Published online December 29, 2008
PEDIATRICS Vol. 123 No. 1 January 2009, pp. 223-228 (doi:10.1542/peds.2007-1921)
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ARTICLE

Using Telemedicine to Improve the Care Delivered to Sexually Abused Children in Rural, Underserved Hospitals

Kristen J. MacLeod, MDa, James P. Marcin, MD, MPHb, Cathy Boyle, MSa, Sheridan Miyamoto, MSa, Robert J. Dimand, MDc and Kristen K. Rogers, PhDa

a Department of Pediatrics, CAARE Center, Children's Hospital
b Section of Critical Care, Department of Pediatrics, University of California, Davis, California
c Department of Pediatrics, Children's Hospital Central California, Madera, California

OBJECTIVE. We used live telemedicine consultations to assist remote providers in the examination of sexually assaulted children presenting to rural, underserved hospitals. We hypothesized that telemedicine would increase the ability of the rural provider to perform a complete and accurate sexual assault examination.

PATIENTS AND METHODS. Child abuse experts from a university children's hospital provided 24/7 live telemedicine consultations to clinicians at 2 rural, underserved hospitals. Consultations consisted of videoconferencing to assist in the examination and interpretation of findings during live examinations. Consecutive female patients <18 years of age presenting to the 2 participating hospitals were included. We developed and used an instrument to assess the quality of care and the interventions provided via telemedicine as it related to patient history, physical examination, colposcopic and manual manipulation techniques, interpretation of findings, and treatment plans for victims of child sexual abuse.

RESULTS. Data from 42 live telemedicine consultations were analyzed. The mean duration of the consultations was 71 minutes (range: 25–210 minutes). The consultations resulted in changes in interview methods (47%), the use of the multimethod examination technique (86%), and the use of adjunct techniques (40%). There were 9 acute sexual assault telemedicine consults that resulted in changes to the collection of forensic evidence (89%). Rankings of practitioners' skills and the telemedicine consult effectiveness were high, with the majority of cases scoring ≥5 on a 7-point Likert scale.

CONCLUSIONS. The use of telemedicine to assist in the examination of sexually assaulted children presenting to underserved, rural communities results in significant changes in the methods of examination and evidence collection. It is possible that this model of care results in increased quality of care and appropriate forensic evidence collection.

Key Words: telehealth • child sexual abuse • nonaccidental trauma • quality of care • telemedicine

Abbreviations: CAARE—Child and Adolescent Abuse Resource and Evaluation • UC—University of California • HPSA—health professional shortage area • ED—emergency department

Accepted Apr 17, 2008.


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