Discussion
SECONDARY
In this pragmatic, cluster-randomized, crossover study, we compared the influence of telemedicine vs telephone consultations on risk-adjusted transfer of acutely ill children presenting to 15 rural and community EDs in northern California. In the adjusted intention-to-treat analysis, we found that consultations allocated to telemedicine resulted in a significantly lower risk of transfer to a pediatric referral center than those allocated to telephone, which is the current standard of care. These findings were even more dramatic in the treatment-received and the per-protocol analyses. The number-needed-to-treat to reduce 1 transfer was relatively small in all analyses. Our findings support previous research conducted using observational data that the use of telemedicine can support triage transport decisions to potentially reduce secondary overtriage.Previous studies have reported that telemedicine consultations provided to rural and community EDs have benefits on quality of care, satisfaction, and patient safety.Our findings are important because they demonstrate that telemedicine may improve local ED clinicians’ ability to care for pediatric patient emergencies. There are current initiatives to increase the pediatric readiness of EDs, especially given evidence that many children live more than 30 minutes away from an ED with a high level of pediatric readiness.