{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:27:24Z","timestamp":1791822444084,"version":"4.3.4"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec><jats:title>Importance<\/jats:title><jats:p>The number of innovations in health care based on the use of platforms, digital devices, apps, and artificial intelligence has grown exponentially in recent years. When used correctly, these technologies allow inequities in access to health care to be addressed by optimizing care and reducing social and geographic barriers. However, most of the technological health care solutions proposed have not undergone rigorous clinical studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess the concordance between measurements from a remote physical examination using a mobile medical device and measurements from a conventional in-person physical examination.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This nonrandomized controlled trial was conducted from January 1 to December 31, 2020. The clinical parameters compared were heart rate; body temperature; heart, lung, and abdominal auscultation; otoscopy; throat and oral examination; and skin examination. A total of 690 patients with clinical stability and various symptoms who were seen in the emergency department of 2 Brazilian pediatric hospitals were eligible to enter this study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcome was concordance between measurements from a telemedicine physical examination using a mobile medical device and measurements from a conventional in-person physical examination. The secondary outcome was the specificity and sensitivity of the digital device, considering the conventional in-person consultation as the gold standard.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 690 patients, the median (IQR) age at study entry was 5 (1-9) years; 348 (50.4%) were female, and 331 (48.0%) presented with a chronic disease. Regarding the primary outcome, the concordance values were 90% or greater for skin examination (94% for rash, 100% for hemorrhagic suffusion, and 95% for signs of secondary infection), characteristics of the mucosa (98% for hydration and 97% for coloring), and heart (95% for murmur, 97% for rhythms, and 98% for sounds), lung (91% for adventitious sounds, 97% for vesicular sounds, and 90% for fever), and abdominal (92% for abdominal sounds) auscultations. Concordance values were lower for otoscopy (72% for the ear canal and 86% for the tympanic membrane), throat and oral examination (72%), and rhinoscopy (79% for mucosa and 81% for secretion). The specificity was greater than 70% (ranging from 74.5% for the ear canal to 99.7% for hemorrhagic suffusion) for all variables. The sensitivity was greater than 52% for skin examination (58.0% for rash and 54.8% for signs of secondary infection), throat and oral examination (52.7%), and otoscopy (66.1% for the ear canal and 64.4% for the tympanic membrane).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this study, measurements from remote physical examination with a mobile medical device had satisfactory concordance with measurements from in-person physical examination for otoscopy, throat and oral examination, skin examination, and heart and lung auscultation, with limitations regarding heart and lung auscultation in infants and abdominal auscultation in children of all ages. Measurements from remote physical examination via a mobile medical device were comparable with those from in-person physical examination in children older than 2 years. These findings suggest that telemedicine may be an alternative to in-person examination in certain contexts and may help to optimize access to health care services and reduce social and geographic barriers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>Brazilian Registry of Clinical Trials Identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/ensaiosclinicos.gov.br\/rg\/RBR-346ymn\">RBR-346ymn<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.52570","type":"journal-article","created":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T16:10:35Z","timestamp":1675354235000},"page":"e2252570","source":"Crossref","is-referenced-by-count":31,"title":["Assessment of Pediatric Telemedicine Using Remote Physical Examinations With a Mobile Medical Device"],"prefix":"10.1001","volume":"6","author":[{"given":"Rafaela","family":"Wagner","sequence":"first","affiliation":[{"name":"Department of Telehealth, Hospital Pequeno Pr\u00edncipe, Curitiba, Paran\u00e1, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thalita Cec\u00edlia","family":"Lima","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, Hospital Pequeno Pr\u00edncipe, Curitiba, Paran\u00e1, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marielen Ribeiro Tavares da","family":"Silva","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, Hospital Pequeno Pr\u00edncipe, Curitiba, Paran\u00e1, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Clara Pereira","family":"Rabha","sequence":"additional","affiliation":[{"name":"Emergency Department, Sabar\u00e1 Hospital Infantil, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marinei Campos","family":"Ricieri","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, Hospital Pequeno Pr\u00edncipe, Curitiba, Paran\u00e1, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana Millan","family":"Fachi","sequence":"additional","affiliation":[{"name":"Value Management Office, Hospital Pequeno Pr\u00edncipe, Curitiba, Paran\u00e1, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rog\u00e9rio Carballo","family":"Afonso","sequence":"additional","affiliation":[{"name":"Department of Innovation and Business Development, Sabar\u00e1 Hospital Infantil, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F\u00e1bio Ara\u00fajo","family":"Motta","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, Hospital Pequeno Pr\u00edncipe, Curitiba, Paran\u00e1, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,2,2]]},"reference":[{"issue":"6","key":"zoi221494r1","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1177\/1357633X14541038","article-title":"Video-otoscopy recordings for diagnosis of childhood ear disease using telehealth at primary health care level.","volume":"20","author":"Biagio","year":"2014","journal-title":"J Telemed Telecare"},{"issue":"11","key":"zoi221494r2","doi-asserted-by":"publisher","first-page":"1289","DOI":"10.1016\/j.amjmed.2005.06.016","article-title":"A randomized trial comparing electronic and conventional stethoscopes.","volume":"118","author":"Iversen","year":"2005","journal-title":"Am J Med"},{"key":"zoi221494r3","doi-asserted-by":"publisher","author":"Mandavia","year":"2018","DOI":"10.1111\/coa.2018.43.issue-1"},{"issue":"9","key":"zoi221494r4","doi-asserted-by":"publisher","first-page":"e58","DOI":"10.1542\/pir.27.9.e58","article-title":"Potential of telemedicine in pediatric primary care.","volume":"27","author":"McConnochie","year":"2006","journal-title":"Pediatr Rev"},{"key":"zoi221494r5","doi-asserted-by":"publisher","author":"McDaniel","year":"2019","DOI":"10.1089\/tmj.2018.0214"},{"issue":"8","key":"zoi221494r6","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1016\/j.ajem.2015.04.063","article-title":"Comparison of traditional otoscope to iPhone otoscope in the pediatric ED.","volume":"33","author":"Richards","year":"2015","journal-title":"Am J Emerg Med"},{"issue":"6","key":"zoi221494r7","doi-asserted-by":"publisher","first-page":"984","DOI":"10.1016\/j.amjcard.2018.12.022","article-title":"Digital stethoscope\u2014improved auscultation at the bedside.","volume":"123","author":"Silverman","year":"2019","journal-title":"Am J Cardiol"},{"issue":"5","key":"zoi221494r8","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1038\/s41390-018-0117-6","article-title":"Physicians\u2019 experiences, attitudes and challenges in a pediatric telemedicine service.","volume":"84","author":"Haimi","year":"2018","journal-title":"Pediatr Res"},{"key":"zoi221494r9","doi-asserted-by":"publisher","author":"Notario","year":"2019","DOI":"10.1089\/tmj.2018.0186"},{"key":"zoi221494r13","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.94.3.361"},{"key":"zoi221494r14","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c332"},{"key":"zoi221494r16"},{"issue":"4","key":"zoi221494r18","doi-asserted-by":"publisher","first-page":"187","DOI":"10.4103\/picr.PICR_123_17","article-title":"Common pitfalls in statistical analysis: measures of agreement.","volume":"8","author":"Ranganathan","year":"2017","journal-title":"Perspect Clin Res"},{"issue":"1","key":"zoi221494r19","doi-asserted-by":"publisher","first-page":"159","DOI":"10.2307\/2529310","article-title":"The measurement of observer agreement for categorical data.","volume":"33","author":"Landis","year":"1977","journal-title":"Biometrics"},{"key":"zoi221494r20","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2019.109628","article-title":"Smartphone otoscopy by non-specialist health workers in rural Greenland: a cross-sectional study.","volume":"126","author":"Demant","year":"2019","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"9","key":"zoi221494r21","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1177\/0009922815593909","article-title":"Assessment of a smartphone otoscope device for the diagnosis and management of otitis media.","volume":"55","author":"Rappaport","year":"2016","journal-title":"Clin Pediatr (Phila)"},{"key":"zoi221494r22","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.ijporl.2018.01.003","article-title":"iPhone otoscopes: currently available, but reliable for tele-otoscopy in the hands of parents?","volume":"106","author":"Shah","year":"2018","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"1","key":"zoi221494r23","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1258\/135763304322764211","article-title":"Accuracy of detecting irregular cardiac rhythms via telemedicine.","volume":"10","author":"Zenk","year":"2004","journal-title":"J Telemed Telecare"},{"key":"zoi221494r24","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1016\/j.ajem.2021.04.030","article-title":"Evaluation of digital otoscopy in pediatric patients: a prospective randomized controlled clinical trial.","volume":"46","author":"Kleinman","year":"2021","journal-title":"Am J Emerg Med"},{"key":"zoi221494r27","doi-asserted-by":"publisher","author":"Doshi","year":"2018","DOI":"10.7759\/cureus.3689"},{"issue":"3","key":"zoi221494r28","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1001\/jama.2012.6223","article-title":"Innocent (harmless) heart murmurs in children.","volume":"308","author":"Punnoose","year":"2012","journal-title":"JAMA"},{"issue":"5","key":"zoi221494r29","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/S0891-5245(97)90103-6","article-title":"The innocent heart murmur in children.","volume":"11","author":"Smith","year":"1997","journal-title":"J Pediatr Health Care"},{"issue":"8","key":"zoi221494r30","first-page":"467","article-title":"Feasibility of an electronic stethoscope system for monitoring neonatal bowel sounds.","volume":"77","author":"Dumas","year":"2013","journal-title":"Conn Med"},{"issue":"18","key":"zoi221494r31","doi-asserted-by":"publisher","first-page":"1125","DOI":"10.12968\/bjon.2009.18.18.44555","article-title":"A critical review of auscultating bowel sounds.","volume":"18","author":"Baid","year":"2009","journal-title":"Br J Nurs"},{"key":"zoi221494r25","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/B978-0-7216-3695-5.50010-9","volume-title":"Kendig's Disorders of the Respiratory Tract in Children","author":"Pasterkamp","year":"2006","edition":"7th ed"},{"key":"zoi221494r26","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/B978-0-323-44887-1.00001-8","volume-title":"Kendig\u2019s Disorders of the Respiratory Tract in Children","author":"Pasterkamp","year":"2019","edition":"9th ed"},{"key":"zoi221494r10","unstructured":"Connected devices to support remote examination and diagnosis in primary care and specialty care. Canadian Agency for Drugs and Technologies in Health. Updated October 28, 2022. Accessed April 2022. https:\/\/www.cadth.ca\/connected-devices-support-remote-examination-and-diagnosis-primary-care-and-specialty-care"},{"key":"zoi221494r11","unstructured":"TytoPro General Operation User Guide. Software version 5.2. TytoCare Ltd. August 2021. Accessed March 2022. https:\/\/static-cloud.tytocare.com\/5_2\/manuals\/en-us\/760-00058_D03_TytoPro-General_Operation_FDA_G2_EN.pdf"},{"key":"zoi221494r12","unstructured":"World Health Organization. Ethics and Governance of Artificial Intelligence for Health. World Health Organization; 2021. Accessed March 2022. https:\/\/www.who.int\/publications\/i\/item\/9789240029200"},{"key":"zoi221494r15","unstructured":"Health Insurance Portability and Accountability Act of 1996, Pub L No. 104-191, 110 Stat 1936 (1996). Accessed December 13, 2022. https:\/\/www.govinfo.gov\/content\/pkg\/PLAW-104publ191\/pdf\/PLAW-104publ191.pdf"},{"key":"zoi221494r17","unstructured":"ALSG Centre for Training & Development. Manchester Triage System. Advanced Life Support Group. 2017. Updated February 24, 2021. Accessed December 13, 2022. https:\/\/www.triagenet.net\/classroom\/mod\/page\/view.php?id=1884"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2800902\/wagner_2023_oi_221494_1674492365.97992.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T16:10:44Z","timestamp":1675354244000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2800902"}},"subtitle":["A Nonrandomized Controlled Trial"],"short-title":[],"issued":{"date-parts":[[2023,2,2]]},"references-count":31,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,2,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.52570","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,2]]}}}