MDCalc Tools for Telehealth

April 13, 2020

Written by Clay Smith

MDCalc Tools for Telehealth

Use of Telehealth is increasing dramatically. After scanning all the resources and calculators on MDCalc, here are the clinical decision tools that may be applied to Telehealth. If there is no calculator on MDCalc, other reliable resources are linked.

Disclaimers:

1. All clinical decision tools require a thinking clinician with good clinical judgment.

2. Most tools were not originally designed for Telehealth. Please read the “When to Use/Pearls and Pitfalls/Why Use” sections.

3. Some tools cannot utilize all components with Telehealth (i.e. labs, SpO2, auscultation…). However, observable components may prove useful and may help you ask the right questions.

4. JournalFeed is not responsible for how you use or apply any of the resources on this site, including this. See disclaimer.

How to Use This Page

1. Try it out first. Click and try the clinical decision tools, considering how you might apply them to Telehealth. Do this well ahead of any Telehealth visit.

2. Know the limits. Deeply understand the limitations of each decision tool, especially when you can’t physically touch the patient.

3. Quick reference – Bookmark this page to quickly find these tools.

General Tools

• Visual acuity

• Pregnancy due date calculator

• Steroid conversion calculator

• Morphine milligram equivalents

• Immunization schedule calculator

Conditions | Tools

Below is a list of conditions that may be amenable to Telehealth evaluation. Use caution and exercise sound clinical judgment in seeing any patient via telemedicine, and refer for in-person evaluation when needed.

• • Abdominal pain

    • ACG Management of Dyspepsia, MDCalc Style (desktop version is better)

    • ACEP Appendicitis Guideline, MDCalc Style – Symptoms may help risk stratify. Anything remotely resembling RLQ pain needs referral. If RLQ pain is present on history, the positive likelihood ratio ranges from 7.31 to 8.46 (95%CI given due to heterogeneity); negative likelihood ratio range 0 to 0.28 (also the 95%CI). Go direct to the ACEP appendicitis guideline full text.

  • Ache, sprain, minor sports injuries

    • Ottawa Ankle Rule

    • Ottawa Knee Rule

    • Pittsburgh Knee Rule – simpler, higher specificity than Ottawa Knee

  • Allergic

    • See this Clinical Practice Guideline, Allergic Rhinitis. Use intranasal steroids, +/- non-sedating antihistamines; discourage oral leukotrienes.

  • Anxiety/PTSD

    • Hamilton Anxiety Scale – not to be confused with the Broadway show.

    • GAD-7 Generalized Anxiety Scale

    • PTSD DSM-5 Criteria

  • Arthritis

    • Is it acute gout? Use this tool.

  • Asthma exacerbations, mild

    • Expected vs. actual peak flow

    • Pediatric asthma score (PAS) – Observable components are very useful.

    • Pediatric asthma severity score (PASS) – simpler but not as helpful for Telehealth

  • Bronchitis/cough

    • MDCalc recommends avoiding the Roth score to assess dyspnea via Telehealth. Here is link to original paper.

  • Cardiac – e.g. new atrial fibrillation on wearable device

    • Apple Watch detects atrial fibrillation? Find the patient’s risk of stroke with the ATRIA score. I would refer such a patient for formal ECG, labs, and likely rate control.

    • Or you could use the CHA₂DS₂-VASc Score.

  • Closed head injury/concussion, minor

    • PECARN for children – You can’t assess the scalp for fracture (step-off) or hematoma and can’t see hemotympanum. However, this can help you ask the right questions.

    • Canadian CT Head Rule, Age ≥16 years – similar limitation for hemotympanum. Warning, I have nearly been fooled with depressed skull fracture and hematoma filling it, making it appear flat. That said, if a patient was hit in the head with a hammer, they probably shouldn’t be using Telehealth.

    • New Orleans Criteria – Age >3 years and up. It is so stringent, most patients cannot be ruled out clinically without CT. That said, all the criteria can be assessed via Telehealth.

  • Conjunctivitis

    • Here is an excellent review article from JAMA.

• COPD

  • COPD Risk Scale – The clinical component may help guide risk stratification. Any positive on history/exam needs referral.

• COVID-19

  • The Apple COVID-19 screening tool is a great resource to direct patients to get testing or not.

  • MDCalc recommends avoiding the Roth score to assess dyspnea via Telehealth. Here is link to original paper.

  • This is what CEBM says may be helpful to ask: https://www.cebm.net/covid-19/covid-19-signs-and-symptoms-tracker/.

• Depression

  • Major Depression Index – This is a handy Q&A method.

  • Quick Inventory of Depressive Symptomatology (QIDS)

  • Hamilton Depression Rating Scale (HAM-D) – Similar to PHQ-9. Choose one. Maybe You’ll Be Back to this one.

  • Patient Health Questionnaire-9 (PHQ-9) – Similar to Hamilton. Choose one.

  • DSM-5 criteria for depression – the official version.

  • Columbia Suicide Severity Rating Scale (C-SSRS Screener) – Anyone with concern for depression should also be screened for suicide risk.

• Diabetes management/refills

  • HbA1C to average glucose converter

• Ear pain

  • See this Clinical Practice Guideline for Acute Otitis Media.

• Headache

  • Ottawa Subarachnoid Hemorrhage Rule – Be very careful with the strict inclusion/exclusion criteria, but this tool is very helpful.

• Hypertension

  • Pediatric Hypertension Guidelines

  • ACEP on Asymptomatic Hypertension – In general, don’t send these patients to the ED because, “…routine screening for acute target organ injury (eg, serum creatinine, urinalysis, electrocardiogram [ECG]) is not required.”

• Influenza-like illness

  • IDSA Guidelines, MDCalc style (desktop version is better)

• Insect bites

  • See this from the CDC. An ounce of prevention…

• Insomnia

  • See this Clinical Practice Guideline.

• Low back pain

  • See this: In the Clinic – Low Back Pain.

• Medication refills

  • See this sage advice from the AAFP on Medication Refills.

• Nausea, vomiting, diarrhea

  • See this IDSA guideline on infectious diarrhea

• Neck pain (trauma)

  • Canadian C-spine Rule – Use caution, but this could be done solely via Telehealth

• Pharyngitis

  • Centor Criteria – It may be hard to see their throat and detect cervical adenopathy on a webcam. They also have to check their temperature.

  • FeverPAIN Score – This score is easier via Telehealth, though you still need a look at the back of the throat.

• Rashes

  • See this incredible resource from AAFP on Skin Conditions. This link is a gem. It’s like a free dermatology encyclopedia.

• Sinusitis

  • See this Cochrane review.

• Skin and soft tissue infection

  • ALT-70 Score for Cellulitis – The WBC variable can’t be used, but you can assess asymmetry, age, and HR, which may be enough to warrant treatment without the lab value.

• Smoking cessation

  • See this from the AHRQ.

• Substance abuse

  • COWS Score for Opiate Withdrawal – Patients may seek help for opiate dependence. This will help objectively assess the severity of withdrawal symptoms. You need a DEA X waiver to prescribe buprenorphine. Does anyone else find it funny this is named COWS? I’m dating myself, but – Where’s the beef?

  • CAGE is a quick screen for excessive drinking and alcoholism. Glad no one has asked me these questions about my coffee consumption…

• Tick borne illness

  • Here is a fantastic resource from the CDC on this.

• URI

  • See this incredible resource from AAFP on Respiratory Infections. It’s like a hit parade of the best practical articles on all kinds of respiratory infections.

• UTI – uncomplicated

  • See the IDSA guidelines.

• Zoster

  • See this from the CDC.

  • And this European Consensus Guideline

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