reingresar siendo la evolución favorable. Conclusiones: Ante sospecha de COVID-19 es recomendable el seguimiento médico por la prolongada duración de síntomas y el riesgo de empeoramiento. Las consultas telefónicas son útiles y seguras para el seguimiento de casos leves y pacientes hospitalizados tras el alta, permitiendo reducir controles presenciales y el consumo de otros recursos.

Keywords

• Pediatría
• Telemedicina
• Infección por coronavirus
• Test serológicos