The clinical impact of bedside fiberoptic laryngoscopic recording on a tertiary consult service

Laryngoscope. 2018 Apr;128(4):818-822. doi: 10.1002/lary.26821. Epub 2017 Aug 22.

Abstract

Objectives/hypothesis: Fiberoptic laryngoscopy is dependent on accurate descriptions of examination findings. Traditional recording methods can be impractical for inpatient consults. Therefore, we aim to determine the utility of a smartphone-coupled portable recording system with flexible laryngoscopy for transmitting information between resident and attending physicians in a real-time setting.

Study design: Pilot prospective study in a tertiary academic hospital.

Methods: This is a prospective study of inpatient consultations in a tertiary referral hospital over a 3-month period from April 2015 to June 2015. Flexible laryngoscopy was performed by a resident physician, and mobile recordings were relayed to an attending physician. Concordance of laryngoscopy interpretations between resident and attending physicians as well as changes in management were documented.

Results: Seventy-nine fiberoptic examinations were recorded and compared. Each consult was categorized as follows: airway evaluation (AE) (43%, 34/79), voice evaluation (VE) (3.7%, 3/79), dysphagia (D) (24%, 19/79), and aerodigestive tract mass/pathology (ADM) (29.1%, 23/79). Nine examinations showed discordance between resident and attending interpretations. Inter-rater agreement was good, with a kappa value of 0.747 (95% confidence interval: 0.643-0.851). The frequency of discordant exams within each group was as follows: AE (15%, 5/34), VE (33%, 1/3), D (11%, 2/19), and ADM (4.3%, 1/23). In five patients, changes in laryngoscopy interpretation changed clinical management. Seven nondiscordant exams had a change in management after attending review. Of the 79 exams, only one required repeat flexible laryngoscopy by the attending physician.

Conclusions: Portable recording of flexible laryngoscopy is an effective tool for timely management of inpatient consultations.

Level of evidence: 4. Laryngoscope, 128:818-822, 2018.

Keywords: Flexible laryngoscopy; inpatient consultation; resident education; telemedicine.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Airway Obstruction / diagnosis
  • Deglutition Disorders / diagnosis
  • Female
  • Fiber Optic Technology
  • Head and Neck Neoplasms / diagnosis
  • Humans
  • Laryngoscopy / methods
  • Laryngoscopy / statistics & numerical data*
  • Male
  • Middle Aged
  • Observer Variation
  • Otolaryngology / instrumentation*
  • Otolaryngology / methods
  • Pilot Projects
  • Point-of-Care Systems*
  • Prospective Studies
  • Referral and Consultation
  • Telemetry / instrumentation
  • Telemetry / methods
  • Telemetry / statistics & numerical data*
  • Tertiary Care Centers
  • Voice Disorders / diagnosis