Comparison of Quality of Pediatric Spirometry via Telemedicine and In-Person Modalities

Abstract

Background:

Quality spirometry testing depends upon maximal patient technique and can be particularly challenging for children. The telemedicine asthma clinic at Arkansas Children's Hospital (ACH) offers pediatric spirometry with an experienced respiratory therapist (RT) operating from ACH (distant site) via telemedicine technology using a spoke and hub model (Berlinski et al. J Allergy Clin Immunol Pract 2018;6(3):1042-1044). The RT at the distant site controls the spirometer at the originating site (where the patient and telepresenter are located) via a remote desktop connection and provides testing instructions in real time via two-way technology with the help of a telepresenter. We hypothesize that the quality of in-person spirometry and testing via telemedicine modalities will be similar.

Methods:

As part of our quality improvement process (not deemed human research by the IRB), we identified children who had completed spirometry via telemedicine for the first time and compared their technique to their previous spirometry done in-person. Demographic data were collected. Using a classification system developed by the ACH Pulmonary Lab (based on 2005 ATS/ERS statements), the RT assessed patient technique on all spirometry for acceptability and usability criteria according to one of these: 1) Full report (all values acceptable or usable), 2) FEV₁ Only (usable peak flow and FEV₁), and 3) Unusable (values do not meet criteria for interpretation). Proportions of tests in each category in both modalities were compared with Fisher exact test. A p value < 0.05 was considered statistically significant.

Results:

Fifty-four children (mean/95%CI age in-person study and age difference between last in-person and first telemedicine tests were 11/10-12.1 and 0.5/0.4-0.6 years old respectively; 77% male, and 77% Caucasian) were included. Pairwise comparison showed a 3.7, 85.2, and 11.1% improvement, no change, or worsening of technique respectively between the in-person and telemedicine modalities. (See Table)

Conclusions:

The quality of pediatric spirometry obtained via telemedicine and in-person modalities is similar.

Classification of Technique

	Full Report	FEV1 Only	Unusable
In-person study	45 (83.3%)	5 (9.3%)	4 (7.4%)
Telemedicine study	44 (81.5%)	1 (1.8%)	9 (16.7%)
p values between modalities	0.99	0.21	0.24