Using Video for Triage of Children With Fever at the Medical Helpline 1813 in Copenhagen, Denmark

NCT04074239 | Completed DMC

• 1 other identifier: Video fever
• Study Type: interventional
• Target: 801
• Locations: 1 country
• Sites: 1

Brief Summary

Background: The Medical Helpline 1813 in Copenhagen, Denmark handles acute, non-life threatening medical emergencies. Approx. 200,000 calls/year concern children, and about 30% are referred to a pediatric urgent care center. However, most of these children have very mild symptoms, which require neither treatment nor tests, merely parental guidance. Initial assessment; triage, of children on the phone is difficult, especially when the operator does not know the child or family, and when it is difficult to describe the symptoms in medical terms. This may result in too many not-so-sick children and too few more severely sick children getting sent to hospital. Many parents are very worried about their sick child, but it is not known if this worry can be integrated in the triage process. Purpose: It will be studied if triage by video calls; video triage; provide greater security for parents and call operators so that more children can stay at home after medical guidance, causing at least 10% fewer visits to pediatric urgent care centers. The degree of worry of the parents will also be registered. Method: Children aged 3 months to 5 years with fever will be triaged by either video or telephone every other day, to compare the results between these to otherwise similar groups. Operators and parents answer surveys about their experiences. Yield: Video triage can "give eyes to the operators" and revolutionize telephone triage. The study may result in fewer children referred to hospitals, more appropriate use of resources and better experiences for the families.

Conditions

Fever; Telemedicine; Pediatrics; Triage

Keywords

telemedicine; Triage; Call centers; Fever; Pediatrics

Outcome Measures

Primary Outcomes (1)

• Disposition

  Difference between the arms in the percentage of children that stays at home the first 8 hours after the call, i.e. referral to self-care or GP.

  Disposition is registered by the operator immediately after the call for all patients included, throughout the project period..

Secondary Outcomes (14)

• Admittance

  The hospital chart of all children is read within 2-8 days after the call for all patients included, throughout the project period.

• Hospital visits

  The hospital chart of all children is read within 2-8 days after the call for all patients included, throughout the project period..

• Treatment

  The hospital chart of all children is read within 2-8 days after the call for all patients included, throughout the project period..

• Operators: satisfaction

  The operators fill out a survey immediately after the call for all patients included, throughout the project period..

• Operators: DOW

  The operators fill out a survey immediately after the call for all patients included, throughout the project period..

Study Arms (2)

Video triage

EXPERIMENTAL

The sick child will be triaged on video by the operator.

Other: Video triage

Telephone triage

NO INTERVENTION

The sick child will be triaged solely on telephone by the operator.

Interventions

Video triage OTHER

The operator at the Medical Helpline will offer the parent who's calling regarding the sick child to assess the child on video, as compared to the routine way; on the telephone.

Video triage

Eligibility Criteria

• Age: 3 Months - 5 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Parents state that the child has fever.
• Parents are calling from a smartphone with Apple, Windows or Android operating system.

You may not qualify if:

• The child has already participated.
• The parent does not call from a Danish telephone number.

Sponsors & Collaborators

• Emergency Medical Services, Capital Region, Denmark: lead
• Copenhagen University Hospital, Hvidovre: collaborator
• Copenhagen University Hospital at Herlev: collaborator
• Rigshospitalet, Denmark: collaborator
• University of Copenhagen: collaborator

Study Sites (1)

Emergency Medical Services

Copenhagen, Denmark

Location

Related Publications (26)

• Rasmussen MV. Data, controlling and IT section, Copenhagen Emergency Services. January 2019.

  BACKGROUND

• Boisen AS. Implementeringen af Enstrenget og Visiteret Akutsystem i Region Hovedstaden - en analyse af samspillet mellem organisatorisk forandring og brugeradfærd. Institut for Folkesundhedsvidenskab, Københavns Universitet; 2015

  BACKGROUND

• Børns brug af regionale sundhedsydelser. Center for Sundhed - Enhed for Tværsektoriel Udvikling. Region Hovedstaden. 2017. https://www.regionh.dk/til-fagfolk/Sundhed/Tvaersektorielt-samarbejde/samarbejdspulje-og-forebyggelse/Documents/rapport-boerns-brug-regionale-sundhedsydelser.pdf

  BACKGROUND

• Analyse af børns brug af sundhedsydelser. Center for Sundhed - Enhed for Tværsektoriel Udvikling. Region Hovedstaden. 2017. https://www.regionh.dk/til-fagfolk/Sundhed/Tvaersektorielt-samarbejde/samarbejdspulje-og-forebyggelse/Documents/analyse_af_boerns_brug_af_sundhedsydelser.pdf

  BACKGROUND

• Nijman RG, Oostenbrink R, Dons EM, Bouwhuis CB, Moll HA. Parental fever attitude and management: influence of parental ethnicity and child's age. Pediatr Emerg Care. 2010 May;26(5):339-42. doi: 10.1097/PEC.0b013e3181db1dce.

  PMID: 20404784 BACKGROUND

• Kelly M, Sahm LJ, Shiely F, O'Sullivan R, McGillicuddy A, McCarthy S. Parental knowledge, attitudes and beliefs regarding fever in children: an interview study. BMC Public Health. 2016 Jul 11;16:540. doi: 10.1186/s12889-016-3224-5.

  PMID: 27401677 BACKGROUND

• Crocetti M, Moghbeli N, Serwint J. Fever phobia revisited: have parental misconceptions about fever changed in 20 years? Pediatrics. 2001 Jun;107(6):1241-6. doi: 10.1542/peds.107.6.1241.

  PMID: 11389237 BACKGROUND

• Parkinson GW, Gordon KE, Camfield CS, Fitzpatrick EA. Anxiety in parents of young febrile children in a pediatric emergency department: why is it elevated? Clin Pediatr (Phila). 1999 Apr;38(4):219-26. doi: 10.1177/000992289903800403.

  PMID: 10326177 BACKGROUND

• Lægehåndbogen. Feber hos børn. https://www.sundhed.dk/sundhedsfaglig/laegehaandbogen/paediatri/symptomer-og-tegn/feber-hos-boern/

  BACKGROUND

• Pantell RH, Newman TB, Bernzweig J, Bergman DA, Takayama JI, Segal M, Finch SA, Wasserman RC. Management and outcomes of care of fever in early infancy. JAMA. 2004 Mar 10;291(10):1203-12. doi: 10.1001/jama.291.10.1203.

  PMID: 15010441 BACKGROUND

• Woll C, Neuman MI, Aronson PL. Management of the Febrile Young Infant: Update for the 21st Century. Pediatr Emerg Care. 2017 Nov;33(11):748-753. doi: 10.1097/PEC.0000000000001303.

  PMID: 29095773 BACKGROUND

• Van den Bruel A, Aertgeerts B, Bruyninckx R, Aerts M, Buntinx F. Signs and symptoms for diagnosis of serious infections in children: a prospective study in primary care. Br J Gen Pract. 2007 Jul;57(540):538-46.

  PMID: 17727746 BACKGROUND

• Verbakel JY, Van den Bruel A, Thompson M, Stevens R, Aertgeerts B, Oostenbrink R, Moll HA, Berger MY, Lakhanpaul M, Mant D, Buntinx F; European Research Network on Recognising Serious Infection (ERNIE). How well do clinical prediction rules perform in identifying serious infections in acutely ill children across an international network of ambulatory care datasets? BMC Med. 2013 Jan 15;11:10. doi: 10.1186/1741-7015-11-10.

  PMID: 23320738 BACKGROUND

• Van den Bruel A, Bartholomeeusen S, Aertgeerts B, Truyers C, Buntinx F. Serious infections in children: an incidence study in family practice. BMC Fam Pract. 2006 Mar 28;7:23. doi: 10.1186/1471-2296-7-23.

  PMID: 16569232 BACKGROUND

• Kool M, Elshout G, Moll HA, Koes BW, van der Wouden JC, Berger MY. Duration of fever and course of symptoms in young febrile children presenting with uncomplicated illness. J Am Board Fam Med. 2013 Jul-Aug;26(4):445-52. doi: 10.3122/jabfm.2013.04.120265.

  PMID: 23833160 BACKGROUND

• Gamst-Jensen H, Huibers L, Pedersen K, Christensen EF, Ersboll AK, Lippert FK, Egerod I. Self-rated worry in acute care telephone triage: a mixed-methods study. Br J Gen Pract. 2018 Mar;68(668):e197-e203. doi: 10.3399/bjgp18X695021. Epub 2018 Feb 12.

  PMID: 29440015 BACKGROUND

• Gamst-Jensen H. Patients' self-assessment of illness and injury in telephone triage using a novel degree-of-worry scale. Ph.D. dissertation. Faculty of Health and Medical Science, University of Copenhagen; 2018.

  BACKGROUND

• Olson CA, Thomas JF. Telehealth: No Longer an Idea for the Future. Adv Pediatr. 2017 Aug;64(1):347-370. doi: 10.1016/j.yapd.2017.03.009. No abstract available.

  PMID: 28688597 BACKGROUND

• COMMITTEE ON PEDIATRIC WORKFORCE; Marcin JP, Rimsza ME, Moskowitz WB. The Use of Telemedicine to Address Access and Physician Workforce Shortages. Pediatrics. 2015 Jul;136(1):202-9. doi: 10.1542/peds.2015-1253.

  PMID: 26122802 BACKGROUND

• Regioner på vej med ny app: Hver tredje konsultation kan ske online. Dagens Medicin. 2018. https://dagensmedicin.dk/danske-regioner-lancerer-ny-app-hver-tredje-konsultation-kan-ske-online/

  BACKGROUND

• Videokonsultationer skal få praktiserende læger til Mors og til andre lægedækningstruede områder. Region Nordjylland. http://rn.dk/service/nyhedsliste-rn/nyhed?id=48723d23-88da-4759-a685-9c9336bc6093

  BACKGROUND

• Ekeland AG, Bowes A, Flottorp S. Effectiveness of telemedicine: a systematic review of reviews. Int J Med Inform. 2010 Nov;79(11):736-71. doi: 10.1016/j.ijmedinf.2010.08.006.

  PMID: 20884286 BACKGROUND

• Siew L, Hsiao A, McCarthy P, Agarwal A, Lee E, Chen L. Reliability of Telemedicine in the Assessment of Seriously Ill Children. Pediatrics. 2016 Mar;137(3):e20150712. doi: 10.1542/peds.2015-0712. Epub 2016 Feb 5.

  PMID: 26908666 BACKGROUND

• McCarthy PL, Sharpe MR, Spiesel SZ, Dolan TF, Forsyth BW, DeWitt TG, Fink HD, Baron MA, Cicchetti DV. Observation scales to identify serious illness in febrile children. Pediatrics. 1982 Nov;70(5):802-9. No abstract available.

  PMID: 7133831 BACKGROUND

• Hemming K, Haines TP, Chilton PJ, Girling AJ, Lilford RJ. The stepped wedge cluster randomised trial: rationale, design, analysis, and reporting. BMJ. 2015 Feb 6;350:h391. doi: 10.1136/bmj.h391. No abstract available.

  PMID: 25662947 BACKGROUND

• Gren C, Hasselager AB, Linderoth G, Frederiksen MS, Folke F, Ersboll AK, Gamst-Jensen H, Cortes D. Video triage in calls concerning children with fever at an out-of-hours medical helpline: a prospective quality improvement study. Scand J Trauma Resusc Emerg Med. 2023 Aug 29;31(1):41. doi: 10.1186/s13049-023-01106-9.

  PMID: 37644510 DERIVED

MeSH Terms

Conditions

Fever

Condition Hierarchy (Ancestors)

Body Temperature Changes; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Dina Cortes, M.D.

  Department of Pediatrics, Copenhagen University Hopsital Hvidovre

  STUDY CHAIR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: SPONSOR

Model Details: The operators at the medical helpline 1813 will triage children meeting the inclusion criteria by video every other day they are at work, and by telephone the other days. The children will hence be randomized to either video or telephone depending on what day they are calling and which operator they are talking to.

Study Record Dates

• First Submitted: August 14, 2019
• First Posted: August 30, 2019
• Study Start: August 5, 2019
• Primary Completion: February 2, 2020
• Study Completion: February 20, 2020
• Last Updated: August 12, 2020

Record last verified: 2020-08

Data Sharing

• IPD Sharing: Will not share

Locations

DK (1)