Assessment of patients with acute respiratory symptoms during the COVID-19 pandemic by Telemedicine: clinical features and impact on referral

Accorsi, Tarso Augusto Duenhas; Amicis, Karine De; Brígido, Alexandra Régia Dantas; Belfort, Deborah de Sá Pereira; Habrum, Fábio Cetinic; Scarpanti, Fernando Garcia; Magalhães, Iuri Resedá; Silva, José Roberto de Oliveira; Sampaio, Leon Pablo Cartaxo; Lira, Maria Tereza Sampaio de Sousa; Morbeck, Renata Albaladejo; Pedrotti, Carlos Henrique Sartorato; Cordioli, Eduardo

OBJECTIVE: To characterize variables associated with referral to the emergency department following Telemedicine consultation during the COVID-19 pandemic. METHODS: Cross-sectional retrospective study conducted between March and May 2020, with a sample of 500 adult patients. The inclusion criterion was the manifestation of respiratory symptoms, regardless of type. RESULTS: The mean age of patients was 34.7±10.5 years, and 59% were women. Most patients (62.6%) perceived their own health status as malaise and some (41.4%) self-diagnosed COVID-19. Cough (74.4%), rhinorrhea (65.6%), sore throat (38.6%) and sneezing (20.6%) were the most common infection-related symptoms. Overall, 29.4% and 16% of patients reported dyspnea and chest pain, respectively. The Roth score was calculated for a sizeable number of patients (67.6%) and was normal, moderately altered or severely altered in 83.5%, 10.7% and 5.6% of patients, respectively. The percentage of suspected COVID-19 cases was 67.6%. Of these, 75% were managed remotely and only one quarter referred for emergency assessment. CONCLUSION: Telemedicine assessment is associated with reclassification of patient's subjective impression, better inspection of coronavirus disease 2019 and identification of risk patients. Referral is therefore optimized to avoid inappropriate in-person assessment, and low-risk patients can be properly guided. Telemedicine should be implemented in the health care system as a cost-effective strategy for initial assessment of acute patients.