Mobile phone videos could help treat sick children
BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39346.512523.3A (Published 27 September 2007) Cite this as: BMJ 2007;335:627
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Sir, we wish to respond to Ashworth's letter (1) regarding the value
of mobile phone video footage for treatment of the sick child. In our
institutions there have been two recent cases whereby video provided by
parents was deemed very valuable in the diagnosis and treatment of upper
airway obstruction.
A previously healthy 2.5 year old boy was reported by his parents to have
severe respiratory distress at night which completely resolved during the
day. He was seen on several occasions at a remote outpatient clinic by a
family doctor and ENT specialist. No diagnosis was made as the child
appears to be well and in no distress. Finally, his parents presented a
video recording from a mobile phone camera showing a boy asleep in severe
respiratory distress http://s214.photobucket.com/albums/cc73/gmacwilson/. He subsequently underwent an examination under
general anaesthesia including direct laryngoscopy and bronchoscopy. He
required urgent adenotonsillectomy and made an uneventful recovery with
complete resolution of his symptoms.
The second patient is a 13 year old girl with cystic fibrosis presenting
for anaesthesia assessment for a scheduled bronchoscopy. The child
appeared well throughout the consultation without any signs of respiratory
distress but the parents supplied a video recording from a mobile phone
demonstrating her in respiratory distress in the morning or when anxious.
She successfully underwent a diagnostic bronchoscopy and postoperative
respiratory symptoms were consistent with the mobile phone recordings.
There are only very few reports of the use of video mobile phones for
diagnosis, and none reporting its use in children. (2,3,4). The presence
of acute upper airway obstruction during sleep in an apparently healthy
child could lead to potentially life threatening complications if sedation
for simple investigations and procedures are employed. These cases
highlight the usefulness of modern technology in the diagnosis of problems
of uncertain severity in children and may represent a useful alternative
to inpatient admissions.
References
1.Ashworth AJ.Mobile phone videos could help treat sick children.
BMJ, Sep 2007; 335: 627
2. Parikh R, Wong R. Video phone diagnosis of ‘funny turns’. Age
Ageing. 2007; 36: 233-4.
3.Armstrong D. The mobile phone as an imaging tool in SLE.
Rheumatology 2004; 43: 1195.
4.Braun RP, Vecchietti JL, Thomas L, Prins C, French LE, Gewirtzman
AJ, Saurat JH, Salomon D. Telemedical wound care using a new generation of
mobile telephones: a feasibility study. Arch Dermatol. 2005;141: 254-8.
Competing interests:
None declared
Editorial note
The parents of the patients whose cases are described have given their signed informed consent to publication.
Competing interests: No competing interests
Multi Media Assessments
Dear Sir,
I won’t be the only person who has found mobile phone media messages
assisting in diagnosing adults over the last few years. (1) Two cases
spring to mind. The first was of a patient transferred to our unit who had
repeated surgical interventions to help a wound that had dehisced. On
first viewing, even with the help of the notes, it was not clear whether
the area had deteriorated. So I asked his son, who helpfully said, “You
should have seen it before, Doc” and then gave me the opportunity, showing
me the multiple pictures he had taken of his poor father's wound. His
son's inquisitive documentation probably saved him unnecessary
antibiotics.
The second case occurred in an outpatient neurology clinic. Whilst
seeing new cases of 'collapse query fit' it was my role to agonisingly
tease out the details of the event. This patient made me stew for a while
before offering me the video footage taken, “If you're that interested,
would you like to have a look?” I was, so I did. A recent review of
'epilepsy' and 'seizure' clips uploaded to video sharing site You Tube
noted that pseudoseizures outnumbered genuine fits 10:1. (2) This suggests
that the videos taken were of good enough quality to be assessed as fits
or not. Assessment of sick children may be possible this way too.
Rhys Thomas
References
1. Ashworth, A Mobile phone videos could help treat sick children BMJ
2007;335:627
2. M. D. Cossburn, P. E. M. Smith. Seizures on “You Tube”: How is epilepsy
represented in the new media? JNNP 2007;78:1014-1038
Competing interests:
None declared
Competing interests: No competing interests