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Paediatric telemedicine: the experience of Médecins Sans Frontières
Daniel Martinez Garcia, Sophie Delaigue, Jaap Karsten, Richard Wootton, Raghu Venugopal
Background and aims
MSF has operated in resource-limited settings since 1971. In 2010 it launched a telemedicine
program to support complex cases. We have reviewed the first 7 years of activities.
We analysed cases (<18 years age) submitted from April 2010 to June 2017. Cases were
categorized as radiology-only or general. General cases could involve a radiologist and other
specialists. We analysed evaluations made by the referrer 21 days after case submission.
A total of 3136 paediatric cases were submitted (56% of all telemedicine cases). During the
first three years 368 cases were referred (2/week) and in the last two years 2222 cases were
referred (21/week). Of the paediatric cases, 1283 (41%) were radiology-only and 1853 (59%)
were general. The median patient age was 3 years (IQR 1 – 8). There were 193 patients aged
<30 days, 972 aged 30 days-2 years, 1194 aged 2-10 years and 566 aged 10-18 years. The
median allocation time was 0.18 hours (IQR 0.07 – 0.53) and the median specialist answer time
was 5.5 hours (IQR 2-17). Most general cases received multispecialty support (63%). The
median dialogue time for paediatric cases (104 hours) was longer than adult cases (80 hours).
There were 300 responses to the 1608 requests for feedback for general cases (19% response
rate). More than 90% reported their case was sent to an appropriate specialist, that the
response was sufficiently quick and that the teleconsultation provided an educational benefit.
The outcome was deemed beneficial for the patient by 48% of respondents.
During the study period, paediatric telemedicine increased with support from headquarters
and external specialists. Field teams are satisfied with the efficient and field-adapted support
provided and report that it helps them manage their patients. The substantial volume of
paediatric cases (more than half of all cases) requires specific case-coordination skills and
support from multidisciplinary experts.