Methods
throat
This prospective multicenter single-arm nonrandomized controlled trial was conducted to assess the ability of a mobile device to accurately perform remote physical examinations as part of a telemedicine consultation. The study compared a traditional physical examination with a teleinterconsultation (an exchange of audio and video information between physicians to aid diagnosis and treatment) using a mobile device in the emergency department of 2 Brazilian pediatric hospitals. The study was assessed and approved by the institutional review boards of Pequeno Príncipe Hospital and Sabará Hospital. The full trial protocol and statistical analysis plan are provided in The medical mobile device used in this study (TytoPro) was designed to perform a physical examination during a teleconsultation and allows the remote evaluation of ears, throat, skin, heart, and lungs in a single device, as reported in previous studies.A total of 690 pediatric patients seen in the emergency department of 2 Brazilian pediatric hospitals between January 1 and December 31, 2020, were included (eFigure in Patients were examined in both a synchronous teleinterconsultation and a conventional in-person consultation. After patients had been screened by a nurse and classified as having nonurgent symptoms, they were first assessed by a first-year pediatric resident using the device and a pediatrician located in a remote room who guided the resident through the teleinterconsultation. As the resident performed the examination, the data were viewed in real time and recorded by the pediatrician in the device’s dashboard, then transferred to the patient’s electronic health record using a data collection sheet specifically designed for the study. All physicians who participated in the study were trained to perform data collection. Because all of the data from the examinations were required to be collected, data loss was minimized.The patient was then examined in person by a different pediatrician. The physician performed the complete routine procedure (medical history and physical examination) and completed the same data collection sheet. The traditional physical examination involved assessment of the same clinical parameters using standard equipment or procedures, such as a digital thermometer, conventional stethoscope, and otoscope. After this stage, a diagnosis or clinical management recommendation was proposed based on the findings of the second consultation. The flowchart of patient consultations is shown in the 