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The clinical impact of bedside fiberoptic laryngoscopic recording on a tertiary consult service
Author(s) -
Lozada Kirkland N.,
Morton Kathryn,
Stepan Katelyn,
Capo Joseph,
Chai Raymond L.
Publication year - 2018
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26821
Subject(s) - medicine , laryngoscopy , concordance , tertiary referral hospital , dysphagia , otorhinolaryngology , prospective cohort study , referral , emergency medicine , physical therapy , general surgery , intubation , surgery , retrospective cohort study , family medicine
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