Digital healthcare consultations not enough for safe assessment of tonsillitis

Tonsillitis is a common reason for visits to the doctor and prescriptions of antibiotics in primary care. To determine whether a patient needs antibiotics, doctors use the so-called Centor Criteria for tonsillitis. The criteria include fever, tender and swollen lymph nodes in the angles of the jaw and inspection of the tonsils.

However, it has been unclear how well these criteria can be assessed during digital healthcare consultations compared to traditional in-person consultations. This lack of scientific evidence has become a growing concern as digital healthcare consultations become more common.

Digital vs physical assessment

The current study, published in the journal Infectious Diseases, examines whether digital assessments are as reliable as physical examinations in determining whether antibiotic treatment is warranted. The study includes 189 patients who sought care at healthcare clinics and urgent care clinics in Region Västra Götaland, Sweden, between January 2020 and October 2023.

Each patient in the study underwent two assessments: a digital medical assessment via video and a physical examination conducted by another doctor. The results show that digital healthcare consultations are not sufficient to assess some of the most important criteria, such as tonsil inspection and lymph node examination.

Digital not safe enough

One of the driving forces behind the study is Patrycja Woldan-Gradalska, a PhD student at Sahlgrenska Academy at the University of Gothenburg and a Resident Physician at Sätila Healthcare Clinic.

"Our study shows that although digital healthcare consultations are convenient for many patients, they are not reliable enough to assess tonsillitis. To ensure a correct diagnosis and treatment, it is still important to conduct a physical examination," she says.

The authors are active in community medicine and public health at Sahlgrenska Academy at the University of Gothenburg and at Region Västra Götaland's FoUUI primary and community healthcare, a support resource for research, education, development and innovation.