HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery | 2021
Telehealth in the Pediatric and Adolescent Population: Unique Considerations
Abstract
Telehealth, the remote delivery of health care via electronic platforms, has experienced tremendous growth in light of the Coronavirus 19 (COVID) pandemic. Market predictions anticipate an overall value beyond $55 billion by 2025 from $25.4 billion in 2020 [8]. Increasing ubiquity of and familiarity with digital communication technologies have contributed to a steady rise of telehealth over the past decade. These advances, coupled with social distancing practices and redistribution of health care resources, have encouraged musculoskeletal care providers to turn to telehealth as a surrogate means for continuing to deliver high-quality health care [4,9]. Initially introduced to provide health care services to rural communities, telehealth has demonstrated early benefit to orthopedic providers and patients alike. Evaluation of the utility of telehealth for perioperative care and consultations among traumatologists and arthroplasty surgeons have demonstrated equivalent patient satisfaction scores when compared with in-patient visits [2,5]. Notable challenges include patient and provider skepticism as well the inability to perform a remote physical examination [7]. As such, focus has turned to establishing an appropriate and robust, albeit surrogate, remote physical examination, as well as continuing to evaluate and meet patient expectations by establishing appropriate criteria for a telehealth visit [3,6,7], particularly within the fields of sports medicine, spine surgery, and pediatric orthopedic surgery. Orthopedic telehealth for the pediatric population carries unique benefits, challenges, and opportunities for growth. While concern has been raised regarding the difficulties that older adults may face with technical unfamiliarity—the socalled “computer anxiety”—when using telehealth [1], the growing ubiquity of smart devices and its on-demand nature may make telehealth an enticing alternative for younger pediatric and adolescent patients. A pilot survey evaluating patient/guardian satisfaction of telehealth for pediatric fracture care suggested no-difference in patients’ satisfaction with their medical care between telehealth and traditional, in-person visits [6]. Similarly, decreased costs, work/school time away, travel, and waiting times are uniquely appreciated by both the patient and parent in the remote setting, further suggesting that telehealth practices may persist beyond the COVID-19 pandemic. As such, establishing best practices for pediatric orthopedic telehealth is critical. The purpose of this focused review is to discuss the unique considerations, barriers, and technicalities musculoskeletal care providers must consider when using telehealth with a pediatric/adolescent patient. While recent literature has provided generalized recommendations for how best to implement this remote platform, various aspects of these guidelines must be re-evaluated when treating children. Our aim is to discern those visits/consultations that are most appropriate for a telehealth visit, as well as provide those technical aspects unique to the pediatric population.