Evaluation of the use of telemedicine in pediatric intensive care units: a cluster-randomized trial

ABSTRACT

Introduction

Telemedicine has shown promising results, allowing specialists to provide rapid and effective care in remote locations. However, to our knowledge, current evidence is not robust enough to prove the effectiveness of this tool. This cluster-randomized trial (CRT) aimed to evaluate the impact of telemedicine on clinical care indicators in pediatric intensive care units (PICUs).

Methods

An open-label CRT was conducted in 16 PICUs within the Brazilian public health system. The trial took place from August 2022 to December 2023 and compared an intervention group, which received telemedicine support, with a control group, which received usual PICU care. The primary outcome was the PICU length of stay. The main secondary outcomes were mortality rate and ventilator-free days.

Results

A total of 1393 participants were included, 657 in the control group and 736 in the intervention group. The mean PICU length of stay was 10.42 (SD, 10.71) days for the control group and 11.52 (SD, 10.80) days for the intervention group. The overall mean of ventilator-free days was 6.82 (SD, 7.71) days. Regarding mortality, 7.54% of participants died in total. No significant difference was found in the outcomes between the groups.

Conclusion

Despite the potential benefits of telemedicine, its effective implementation in the Brazilian public health system faces considerable challenges, highlighting the continued importance of investigating and improving the role of telemedicine in pediatric critical care.

Clinical trial registration

ClinicalTrials.gov NCT05260710 and ReBEC – RBR-7×j4wyp.

KEYWORDS:

• Telemedicine
• intensive care units
• pediatrics

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors are grateful to the Hospital Moinhos de Vento team involved in the design and implementation of the project together with the Brazilian Ministry of Health and to the teams from the following hospitals that participated in this project: Santa Casa de Misericórdia de Sobral, Hospital Maternidade São Francisco de Assis, Hospital Maternidade Santa Isabel, Fundação Santa Casa de Misericórdia do Pará, Hospital Geral de Vitória da Conquista, Hospital Geral do Estado de Alagoas – Prof. Osvaldo Brandão Vilela, Santa Casa de Itabuna – Hospital Manoel Novaes, Hospital Barão de Lucena, Hospital Regional do Baixo Amazonas, Hospital Infantil Iolanda Costa e Silva, Hospital Municipal de Araguaína, Hospital Santo Antônio – Irmã Dulce, Hospital Universitário Dr Miguel Riet Corrêa Jr., Hospital Infantil Dr Waldemar Monastier, Hospital Guilherme Álvaro, and Hospital Geral Dr Waldemar Alcântara. We also thank all the children and families in the PICUs who trusted our care and allowed us to use their data for this study. The authors also acknowledge the support of all individuals and organizations who have provided assistance throughout this study.

Author contributions

Felipe Cezar Cabral, João Ronaldo Mafalda Krauzer, Taís de Campos Moreira, Hilda Maria Rodrigues Moleda Constant, Vanessa Cristina Jacovas, Aristóteles de Almeida Pires made a substantial contribution to the concept and design of the study. Gabriela de Oliveira Laguna Silva and Emanuele König Klever researched literature. Mariana Motta Dias da Silva did the data analysis. Gabriela de Oliveira Laguna Silva and Mariana Motta Dias da Silva interpreted the data. Gabriela de Oliveira Laguna Silva wrote the first draft of the manuscript. Gabriela de Oliveira Laguna Silva, Taís de Campos Moreira, and Emanuele König Klever wrote the final draft of the manuscript. Felipe Cezar Cabral, João Ronaldo Mafalda Krauzer, Taís de Campos Moreira, Hilda Maria Rodrigues Moleda Constant, Vanessa Cristina Jacovas, Aristóteles de Almeida Pires, Luciane Gomes da Cunha, Bárbara Marina Simionato, and Bárbara Marina Simionato revised it critically for important intellectual content. All authors reviewed and approved the final version of the manuscript.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/00325481.2024.2388023.

Additional information

Funding

Financial support was provided by the Brazilian Ministry of Health, through the Institutional Development Program of the Unified Health System (PROADI-SUS). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.