Where to Access Urgent Pediatric Neurology Evaluation Online
Patients can access urgent pediatric neurology evaluation through telemedicine platforms integrated with hospital electronic health record systems, such as Teladoc Health or VidyoConnect, which enable real-time video consultation with pediatric neurologists from the patient's home. 1
Established Telemedicine Platforms for Neurology
Hospital-based telemedicine systems like Teladoc Health and VidyoConnect are integrated within EPIC electronic health records and allow for secure video communication between patients and neurologists from home. 1
HIPAA-compliant smartphone applications such as Doximity can serve as backup options when technical issues arise with primary telemedicine platforms. 1
Web-based videoconferencing systems capable of wired or wireless connectivity over public Internet with pan/tilt/zoom cameras have been validated for neurological examinations, requiring high bandwidth access (typically 384 kilobits per second). 1
Clinical Effectiveness and Limitations
Telemedicine neurological examinations demonstrate strong reliability with intraclass correlation coefficients of 0.94-0.97 when compared to bedside examinations, though items like facial palsy, ataxia, and dysarthria show lower interrater reliability. 1
Virtual neurology consultations are safe and effective for outpatient evaluations, with high patient satisfaction rates comparable to face-to-face visits. 2
Critical limitation: The inability to perform complete neurological examinations remotely, particularly assessment of sensation and reflexes, is the major drawback identified by 95.81% of neurosurgeons surveyed. 3
When Urgent In-Person Evaluation Is Required
Children with extracerebellar neurological signs (somnolence, encephalopathy, focal motor weakness, cranial nerve involvement) require in-person evaluation with neuroimaging rather than telemedicine alone. 1
Post-traumatic seizures mandate emergent CT imaging and cannot be adequately managed through telemedicine initially. 4
Patients who have not returned to baseline within several hours after seizure or exhibit persistent postictal focal deficits require emergent in-person neurological evaluation. 4
Important Considerations for Virtual Pediatric Neurology
Virtual consultations have higher rates of reassessment (RR: 2.2) and re-investigation (RR: 1.50) compared to face-to-face clinics, particularly in patients aged ≥60 years. 5
Certain conditions are better suited for telemedicine: Patients with headaches and suspected seizures are less likely to need reassessment following virtual clinics compared to those with multiple sclerosis, neuroinflammatory disorders, or functional neurological disorders. 5
Telemedicine requires specific equipment: A computer with remote access to hospital intranet, a second device for parallel communication with nursing staff, and share-screen functionality for reviewing imaging with patients and families. 1
Access Barriers and Global Context
Severe shortage of pediatric neurologists globally: There is a median of 0.07 child neurologists per 100,000 population worldwide, with the greatest deficits in low-income countries (0-0.008 per 100,000). 6
Telemedicine can improve access: 89.84% of neurosurgeons believe evaluating patients across state lines with telemedicine is beneficial, and 95.81% believe it improves patient access to care. 3
Practical Implementation Steps
Contact your child's primary care provider to request a telemedicine referral to pediatric neurology through hospital-affiliated telemedicine networks. 1
Ensure adequate technology: Verify you have high-bandwidth Internet access and a device capable of video conferencing before the scheduled consultation. 1
Prepare for potential in-person follow-up: Understand that virtual consultations may require subsequent face-to-face evaluation for complete neurological examination or emergent imaging. 3, 5