Advancing Pediatric Emergency Care Through Virtual Clinics

Advancing Pediatric Emergency Care Through Virtual Clinics | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Advancing Pediatric Emergency Care Through Virtual Clinics Nouf Albalawi, Nesrin Alharthy, Dina Alafandi, Abdulaziz Ajeebi, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8176872/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background: Telemedicine involves remote communication between patients and healthcare providers throughvarious information technology methods. Literature reviews have shown that virtual emergency clinics save time and costs compared with in-person visits, while reducing commuting expenses. These findings underscore the increasing demand for accessible healthcare and highlight technological advancements in telemedicine applications in emergency settings. The aim of the study was to describe the feasibility, utilization rate, and satisfaction associated with using the pediatric virtual emergency clinic at King Abdullah Specialized Children’s Hospital (KASCH). Methods: This descriptive study was conducted based on the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance), which guided data collection and variable analysis. Results: During the study period, 1,663 pediatric patients visited the virtual clinic. The mean, median, and modal ages were 5.5, 5, and 3 years, respectively. Slightly more patients were male (54.1%) than female (45.6%). Triage according to the Canadian Triage and Acuity Scale (CTAS) showed that most patients were classified at level 4 (75.2%), 14.4 % at level 3, 10.3% at level 5, and 0.1% at level 2. The most common complaints were fever (14.4%), cough (10.7%), rashes (9.2%), and non-specific issues (18.7%). Approximately 65.8% of visits resulted in discharge from the virtual clinic, with 54.4% of patients discharged without medication. Approximately 25.4% of patients were referred from the virtual clinic to the emergency room (ER) for clinical evaluation or laboratory tests, 5.1% were referred to other services, and only 3.7% visited the ER within 72 hours post-telemedicine visit. Of these, 93.5% were discharged from the ER. Parent satisfaction rates ranged from 81.7% to 99%, and agreement with virtual care plans ranged from 82% to 98%. Healthcare providers reported favorable experiences: 66% very positive, 29% somewhat positive, and only 2% negative. Conclusions: The implementation of telemedicine in pediatric emergency care proved feasible and beneficial. It improved patient flow, reduced unnecessary hospital visits, and alleviated ER overcrowding. The virtual clinic effectively managed CTAS level 4 cases, with the aim of further reducing ER visits by 20%. These findings support the integration of telemedicine into pediatric emergency services to enhance care delivery. Telemedicine Pediatric emergency care Virtual clinic Patient satisfaction Figures Figure 1 Figure 2 Figure 3 Figure 4 Background The first device used to deliver medical care across large distances was the telegraph, known as "the Victorian Internet” [ 1 ]. Telemedicine and telecommunications have been around since the 19th century, as documented in the literature [ 2 , 3 ]. Over time, this technology has significantly impacted how health care is delivered, especially during emergencies. During the coronavirus disease 2019 (COVID-19) pandemic, the healthcare system was overwhelmed by acute cases of serious infections, resulting in a significant diversion of medical care from other conditions, causing serious long-term consequences for children’s health, development, and welfare [ 4 ]. The pandemic and associated public restrictions were led to difficulties accessing care [ 5 ]. As a result, efforts were made to explore alternative patient care solutions to improve system sustainability and optimize resource use. Virtual care refers to remote contact between patients and their healthcare providers using various communication or information technology channels to enhance the quality and efficiency of patient care [ 6 ]. To date, many centers with different departments have established teleclinics, which have shown promising outcomes, high satisfaction rates, and improved access to care [ 7 – 9 ]. Studies have been conducted to explore the advantages of virtual clinics, including time and cost savings compared with in-person appointments and decreased commuting expenses [ 3 , 10 ]. According to the American Academy of Pediatrics, telemedicine clinics have a broad range of applications for education, consultation, practice, and research [ 3 ]. Thus, highlighting the growing demand for accessible healthcare and advancements in telemedicine technology, virtual emergency medicine clinics aim to bridge the gap between patients in need of urgent medical attention and qualified emergency medicine professionals by providing remote, immediate medical assistance and triage services [ 11 ]. Research has been conducted to examine the implementation of virtual medicine in pediatric emergency settings in terms of implementation principles and guidelines of care. The regulatory guidelines outline the resources needed, the setting for virtual encounters, legality, and patient criteria for efficient virtual encounters [ 12 ]. A study conducted in a tertiary pediatric hospital on the feasibility and impact of pediatric emergency virtual care revealed reductions in the burden of in-person emergency visits and higher satisfaction rates among caregivers [ 13 ]. Another descriptive study describing the experience of telemedicine in an emergency setting showed that the service yielded short visit times and fewer referrals to pediatric emergency services [ 14 ]. By combining the structured framework of the Canadian Triage and Acuity Scale (CTAS) with visual assessment elements from the pediatric assessment triangle (PAT), including appearance, work of breathing, and circulation, we aimed to ensure safe and accurate triage categorization in remote pediatric care [ 15 , 16 ]. This adaptation was designed to facilitate the rapid identification of critically ill children in virtual settings, where traditional in-person cues are limited [ 17 ]. Implementing telemedicine services can help alleviate the strain on emergency departments (ED) by providing timely medical assistance, reducing overcrowding, and reducing unnecessary hospital visits. By utilizing remote triage services, we aimed to deliver timely and efficient emergency medical services that optimize patient outcomes. Methods Study design and population This observational cross-sectional study was conducted among patients who visited the virtual clinic at King Abdullah Specialized Children’s Hospital between February 2024 and January 2025. Pediatric patients fully eligible for the National Guard in Riyadh aged 3 months to 24 years whose caregivers requested virtual care, and who presented with medical complaints (excluding administrative requests) were included. Those without access to the necessary technology or Internet connectivity required for participation were excluded. Trained triage nurses ensured proper patient identification and performed a full audiovisual assessment using the PAT to rapidly evaluate appearance, breathing, and circulation to identify children who required immediate attention [ 18 ]. This CTAS was then applied for standardized case prioritization [ 19 ]. For patients without documented weights, the Advanced Pediatric Life Support (APLS) formula was applied for weight estimation, with the analysis considering its known limitations, including the potential underestimation of actual weights [ 20 , 21 ]. Study framework Based on the published RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance), the following dimensions were adapted to guide study variable collection [ 22 ]: (1) Reach focused on identifying patients who accessed the virtual emergency department (VED), using demographic characteristics such as age, sex, presenting complaint, triage level, and medication prescribed (2) Effectiveness examined the impact of the VED on quality of care, continuity of care, and access to care, using patient survey data (3) Adoption examined how the VED was adopted by ED physicians, using physician survey data (4) Implementation assessed how the VED was implemented and adapted in practice, using physician survey data (5) Maintenance assessed whether the VED transitioned beyond a pilot and how long it could be sustained, using data on clinics created with a one-year strategy for sustainability. Data collection A data collection sheet was used to gather study variables, which included the following items: (1) Demographic characteristics such as age, sex, presenting complaint, triage level, and prescribed medication; (2) Pediatric virtual emergency clinic outcomes, such as discharge from the virtual clinic, request to visit the ED, referral to other services, revisit within 72 hours, and admission; (3) Patient satisfaction evaluated as overall satisfaction rate from the patient experience survey conducted 24 hours post-visit; and (4) Staff satisfaction evaluated as overall satisfaction based on pediatric emergency medicine (PEM) department survey of virtual care. Data management and analysis All data were coded and entered into Excel, reviewed, and cleaned before being imported into statistical software for analysis. Descriptive statistics (numbers, frequencies, and percentages) were used for categorical data. Admission, discharge, outpatient referral, and return visit rates were calculated as the number of events (numerator) divided by the total number of virtual visits (denominator). Satisfaction was reported as the rate of overall satisfaction with a virtual service. Results Study population During the 12-month study period, 2,034 pediatric patients initially visited the virtual emergency clinic, of whom 1,663 were included in the analysis after exclusions (age less than three months, lost internet connectivity during consultation, nonattendance at the scheduled appointment after triage, and wrong booking). More than half of the patients were male (54.1%), and the mean age was 5.5 years (Table 1). Table 1: Distribution of patient age Triage dimensions The majority of patients (75.2%) were triaged as level 4 (less urgent), with smaller proportions triaged as level 3 (urgent 14.4%) and level 5 (non-urgent 10.3%), and only one patient classified as emergent (level 2) (Figure 1). The most common complaints were fever (14.2%), cough (10.7%), and rashes or infestations (9.2%). Vomiting and nasal congestion/runny nose were each reported in approximately 6%. Additional complaints included throat pain, diarrhea, and abdominal pain (approximately 4% for each) ( Table 2) . Notably, 311 patients (18.7%) presented with various non-specific complaints grouped under “others.” These included dental and oral cavity complaint (3.2%), administrative issues (1.1%), and request for medication refill or information (2.8%) (Table 3). [Table 2 and Table 3 here] More than half of the patients (54.4%) were not prescribed any medications. Among those who received prescriptions, the most common medications were antipyretics (8.5%), followed by antibiotics (7.5%), topical agents (5.8%), and inhalers (4.3%) (Table 4). [Table 4 here] Over half of the patients were discharged from the virtual clinic (65.8, n=1,094). In contrast, approximately one-quarter (25.4%, n=423) were referred to the ER for further evaluation; of these, the majority (61.4%) were discharged, 27.9% did not attend, 7.5% (n=32) were admitted to the ward, and 20.3% (n=86) were referred to other services. Furthermore, only 62 patients (3.7%) revisited the ED within 72 hours, with 93.5% discharged and 4.9% admitted (Figure 2). Effectiveness was assessed based on clinical outcomes and satisfaction measures. Rates of parental agreement with virtual care plans and satisfaction were high, ranging from 81.7% to 98% (Figure 3). Adaptation was achieved through healthcare provider feedback, which indicated high levels of acceptance of the virtual clinic model. Among physicians and nurses, 66% reported very positive experiences, 29% somewhat positive, and only 2% negative (Figure 4). The virtual clinic was successfully implemented with clear triage protocols using a modified CTAS with PAT integration. Operational logistics played a crucial role in ensuring provider availability throughout virtual clinic hours. Finally, using the RE-AIM framework, the service evolved successfully from the pilot phase to an essential and sustainable component of emergency care delivery. Resources and institutional support were secured to maintain ongoing operations and expand service capacity. Discussion The implementation of a virtual clinic for PEM holds great potential for enhancing patient care, optimizing resource use, and sustaining patient satisfaction. Given that our institution records over 100,000 annual ED visits, it is essential to develop, implement, and disseminate strategies aimed at reducing non-urgent ED use. Additionally, improving patient flow and effectively triaging non-urgent cases through alternative care pathways are necessary to provide timely and quality care for acutely ill children. In this context, virtual clinics represent a desirable alternative for remote assessment, triaging, and management of patients. In the present study, we explored the innovative implementation of virtual clinics in PEM and evaluated their effectiveness in safely reducing ED visits while improving patient satisfaction, decision-making, and maintaining high quality of care. Over the past 12 months, our virtual clinic has facilitated 1,663 visits, the outcomes of which underscore the its effectiveness in providing remote care and efficiently managing patients’ needs. Successful treatment without ED visits was achieved in 65.8% of patients (approximately 1,097 visits) who received effective treatment through our virtual clinic, avoiding the need for in-person visits to the ED. Moreover, 54.4% of patients (approximately 905 visits) were discharged without any medication prescriptions, indicating that many patients were successfully managed through non-pharmacological strategies, education, or reassurance. Utilizing the modified triage in the virtual clinic showed that most of our patients (75.2%) were triaged at CTAS level 4, 14.4 % level 3, 10.3% level 5, and 0.1% level 2. The literature suggests that telemedicine triage can either lead to over-triaging or align closely with assessments made during on-site hospital triage, indicating that its effectiveness may be influenced by the standards and practices of traditional hospital triage protocols [23]. It has also been associated with several benefits, including improved accuracy in patient assessments, reduced time to disposition, and significant cost savings compared with conventional care. This is particularly notable in patients who avoided unnecessary hospital transfers [24]. In our study, only 5% of patients were referred to other services. Similarly, a case series from the child ready virtual pediatric ED telehealth network revealed that only 26% of patients required transfer to tertiary-level care, highlighting the ability of virtual consultations to successfully manage most cases [25]. In addition, only 62 patients (3.7%) in our study presented to the ED within 72 hours post-telemedicine visit, of whom 93% were discharged home, further indicating that most virtual assessments were appropriate. Evidence supporting this includes a study that showed that only 2.2% of patients suffered harm in the period following virtual consultations, most of which were avoidable and related to poor follow-up rather than the virtual consultation [26]. We studied the effectiveness of our virtual pediatric emergency clinic and found that parental satisfaction is an important outcome of healthcare delivery models. Our survey revealed the highest level of parental satisfaction (99%). Nevertheless, this number dropped to 81% during the peak of the winter season, indicating increased pressure on the ED. In addition, the rate of parental agreement with virtual clinic ranged from 82% to 98% and decreased again throughout winter. These findings are consistent with those of a systematic review on telehealth satisfaction, which showed that caregivers and patients who participated in telemedicine visits were more willing to recommend the intervention to others than in-person visits [27]. Furthermore, a study of pediatric ambulatory surgical patients showed a higher overall satisfaction with a virtual clinic (92%) than with in-person visits (63%) [28]. We measured the adoption and implementation of our pediatric emergency virtual clinic by physician and nurse satisfaction over one year, and the results showed that 66% were very positive, 29% somewhat positive, and only 2% were very negative about the practice of virtual clinic. The negative feedback was due to limited access to the clinics outside our institution, as legislations require physicians and nurses to be physically in the hospital. This study has several limitations. Its single-center design may limit the generalizability of the findings. Additionally, patient eligibility criteria for the virtual clinic may have restricted the inclusion of a broader patient population, potentially affecting the representativeness of the results. Conclusions In summary, our objective findings further support the incorporation of virtual clinics in pediatric EDs to provide prompt, high-quality, and patient-centered care. The alignment of our findings with those of previous reports suggests that telemedicine can improve access to and quality of pediatric care. Additional studies are needed to evaluate long-term outcomes, compare cost-effectiveness, and develop programs to mitigate potential adverse events of virtual care. Abbreviations ED,:emergency department. VED: virtual emergency department. CTAS,:Canadian Triage and Acuity Scale. PAT,:pediatric assessment triangle. PEM,:pediatric emergency medicine. Declarations Ethical approval This study was approved by the Institutional Review Board of King Abdullah International Medical Research Center (IRB approval no: 000002224, study number: NRR24/002/5). Ethics approval and consent to participate : This study was approve and Informed consent was waived by the Institutional Review Board of King Abdullah International Medical Research Center (IRB approval no: 000002224, study number: NRR24/002/5), the study complied with the ethical standards outlined in the Declaration of Helsinki and the study was retrospective in nature and involved the analysis of previously collected data. Consent for publication Not applicable. Availability of data and materials Yes , The corresponding author can provide statistics that substantiate the conclusions of the current study upon accepted request. Competing interest The authors declare no conflicts of interest. Funding No funds Authors’ contributions Author D.A conceived the project and designed the study. Authors N.B., D.A., A.A., B.B., and M.A. performed collected the data. Author N.B. analyzed the data. Author A.A. wrote the first draft of the manuscript. Author N.B. prepared the abstract, graphs, tables, edited and finalized the manuscript, and approved the final manuscript. Acknowledgements The authors would like to express their sincere gratitude to all the pediatric emergency physicians and nurses of the Emergency Department at King Abdullah Specialized Children’s Hospital, National Guard Health Affairs, Riyadh , for their dedication and continuous support in providing high quality virtual pediatric emergency care. References Jagarapu J, Savani RC. A brief history of telemedicine and the evolution of teleneonatology. In: Seminars in perinatology. Amsterdam: Elsevier; 2021. p. 151416. Shawwa L. The use of telemedicine in medical education and patient care. Cureus. 2023;15:e37766. Burke BL Jr, Hall RW; SECTION ON TELEHEALTH CARE. Telemedicine: pediatric applications. Pediatrics. 2015;136:e293-308. Bhattacharyya H, Agarwalla R, Khandelwal A. Impact of COVID-19 on child health and healthcare services. Med J Armed Forces India. 2022;78:3. Conlon C, McDonnell T, Barrett M, Cummins F, Deasy C, Hensey C, et al. The impact of the COVID-19 pandemic on child health and the provision of care in paediatric emergency departments: a qualitative study of frontline emergency care staff. BMC Health Serv Res. 2021;21:1-11. Wong A, Bhyat R, Srivastava S, Lomax LB, Appireddy R. Patient care during the COVID-19 pandemic: use of virtual care. J Med Internet Res. 2021;23:e20621. Al Jabir W, Al-alfard BA, Muhaya AA, Al Farhan A. Non-urgent pediatric presentations to the emergency department, Khamis Mushayt Maternity and Children Hospital, Saudi Arabia. World Fam Med. 2023;21:87-97 Rutherford E, Noray R, HEarráin CÓ, Quinlan K, Hegarty A, Ekpotu L, et al. Potential benefits and drawbacks of virtual clinics in general surgery: pilot cross-sectional questionnaire study. JMIR Perioper Med. 2020;3:e12491. Shammout S, Wall R, Murphy PN, Jain K. 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Tables Table 1: Distribution of patient age Age categories Frequency (N) Percentage (%) 3 Months-1 Year 199 12.0 More 1-3 Years 526 31.6 More than 3-5 Years 329 19.8 More than 5-7 Years 220 13.2 More than 7-9 Years 153 9.2 More than 9-11 Years 128 7.7 More than 11-14 Years 108 6.5 Table 2: Patient complaints reported in the virtual clinic Presenting complaints Frequency (N) Percent (%) Body aches 5 .3 Constipation 46 2.8 Cough 178 10.7 Diarrhea 68 4.1 Noisy breathing 4 .2 Others 311 18.7 Red eye 40 2.4 Abdominal pain 65 3.9 Bites and stinges 6 .4 Chest pain 6 .4 Ear pain 59 3.5 eating / feeding issues 23 1.4 Eye pain 34 2.0 Fever 236 14.2 Headache 18 1.1 Jaundice 4 .2 minor allergy symptoms 15 .9 Minor injuries / cut wound 45 2.7 Nausea 2 .1 Presenting complaint 1 .1 Rashes / haives / infestation 153 9.2 Runny nose / congested nose 98 5.9 SOB 50 3.0 Throat pain 68 4.1 Urinary symptoms 23 1.4 Vomiting 105 6.3 Total 1663 100.0 Table 3: Patient presented with various non-specific complaints grouped under “others” Frequency(N) for total patient seen in clinic. Percent (%) for total patient seen in clinic. Abnormal movement 3 .2 Accidental ingestion substance or foreign body 9 .5 Administrative issue 18 1.1 Bloody / abnormal color of stool 4 .2 Crying 4 .2 Dental and oral cavity complain 53 3.2 Endocrine complain 2 .1 Eye, nose and ear complain 31 1.9 Genitourinary complain 24 1.4 Head and neck complain 20 1.2 Laboratory and radiological result 25 1.5 Low heart rate 1 .1 Medical question 7 .4 Medication refill or information 46 2.8 Menstrual disorders 3 .2 Musculoskeletal complain 33 2.0 Nutrition questions 3 .2 Scalp or hair complains 9 .5 Suture Remove 1 .1 Syncope / dizziness 2 .1 Umbilical infection / rash / shape 3 .2 Wound discharge 2 .1 Total 1663 100.0 Table 4: Prescribed medications Medication Frequency (N) Percentage (%) Analgesia 42 2.5 Antibiotics 124 7.5 Antiemetic 18 1.1 Antihistamines 57 3.4 Antipyretics 142 8.5 Eye / Ear Drops 56 3.4 Inhalers 71 4.3 Medication Refill 25 1.5 None 905 54.4 ORS 40 2.4 Others 87 5.2 Topical Medicines and Emolliates 96 5.8 ORS, oral rehydration solution Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8176872","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":578340114,"identity":"352d4962-bf28-4af6-99b4-5118996a3715","order_by":0,"name":"Nouf 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1","display":"","copyAsset":false,"role":"figure","size":26006,"visible":true,"origin":"","legend":"\u003cp\u003ePercentage of patients using virtual clinics according to the Canadian Triage Acuity Scale.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8176872/v1/1259ce402e42bf41cf80605d.png"},{"id":100950853,"identity":"23957a4e-9ecc-427a-a2aa-a6b8669b8740","added_by":"auto","created_at":"2026-01-23 07:09:22","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":85777,"visible":true,"origin":"","legend":"\u003cp\u003eOutcomes of pediatric virtual emergency clinic.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8176872/v1/eea20965986bd007d6cd55e2.png"},{"id":100896549,"identity":"07fe180f-4b66-4c99-8def-c6f1485d0319","added_by":"auto","created_at":"2026-01-22 14:16:29","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":114177,"visible":true,"origin":"","legend":"\u003cp\u003eParental agreement on virtual clinic plans and satisfaction.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8176872/v1/3df0eb6cb661d0606ecd223a.png"},{"id":100896534,"identity":"60248e09-9dfa-4888-9ce2-7872bd197e29","added_by":"auto","created_at":"2026-01-22 14:16:28","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":53969,"visible":true,"origin":"","legend":"\u003cp\u003ePhysician and nurse satisfaction.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8176872/v1/135562f8e008fd95a48e6fc9.png"},{"id":100952878,"identity":"47749295-0320-4268-8f0f-d9631ef44118","added_by":"auto","created_at":"2026-01-23 07:18:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1039188,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8176872/v1/cfc0e061-e9af-44df-96bd-44c650ea15b8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Advancing Pediatric Emergency Care Through Virtual Clinics","fulltext":[{"header":"Background","content":"\u003cp\u003eThe first device used to deliver medical care across large distances was the telegraph, known as \"the Victorian Internet\u0026rdquo; [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Telemedicine and telecommunications have been around since the 19th century, as documented in the literature [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Over time, this technology has significantly impacted how health care is delivered, especially during emergencies. During the coronavirus disease 2019 (COVID-19) pandemic, the healthcare system was overwhelmed by acute cases of serious infections, resulting in a significant diversion of medical care from other conditions, causing serious long-term consequences for children\u0026rsquo;s health, development, and welfare [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The pandemic and associated public restrictions were led to difficulties accessing care [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs a result, efforts were made to explore alternative patient care solutions to improve system sustainability and optimize resource use. Virtual care refers to remote contact between patients and their healthcare providers using various communication or information technology channels to enhance the quality and efficiency of patient care [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. To date, many centers with different departments have established teleclinics, which have shown promising outcomes, high satisfaction rates, and improved access to care [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Studies have been conducted to explore the advantages of virtual clinics, including time and cost savings compared with in-person appointments and decreased commuting expenses [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. According to the American Academy of Pediatrics, telemedicine clinics have a broad range of applications for education, consultation, practice, and research [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Thus, highlighting the growing demand for accessible healthcare and advancements in telemedicine technology, virtual emergency medicine clinics aim to bridge the gap between patients in need of urgent medical attention and qualified emergency medicine professionals by providing remote, immediate medical assistance and triage services [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Research has been conducted to examine the implementation of virtual medicine in pediatric emergency settings in terms of implementation principles and guidelines of care. The regulatory guidelines outline the resources needed, the setting for virtual encounters, legality, and patient criteria for efficient virtual encounters [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. A study conducted in a tertiary pediatric hospital on the feasibility and impact of pediatric emergency virtual care revealed reductions in the burden of in-person emergency visits and higher satisfaction rates among caregivers [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Another descriptive study describing the experience of telemedicine in an emergency setting showed that the service yielded short visit times and fewer referrals to pediatric emergency services [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. By combining the structured framework of the Canadian Triage and Acuity Scale (CTAS) with visual assessment elements from the pediatric assessment triangle (PAT), including appearance, work of breathing, and circulation, we aimed to ensure safe and accurate triage categorization in remote pediatric care [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This adaptation was designed to facilitate the rapid identification of critically ill children in virtual settings, where traditional in-person cues are limited [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eImplementing telemedicine services can help alleviate the strain on emergency departments (ED) by providing timely medical assistance, reducing overcrowding, and reducing unnecessary hospital visits. By utilizing remote triage services, we aimed to deliver timely and efficient emergency medical services that optimize patient outcomes.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and population\u003c/h2\u003e \u003cp\u003eThis observational cross-sectional study was conducted among patients who visited the virtual clinic at King Abdullah Specialized Children\u0026rsquo;s Hospital between February 2024 and January 2025. Pediatric patients fully eligible for the National Guard in Riyadh aged 3 months to 24 years whose caregivers requested virtual care, and who presented with medical complaints (excluding administrative requests) were included. Those without access to the necessary technology or Internet connectivity required for participation were excluded.\u003c/p\u003e \u003cp\u003eTrained triage nurses ensured proper patient identification and performed a full audiovisual assessment using the PAT to rapidly evaluate appearance, breathing, and circulation to identify children who required immediate attention [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This CTAS was then applied for standardized case prioritization [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. For patients without documented weights, the Advanced Pediatric Life Support (APLS) formula was applied for weight estimation, with the analysis considering its known limitations, including the potential underestimation of actual weights [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy framework\u003c/h3\u003e\n\u003cp\u003eBased on the published RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance), the following dimensions were adapted to guide study variable collection [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]:\u003c/p\u003e \u003cp\u003e(1) \u003cb\u003eReach\u003c/b\u003e focused on identifying patients who accessed the virtual emergency department (VED), using demographic characteristics such as age, sex, presenting complaint, triage level, and medication prescribed (2) \u003cb\u003eEffectiveness\u003c/b\u003e examined the impact of the VED on quality of care, continuity of care, and access to care, using patient survey data (3) \u003cb\u003eAdoption\u003c/b\u003e examined how the VED was adopted by ED physicians, using physician survey data (4) \u003cb\u003eImplementation\u003c/b\u003e assessed how the VED was implemented and adapted in practice, using physician survey data (5) \u003cb\u003eMaintenance\u003c/b\u003e assessed whether the VED transitioned beyond a pilot and how long it could be sustained, using data on clinics created with a one-year strategy for sustainability.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eA data collection sheet was used to gather study variables, which included the following items: (1)\u003c/p\u003e \u003cp\u003eDemographic characteristics such as age, sex, presenting complaint, triage level, and prescribed medication; (2) Pediatric virtual emergency clinic outcomes, such as discharge from the virtual clinic, request to visit the ED, referral to other services, revisit within 72 hours, and admission; (3) Patient satisfaction evaluated as overall satisfaction rate from the patient experience survey conducted 24 hours post-visit; and (4) Staff satisfaction evaluated as overall satisfaction based on pediatric emergency medicine (PEM) department survey of virtual care.\u003c/p\u003e\n\u003ch3\u003eData management and analysis\u003c/h3\u003e\n\u003cp\u003e All data were coded and entered into Excel, reviewed, and cleaned before being imported into statistical software for analysis. Descriptive statistics (numbers, frequencies, and percentages) were used for categorical data. Admission, discharge, outpatient referral, and return visit rates were calculated as the number of events (numerator) divided by the total number of virtual visits (denominator). Satisfaction was reported as the rate of overall satisfaction with a virtual service.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudy population\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the 12-month study period, 2,034 pediatric patients initially visited the virtual emergency clinic, of whom 1,663 were included in the analysis after exclusions (age less than three months, lost internet connectivity during consultation, nonattendance at the scheduled appointment after triage, and wrong booking). More than half of the patients were male (54.1%), and the mean age was 5.5 years (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1:\u0026nbsp;\u003c/strong\u003eDistribution of patient age\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTriage dimensions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe majority of patients (75.2%) were triaged as level 4 (less urgent), with smaller proportions triaged as level 3 (urgent 14.4%) and level 5 (non-urgent 10.3%), and only one patient classified as emergent (level 2) (Figure 1).\u003c/p\u003e\n\u003cp\u003eThe most common complaints were fever (14.2%), cough (10.7%), and rashes or infestations (9.2%). Vomiting and nasal congestion/runny nose were each reported in approximately 6%. Additional complaints included throat pain, diarrhea, and abdominal pain (approximately 4% for each) (\u003cstrong\u003eTable 2)\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e Notably, 311 patients (18.7%) presented with various non-specific complaints grouped under \u0026ldquo;others.\u0026rdquo; These included dental and oral cavity complaint (3.2%), administrative issues (1.1%), and request for medication refill or information (2.8%) (Table 3).\u003c/p\u003e\n\u003cp\u003e[Table 2 and Table 3 here]\u003c/p\u003e\n\u003cp\u003eMore than half of the patients (54.4%) were not prescribed any medications. Among those who received prescriptions, the most common medications were antipyretics (8.5%), followed by antibiotics (7.5%), topical agents (5.8%), and inhalers (4.3%) (Table 4).\u003c/p\u003e\n\u003cp\u003e[Table 4 here]\u003c/p\u003e\n\u003cp\u003eOver half of the patients were discharged from the virtual clinic (65.8, n=1,094). In contrast, approximately one-quarter (25.4%, n=423) were referred to the ER for further evaluation; of these, the majority (61.4%) were discharged, 27.9% did not attend, 7.5% (n=32) were admitted to the ward, and 20.3% (n=86) were referred to other services. Furthermore, only 62 patients (3.7%) revisited the ED within 72 hours, with 93.5% discharged and 4.9% admitted (Figure 2).\u003c/p\u003e\n\u003cp\u003eEffectiveness was assessed based on clinical outcomes and satisfaction measures. Rates of parental agreement with virtual care plans and satisfaction were high, ranging from 81.7% to 98%\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e(Figure 3).\u003c/p\u003e\n\u003cp\u003eAdaptation was achieved through healthcare provider feedback, which indicated high levels of acceptance of the virtual clinic model. Among physicians and nurses, 66% reported very positive experiences, 29% somewhat positive, and only 2% negative (Figure 4). The virtual clinic was successfully implemented with clear triage protocols using a modified CTAS with PAT integration. Operational logistics played a crucial role in ensuring provider availability throughout virtual clinic hours.\u003c/p\u003e\n\u003cp\u003eFinally, using the RE-AIM framework, the service evolved successfully from the pilot phase to an essential and sustainable component of emergency care delivery. Resources and institutional support were secured to maintain ongoing operations and expand service capacity.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe implementation of a virtual clinic for PEM holds great potential for enhancing patient care, optimizing resource use, and sustaining patient satisfaction. Given that our institution records over 100,000 annual ED visits, it is essential to develop, implement, and disseminate strategies aimed at reducing non-urgent ED use. Additionally, improving patient flow and effectively triaging non-urgent cases through alternative care pathways are necessary to provide timely and quality care for acutely ill children. In this context, virtual clinics represent a desirable alternative for remote assessment, triaging, and management of patients.\u003c/p\u003e\n\u003cp\u003eIn the present study, we explored the innovative implementation of virtual clinics in PEM and evaluated their effectiveness in safely reducing ED visits while improving patient satisfaction, decision-making, and maintaining high quality of care. Over the past 12 months, our virtual clinic has facilitated 1,663 visits, the outcomes of which underscore the its effectiveness in providing remote care and efficiently managing patients\u0026rsquo; needs.\u003c/p\u003e\n\u003cp\u003eSuccessful treatment without ED visits was achieved in 65.8% of patients (approximately 1,097 visits) who received effective treatment through our virtual clinic, avoiding the need for in-person visits to the ED. Moreover, 54.4% of patients (approximately 905 visits) were discharged without any medication prescriptions, indicating that many patients were successfully managed through non-pharmacological strategies, education, or reassurance.\u003c/p\u003e\n\u003cp\u003eUtilizing the modified triage in the virtual clinic showed that most of our patients (75.2%) were triaged at CTAS level 4, 14.4 % level 3, 10.3% level 5, and 0.1% level 2. The literature suggests that telemedicine triage can either lead to over-triaging or align closely with assessments made during on-site hospital triage, indicating that its effectiveness may be influenced by the standards and practices of traditional hospital triage protocols [23]. It has also been associated with several benefits, including improved accuracy in patient assessments, reduced time to disposition, and significant cost savings compared with conventional care. This is particularly notable in patients who avoided unnecessary hospital transfers [24].\u003c/p\u003e\n\u003cp\u003eIn our study, only 5% of patients were referred to other services.\u0026nbsp;Similarly, a case series from the child ready virtual pediatric ED telehealth network revealed that only 26% of patients required transfer to tertiary-level care, highlighting the ability of virtual consultations to successfully manage most cases [25]. In addition, only 62 patients (3.7%) in our study presented to the ED within 72 hours post-telemedicine visit, of whom 93% were discharged home, further indicating that most virtual assessments were appropriate. Evidence supporting this includes a study that showed that only 2.2% of patients suffered harm in the period following virtual consultations, most of which were avoidable and related to poor follow-up rather than the virtual consultation [26].\u003c/p\u003e\n\u003cp\u003eWe studied the\u0026nbsp;effectiveness of our\u0026nbsp;virtual pediatric emergency\u0026nbsp;clinic and\u0026nbsp;found that parental satisfaction is an important outcome of healthcare delivery models. Our survey revealed the highest level of parental satisfaction (99%).\u0026nbsp;Nevertheless, this number dropped to 81% during the peak of the winter season, indicating increased pressure on the ED. In addition, the rate of parental agreement with virtual clinic ranged from\u0026nbsp;82% to 98% and decreased\u0026nbsp;again throughout winter.\u0026nbsp;These findings are consistent with\u0026nbsp;those of a systematic review on telehealth satisfaction, which\u0026nbsp;showed that caregivers and patients who participated in telemedicine visits were more willing to recommend the intervention to others than in-person visits [27]. Furthermore, a study of pediatric ambulatory surgical patients showed a higher overall satisfaction with a virtual clinic (92%) than with in-person visits (63%) [28].\u003c/p\u003e\n\u003cp\u003eWe measured the adoption and implementation of our pediatric emergency virtual clinic\u0026nbsp;by physician and nurse satisfaction over one year, and the results showed that 66% were very positive, 29% somewhat positive, and only 2% were very negative about the practice of virtual clinic. The negative feedback was due to limited access to the clinics outside our institution, as legislations require physicians and nurses to be physically in the hospital.\u003c/p\u003e\n\u003cp\u003eThis study has several limitations. Its single-center design may limit the generalizability of the findings. Additionally, patient eligibility criteria for the virtual clinic may have restricted the inclusion of a broader patient population, potentially affecting the representativeness of the results.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn summary, our objective findings further support the incorporation of virtual clinics in pediatric EDs to provide prompt, high-quality, and patient-centered care. The alignment of our findings with those of previous reports suggests that telemedicine can improve access to and quality of pediatric care. Additional studies are needed to evaluate long-term outcomes, compare cost-effectiveness, and develop programs to mitigate potential adverse events of virtual care.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eED,:emergency department.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;VED: virtual emergency department.\u003c/p\u003e\n\u003cp\u003eCTAS,:Canadian Triage and Acuity Scale.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;PAT,:pediatric assessment triangle.\u003c/p\u003e\n\u003cp\u003ePEM,:pediatric emergency medicine.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical approval\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board of King Abdullah International Medical Research Center (IRB approval no: 000002224, study number: NRR24/002/5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003eand consent to participate\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approve\u0026nbsp;and\u0026nbsp;Informed consent was waived by the Institutional Review Board of King Abdullah International Medical Research Center (IRB approval no: 000002224, study number: NRR24/002/5), the\u0026nbsp;study complied with the ethical standards outlined in the Declaration of Helsinki and the study was retrospective in nature and involved the analysis of previously collected data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYes , The corresponding author can provide statistics that substantiate the conclusions of the current study upon accepted request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interest\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funds\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors’ contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthor D.A\u003c/em\u003e conceived the project and designed the study. \u003cem\u003eAuthors N.B., D.A., A.A., B.B., and M.A.\u003c/em\u003e performed collected the data.\u0026nbsp;\u003cem\u003eAuthor N.B.\u003c/em\u003e analyzed the data. \u003cem\u003eAuthor A.A.\u0026nbsp;\u003c/em\u003ewrote the first draft of the manuscript. \u003cem\u003eAuthor N.B. prepared the abstract, graphs, tables,\u0026nbsp;\u003c/em\u003eedited and\u003cem\u003e\u0026nbsp;\u003cem\u003efinalized the manuscript,\u003c/em\u003e\u0026nbsp;\u003c/em\u003eand approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their sincere gratitude to all the pediatric emergency physicians and nurses of the Emergency Department at \u003cstrong\u003eKing Abdullah Specialized Children’s Hospital, National Guard Health Affairs, Riyadh\u003c/strong\u003e, for their dedication and continuous support in providing high quality virtual pediatric emergency care.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eJagarapu J, Savani RC. A brief history of telemedicine and the evolution of teleneonatology. In: Seminars in perinatology. Amsterdam: Elsevier; 2021. p. 151416.\u003c/li\u003e\n \u003cli\u003eShawwa L. The use of telemedicine in medical education and patient care. Cureus. 2023;15:e37766.\u003c/li\u003e\n \u003cli\u003eBurke BL Jr, Hall RW; SECTION ON TELEHEALTH CARE. Telemedicine: pediatric applications. Pediatrics. 2015;136:e293-308.\u003c/li\u003e\n \u003cli\u003eBhattacharyya H, Agarwalla R, Khandelwal A. Impact of COVID-19 on child health and healthcare services. Med J Armed Forces India. 2022;78:3.\u003c/li\u003e\n \u003cli\u003eConlon C, McDonnell T, Barrett M, Cummins F, Deasy C, Hensey C, et al. The impact of the COVID-19 pandemic on child health and the provision of care in paediatric emergency departments: a qualitative study of frontline emergency care staff. BMC Health Serv Res. 2021;21:1-11.\u003c/li\u003e\n \u003cli\u003eWong A, Bhyat R, Srivastava S, Lomax LB, Appireddy R. Patient care during the COVID-19 pandemic: use of virtual care. J Med Internet Res. 2021;23:e20621.\u003c/li\u003e\n \u003cli\u003eAl Jabir W, Al-alfard BA, Muhaya AA, Al Farhan A. Non-urgent pediatric presentations to the emergency department, Khamis Mushayt Maternity and Children Hospital, Saudi Arabia. World Fam Med. 2023;21:87-97\u003c/li\u003e\n \u003cli\u003eRutherford E, Noray R, HEarr\u0026aacute;in C\u0026Oacute;, Quinlan K, Hegarty A, Ekpotu L, et al. Potential benefits and drawbacks of virtual clinics in general surgery: pilot cross-sectional questionnaire study. JMIR Perioper Med. 2020;3:e12491.\u003c/li\u003e\n \u003cli\u003eShammout S, Wall R, Murphy PN, Jain K. Virtual clinics versus face-to-face review: Is the benefit the same for new orthopaedic patients? Health Policy (New York). 2022;126:688-92.\u003c/li\u003e\n \u003cli\u003eMurphy RP, Dennehy KA, Costello MM, Murphy EP, Judge CS, O\u0026rsquo;Donnell MJ, et al. Virtual geriatric clinics and the COVID-19 catalyst: a rapid review. Age Ageing. 2020;49:907-14.\u003c/li\u003e\n \u003cli\u003eCurfman AL, Hackell JM, Herendeen NE, Alexander JJ, Marcin JP, Moskowitz WB, et al. Telehealth: improving access to and quality of pediatric health care. Pediatrics. 2021;148:e2021053129.\u003c/li\u003e\n \u003cli\u003eRosenfield D, Lim R, Tse S. Implementing virtual care in the emergency department: building on the pediatric experience during COVID-19. Can J Emerg Med. 2021;23:15-8.\u003c/li\u003e\n \u003cli\u003eReid S, Bhatt M, Zemek R, Tse S. Virtual care in the pediatric emergency department: a new way of doing business? Can J Emerg Med. 2021;23:80-4.\u003c/li\u003e\n \u003cli\u003eKim JW, Friedman J, Clark S, Hafeez B, Listman D, Lame M, et al. Implementation of a pediatric emergency telemedicine program. Pediatr Emerg Care. 2020;36:e104-7.\u003c/li\u003e\n \u003cli\u003eMirhaghi A, Heydari A, Mazlom R, Ebrahimi M. The reliability of the Canadian triage and acuity scale: Meta-analysis. N Am J Med Sci. 2015;7:299-305.\u003c/li\u003e\n \u003cli\u003eT\u0026oslash;risen TAG, Glanville JM, Loaiza AF, Bidonde J. Emergency pediatric patients and use of the pediatric assessment triangle tool (PAT): a scoping review. BMC Emerg Med. 2024;24:158.\u003c/li\u003e\n \u003cli\u003eBeyer A, Moon K, Penndorf P, Hirsch T, Zahn-Tesch U, Hoffmann W, et al. Triage through telemedicine in paediatric emergency care\u0026mdash;Results of a concordance study. PLoS One. 2022;17:e0269058.\u003c/li\u003e\n \u003cli\u003eDieckmann RA, Brownstein D, Gausche-Hill M. The Pediatric Assessment Triangle. Pediatr Emerg Care. 2010;26:312-5.\u003c/li\u003e\n \u003cli\u003eBullard MJ, Musgrave E, Warren D, Unger B, Skeldon T, Grierson R, et al. Revisions to the Canadian Emergency Department Triage and Acuity Scale (CTAS) Guidelines 2016. CJEM. 2017;19:S18-27.\u003c/li\u003e\n \u003cli\u003eAli K, Sammy I, Nunes P. Is the APLS formula used to calculate weight-for-age applicable to a Trinidadian population? BMC Emerg Med. 2012;12:9.\u003c/li\u003e\n \u003cli\u003eSeddon C, Lockitt L, Dhanjal S, Eisenhut M. Validation of advanced paediatric life support formulas for weight calculation in a multiethnic population. ISRN Pediatr. 2012;2012:869634.\u003c/li\u003e\n \u003cli\u003eShuldiner J, Srinivasan D, Desveaux L, Hall JN. The implementation of a virtual emergency department: multimethods study guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. JMIR Form Res. 2023;7:e49786.\u003c/li\u003e\n \u003cli\u003eBeyer A, Moon K, Penndorf P, Hirsch T, Zahn-Tesch U, Hoffmann W, et al. Triage through telemedicine in paediatric emergency care\u0026mdash;Results of a concordance study. PLoS One. 2022;17:e0269058.\u003c/li\u003e\n \u003cli\u003eMitra A, Veerakone R, Li K, Nix T, Hashikawa A, Mahajan P. Telemedicine in paediatric emergency care: a systematic review. J Telemed Telecare. 2023;29:579-90.\u003c/li\u003e\n \u003cli\u003eCotton J, Bullard-Berent J, Sapien R. Virtual pediatric emergency department telehealth network program: a case series. Pediatr Emerg Care. 2020;36:217-21.\u003c/li\u003e\n \u003cli\u003eManolescu S, Chase A, Belisle S, Joubert G, Berhe A, Istasy P. 37 Adverse events associated with paediatric emergency medicine virtual clinic visits. Paediatr Child Health. 2024;29:e17.\u003c/li\u003e\n \u003cli\u003eKodjebacheva GD, Culinski T, Kawser B, Coffer K. Satisfaction with telehealth services compared with nontelehealth services among pediatric patients and their caregivers: systematic review of the literature. JMIR Pediatr Parent. 2023;6:e41554.\u003c/li\u003e\n \u003cli\u003eMahmoud MA, Daboos M, Gouda S, Othman A, Abdelmaboud M, Hussein ME, et al. Telemedicine (virtual clinic) effectively delivers the required healthcare service for pediatric ambulatory surgical patients during the current era of COVID-19 pandemic: a mixed descriptive study. J Pediatr Surg. 2022;57:630-6.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1:\u0026nbsp;\u003c/strong\u003eDistribution of patient age\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAge categories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e3 Months-1 Year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e12.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eMore 1-3 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e526\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e31.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eMore than 3-5 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e19.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eMore than 5-7 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eMore than 7-9 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eMore than 9-11 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eMore than 11-14 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u0026nbsp;\u003c/strong\u003ePatient complaints reported in the virtual clinic\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"561\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresenting complaints\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eBody aches\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eConstipation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eCough\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eDiarrhea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eNoisy breathing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e18.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eRed eye\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eAbdominal pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eBites and stinges\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eChest pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eEar pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eeating / feeding issues\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eEye pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eFever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e14.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eHeadache\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eJaundice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eminor allergy symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eMinor injuries / cut wound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eNausea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003ePresenting complaint\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eRashes / haives / infestation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eRunny nose / congested nose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eSOB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eThroat pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eUrinary symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eVomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e1663\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u0026nbsp;\u003c/strong\u003ePatient presented with various non-specific complaints grouped under \u0026ldquo;others\u0026rdquo;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency(N) for total patient seen in clinic.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%) for total patient seen in clinic.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eAbnormal movement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eAccidental ingestion substance or foreign body\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eAdministrative issue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eBloody / abnormal color of stool\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eCrying\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eDental and oral cavity complain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eEndocrine complain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eEye, nose and ear complain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eGenitourinary complain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eHead and neck complain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eLaboratory and radiological result\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eLow heart rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eMedical question\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eMedication refill or information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eMenstrual disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eMusculoskeletal complain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eNutrition questions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eScalp or hair complains\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eSuture Remove\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eSyncope / dizziness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eUmbilical infection / rash / shape\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eWound discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1663\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u0026nbsp;\u003c/strong\u003ePrescribed medications\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eAnalgesia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eAntibiotics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eAntiemetic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eAntihistamines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eAntipyretics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eEye / Ear Drops\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eInhalers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMedication Refill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e905\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e54.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eORS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eTopical Medicines and Emolliates\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eORS, oral rehydration solution\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Telemedicine, Pediatric emergency care, Virtual clinic, Patient satisfaction","lastPublishedDoi":"10.21203/rs.3.rs-8176872/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8176872/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Telemedicine involves remote communication between patients and healthcare providers throughvarious information technology methods. Literature reviews have shown that virtual emergency clinics save time and costs compared with in-person visits, while reducing commuting expenses. These findings underscore the increasing demand for accessible healthcare and highlight technological advancements in telemedicine applications in emergency settings.\u003cstrong\u003e \u003c/strong\u003eThe aim of the study was to describe the feasibility, utilization rate, and satisfaction associated with using the pediatric virtual emergency clinic at King Abdullah Specialized Children’s Hospital (KASCH).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This descriptive study was conducted based on the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance), which guided data collection and variable analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eDuring the study period, 1,663 pediatric patients visited the virtual clinic. The mean, median, and modal ages were 5.5, 5, and 3 years, respectively. Slightly more patients were male (54.1%) than female (45.6%). Triage according to the Canadian Triage and Acuity Scale (CTAS) showed that most patients were classified at level 4 (75.2%), 14.4 % at level 3, 10.3% at level 5, and 0.1% at level 2. The most common complaints were fever (14.4%), cough (10.7%), rashes (9.2%), and non-specific issues (18.7%). Approximately 65.8% of visits resulted in discharge from the virtual clinic, with 54.4% of patients discharged without medication. Approximately 25.4% of patients were referred from the virtual clinic to the emergency room (ER) for clinical evaluation or laboratory tests, 5.1% were referred to other services, and only 3.7% visited the ER within 72 hours post-telemedicine visit. Of these, 93.5% were discharged from the ER. Parent satisfaction rates ranged from 81.7% to 99%, and agreement with virtual care plans ranged from 82% to 98%. Healthcare providers reported favorable experiences: 66% very positive, 29% somewhat positive, and only 2% negative.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe implementation of telemedicine in pediatric emergency care proved feasible and beneficial. It improved patient flow, reduced unnecessary hospital visits, and alleviated ER overcrowding. The virtual clinic effectively managed CTAS level 4 cases, with the aim of further reducing ER visits by 20%. These findings support the integration of telemedicine into pediatric emergency services to enhance care delivery.\u003c/p\u003e","manuscriptTitle":"Advancing Pediatric Emergency Care Through Virtual Clinics","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-22 14:16:20","doi":"10.21203/rs.3.rs-8176872/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-01-29T20:44:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-28T20:14:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"54076415666574168822178253010499072806","date":"2026-01-23T09:00:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"224307919118178174041578061243088579877","date":"2026-01-21T19:44:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"234972459779634880101836844427017839934","date":"2026-01-21T15:12:09+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-20T13:22:19+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-29T18:53:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-29T18:49:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-26T15:27:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-12-26T15:19:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4690da90-90c4-4005-a93d-07264b8bcfad","owner":[],"postedDate":"January 22nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-22T14:16:20+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-22 14:16:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8176872","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8176872","identity":"rs-8176872","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}