Diagnostic accuracy and management concordance of otorhinolaryngological diseases through telehealth or remote visits: A systematic review & meta-analysis
Abstract
Introduction
COVID-19 has led to delays in providing healthcare in both emergency and non-emergency settings, especially in surgical subspecialties which rely heavily on referrals and in-person visits. Without an established telehealth infrastructure, many otorhinolaryngological departments experienced decreases in consultations. Telemedicine has attempted to bridge the gap between pre- and post-pandemic periods by creating a safe avenue of communication between otorhinolaryngologists and patients. This review hopes to address the accuracy of telemedicine in patient diagnosis and management.
Methods
Searches were conducted since study conception until June 30, 2022, on multiple databases including PubMed, SCOPUS, and CINAHL for this systematic review and meta-analysis. Diagnostic accuracy, management accuracy, kappa, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were meta-analyzed by comparing virtual visits to in-person visits (gold standard).
Results
Nineteen studies were included in this review. A total of 1518 patients were included across all studies. When comparing virtual visits against in-person visits, accurate diagnosis was made in 86.2% [82.1,89.9, I2 = 73.5%, P < 0.0001] of patients and management accuracy was 91.5% [86.1,95.7, I2 = 81.8%, P < 0.0001] when treating patients. Kappa value determining interrater reliability was 0.8 [0.7,0.9, I2 = 81.8%, P < 0.0001].
Conclusion
Our data suggest that diagnostic and management concordance is above 80% when comparing diagnosis and management strategies in patients who underwent both telehealth and in-person visits with an otorhinolaryngologist. In uncomplicated patients, telehealth might be a reliable source for diagnosis and management however, in-person consultation is likely still required for pathologies in which physical exam, imaging or procedural elements represent a vital component of the work-up.
Get full access to this article
View all access and purchase options for this article.
References
1. Smith AC, Thomas E, Snoswell CL, et al. Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). J Telemed Telecare 2020; 26: 309–313.
2. Saraswathula A, Gourin CG, Stewart CM. National trends in US otolaryngology surgical volume during the early COVID-19 pandemic. JAMA Otolaryngology–Head & Neck Surgery 2021; 147: 397–399.
3. Kasle DA, Torabi SJ, Savoca EL,. et al. Outpatient otolaryngology in the Era of COVID-19: A data-driven analysis of practice patterns. Otolaryngol Head Neck Surg 2020; 163: 138–144.
4. Patel ZM, Fernandez-Miranda J, Hwang PH, et al. Letter: Precautions for endoscopic transnasal skull base surgery during the COVID-19 pandemic. Neurosurgery 2020; 87: E66–E67.
5. Snoswell CL, Taylor ML, Comans TA,. et al. Determining if telehealth can reduce health system costs: Scoping review. J Med Internet Res 2020; 22: e17298.
6. Todd N, Ditkowsky J, Sharma VK. The Impact of Telemedicine on ED Costs and Utilization: Literature and Strategies Review. Admin & Ops Literature Review 2020. https://www.emra.org/emresident/article/lit-review-telemedicine/
7. Shah M, Douglas J, Carey R, et al. Reducing ER visits and readmissions after head and neck surgery through a phone-based quality improvement program. Ann Otol Rhinol Laryngol 2021; 130: 24–31.
8. Manning LA, Gillespie CM. E-Health and telemedicine in otolaryngology: Risks and rewards. Otolaryngol Clin North Am 2022; 55: 145–151.
9. Vogt EL, Welch BM, Bunnell BE, et al. Quantifying the impact of COVID-19 on telemedicine utilization: Retrospective observational study. Interact J Med Res 2022; 11: e29880.
10. Wiadji E, Mackenzie L, Reeder P, et al. Utilization of telehealth by surgeons during the COVID 19 pandemic in Australia: Lessons learnt. ANZ J Surg 2021; 91: 507–514.
11. Samson LW, Tarazi W, Turrini G,. et al. Medicare Beneficiaries’ Use of Telehealth in 2020: Trends by Beneficiary Characteristics and Location. Office of Health Policy: U.S. Department of Health and Human Services; December 2021.
12. Oxford Center for Evidence-Based Medicine. OCEBM Levels of Evidence Oxford Center for Evidence-Based Medicine. 2016.
13. Joanna Briggs Institute (JBI) critical appraisal tools assist in assessing the trustworthiness, relevance and results of published papers 2021. Health and Medical Sciences at the University of Adelaide SA. 2021.
14. Tufanaru C MZ, Aromataris E, Campbell J,. et al. Chapter 3: Systematic reviews of effectiveness. In: JBI Manual for Evidence Synthesis. Adelaide: JBI, 2020.
15. Moola S MZ, Tufanaru C, Aromataris E, et al. Chapter 7: Systematic reviews of etiology and risk. JBI Manual for Evidence Synthesis 2020.
16. Viera AJ GJ. Understanding interobserver agreement: The kappa statistic. Fam Med 2005; 37: 360–363.
17. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177–188.
18. Freeman MF, Tukey JW. Transformations related to the angular and the square root. The Annals of Mathematical Statistics 1950; 21: 607–611. 605.
19. Egger M, Davey Smith G, Schneider M,. et al. Bias in meta-analysis detected by a simple, graphical test. Br Med J 1997; 315: 629–634.
20. Sterne JA, Egger M. Funnel plots for detecting bias in meta-analysis: Guidelines on choice of axis. J Clin Epidemiol 2001; 54: 1046–1055.
21. Kwok M, Hunn S, Tan H,. et al. Diagnostic concordance of telemedicine for otolaryngology, head and neck surgery in regional Australia. ANZ J Surg 2021; 91: 1668–1672.
22. Barghouthi T, Glynn F, Speaker RB,. et al. The use of a camera-enabled mobile phone to triage patients with nasal bone injuries. Telemed J E Health 2012; 18: 150–152.
23. Biagio L, Swanepoel de W, Adeyemo A,. et al. Asynchronous video-otoscopy with a telehealth facilitator. Telemed J E Health 2013; 19: 252–258.
24. Cha D, Shin SH, Kim J, et al. Feasibility of asynchronous and automated telemedicine in otolaryngology: Prospective cross-sectional study. JMIR Med Inform 2020; 8: e23680.
25. Choi JS, Yin V, Wu F,. et al. 3rd. Utility of telemedicine for diagnosis and management of laryngology-related complaints during COVID-19. Laryngoscope 2022; 132: 831–837.
26. Shilo S, Ungar OJ, Handzel O, et al. Telemedicine for patients with unilateral sudden hearing loss in the COVID-19 era. JAMA Otolaryngol Head Neck Surg 2022; 148: 166–172.
27. Mallen JR, Shah MU, Drake R, et al. Utility of smartphone telemedical consultations for peritonsillar abscess diagnosis and triage. JAMA Otolaryngol Head Neck Surg 2020; 146: 909–913.
28. Mandavia R, Lapa T, Smith M,. et al. A cross-sectional evaluation of the validity of a smartphone otoscopy device in screening for ear disease in Nepal. Clin Otolaryngol 2018; 43: 31–38.
29. Smith AC, Perry C, Agnew J,. et al. Accuracy of pre-recorded video images for the assessment of rural indigenous children with ear, nose and throat conditions. J Telemed Telecare 2006; 12: 76–80.
30. Smith AC, Dowthwaite S, Agnew J,. et al. Concordance between real-time telemedicine assessments and face-to-face consultations in paediatric otolaryngology. Med J Aust 2008; 188: 457–460.
31. Miller LE, Buzi A, Williams A, et al. Reliability and accuracy of remote fiberoptic nasopharyngolaryngoscopy in the pediatric population. Ear Nose Throat J 2021; 100: 604–609.
32. Moshtaghi O, Sahyouni R, Haidar YM, et al. Smartphone-Enabled otoscopy in neurotology/otology. Otolaryngol Head Neck Surg 2017; 156: 554–558.
33. Stalfors J, Edström S, Björk-Eriksson T,. et al. Accuracy of tele-oncology compared with face-to-face consultation in head and neck cancer case conferences. J Telemed Telecare 2001; 7: 338–343.
34. Seim NB, Philips RHW, Matrka LA, et al. Developing a synchronous otolaryngology telemedicine clinic: Prospective study to assess fidelity and diagnostic concordance. Laryngoscope 2018; 128: 1068–1074.
35. Ullah R, Gilliland D, Adams D. Otolaryngology consultations by real-time telemedicine. Ulster Med J 2002; 71: 26–29.
36. Lundberg T, Biagio L, Laurent C,. et al. Remote evaluation of video-otoscopy recordings in an unselected pediatric population with an otitis media scale. Int J Pediatr Otorhinolaryngol 2014; 78: 1489–1495.
37. Shah MU, Sohal M, Valdez TA,. et al. Iphone otoscopes: Currently available, but reliable for tele-otoscopy in the hands of parents? Int J Pediatr Otorhinolaryngol 2018; 106: 59–63.
38. Shah MU, Lotterman S, Roberts D,. et al. Smartphone telemedical emergency department consults for screening of nonacute dizziness. Laryngoscope 2019; 129: 466–469.
39. Wu CJ, Wu SY, Chen PC,. et al. An innovative smartphone-based otorhinoendoscope and its application in mobile health and teleotolaryngology. J Med Internet Res 2014; 16: e71.
40. Ueda K, Ota I, Yamanaka T,. et al. The impact of the COVID-19 pandemic on follow-ups for vertigo/dizziness outpatients. Ear Nose Throat J 2021; 100: 163s–168s.
41. Ohlstein JF, Ahmed OG, Garner J,. et al. Telemedicine in otolaryngology in the COVID-19 Era: A year out. Cureus 2021; 13: e20794.
42. Kokesh J, Ferguson AS, Patricoski C. Preoperative planning for ear surgery using store-and-forward telemedicine. Otolaryngol Head Neck Surg 2010; 143: 253–257.
43. Garritano FG, Goldenberg D. Successful telemedicine programs in otolaryngology. Otolaryngol Clin North Am 2011; 44: 1259–1274., vii.
44. Thomas EE, Haydon HM, Mehrotra A, et al. Building on the momentum: Sustaining telehealth beyond COVID-19. J Telemed Telecare 2022; 28: 301–308.
45. Sclafani AP, Shomorony A, Stewart MG,. et al. Telemedicine lessons learned during the COVID-19 pandemic: The augmented outpatient otolaryngology teleconsultation. Am J Otolaryngol 2021; 42: 102960.
46. Levi JR, Yu VX, Cheung AY,. et al. Tele-otolaryngology: Through the Pandemic, and Beyond | Interim Findings of the Study of Telehealth in Otolaryngology. 2021.
47. Fang CH, Smith RV. COVID-19 and the resurgence of telehealth in otolaryngology. Oper Tech Otolayngol Head Neck Surg 2022; 33: 158–164.
48. Lechien JR, Radulesco T, Distinguin L, et al. Patient and otolaryngologist perceptions of telemedicine during COVID-19 pandemic. Eur Arch Otorhinolaryngol 2021; 278: 4101–4105.
49. Eze ND, Mateus C, Cravo Oliveira Hashiguchi T. Telemedicine in the OECD: An umbrella review of clinical and cost-effectiveness, patient experience and implementation. PLOS ONE 2020; 15: e0237585.
50. Moentmann MR, Miller RJ, Chung MT,. et al. Using telemedicine to facilitate social distancing in otolaryngology: A systematic review. J Telemed Telecare 2021: 1357633×20985391.
51. Chowdhury A, Hafeez-Baig A, Gururajan R,. et al. The Role of Image Quality in Telehealth: Adoption Challenges in the Subcontinent. Pacific Asia Journal of the Association for Information Systems 2021; 13: 131–145.
52. McCool RR, Davies L. Where does telemedicine fit into otolaryngology? An assessment of telemedicine eligibility among otolaryngology diagnoses. Otolaryngology–Head and Neck Surgery 2018; 158: 641–644.
53. Samarrai R, Riccardi AC, Tessema B,. et al. Continuation of telemedicine in otolaryngology post-COVID-19: Applications by subspecialty. Am J Otolaryngol 2021; 42: 102928.
54. Snoswell CL, Stringer H, Taylor ML,. et al. An overview of the effect of telehealth on mortality: A systematic review of meta-analyses. J Telemed Telecare 2021: 1357633X211023700.
55. Snoswell CL, Chelberg G, De Guzman KR, et al. The clinical effectiveness of telehealth: A systematic review of meta-analyses from 2010 to 2019. J Telemed Telecare 2021: 1357633X211022907.
Supplementary Material
Please find the following supplemental material visualised and available to download via Figshare in the display box below. Where there are more than one item, you can scroll through each tab to see each separate item.
For Open Access articles published under Creative Commons License https://creativecommons.org/licenses/, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
