Guideline-Based Telemedicine Assessment of Orthopedic Low-Risk Conditions by General Practitioners is Not Inferior to that of Face-to-Face Consultations with Specialists in the Emergency Department: A Randomized Trial

Background: There is a lack of randomized controlled trials focusing on orthopedic telemedicine (TM). The objective of this research was to compare the diagnostic accuracy and pattern of TM consultations of low-risk orthopedic patients performed by general practitioners (GPs) with those of face-to-face evaluations by orthopedists at an emergency department (ED). Methods: This randomized, single-center study was conducted between October 2021 and November 2022 on patients at an ED. Inclusion criteria were age >18 years, low back pain, extremity contusion, ankle sprain, or neck pain. Eligible patients were randomized 1:1 for TM consultations by generalist physicians with subsequent face-to-face orthopedic evaluations (TM-ED group) or face-to-face evaluations by orthopedic physicians (ED group). Primary outcomes were syndromic diagnosis, physical examination, and tests ordered. Secondary analysis included a satisfaction survey. Results: A total of 99 patients were enrolled; mean age was 41 +/- 10.1 years, and 62.6% were female. The most common conditions were foot contusion (28.3%), ankle sprain (27.3%), hand contusion (19.2%), low back pain (19.2%), and neck pain (6.1%). Syndromic diagnosis showed no difference between groups (p = 0.231). In the TM-ED group (n = 51), self-examination demonstrated moderate to good agreement with face-to-face evaluations in several areas. Both groups showed similar tests practices. Patient satisfaction was higher in the TM-ED group across multiple measures. Conclusion: TM consultations for low-risk orthopedic patients by GPs are not inferior to face-to-face specialist evaluations at the ED. Virtual assessments are associated with higher patient satisfaction. Clinical Trial Identifier: NCT04981002.