Design: prospective multicentre observational study across 11 hospitals
Population: 830 children, median age 6.7 years, undergoing anaesthesia preoperative assessment by teleconsultation
Primary outcome: teleconsultation feasibility — completed with child and parent present, platform only, no in-person follow-up needed
Effect: 73% feasibility; 91% of failures technical; no pre-connection test OR 6.21 (3.05 to 12.66); tablet or smartphone OR 2.44 (1.40 to 4.26)

Eleven major French hospitals prospectively assessed 830 anaesthesia teleconsultations in children with a median age of 6.7 years. Success was defined strictly: child and parent both present, conducted entirely on the secure audiovisual platform, no in-person appointment needed afterwards.

Seventy-three per cent succeeded. Of the failures, 91 per cent were technical, 9 per cent organisational and 1 per cent medical. Two factors stand out because both are fixable: not doing a pre-connection test raised the odds of technical failure more than sixfold (OR 6.21, 95% CI 3.05 to 12.66), and using a tablet or smartphone instead of a computer more than doubled them (OR 2.44, 1.40 to 4.26). Sociodemographic factors also predicted failure, which is the equity problem sitting underneath this.

Clinically, the consultations worked. Only three converted to in-person assessment, nothing was cancelled on the day of surgery, one case was postponed and one anaesthetic strategy changed. Median medical time was 28 minutes. Ninety-three per cent of parents would choose teleconsultation again, and anaesthetists were satisfied with the medical content in 96 per cent of cases — but with the quality of information delivered in only 72 per cent, and technical failure degraded every satisfaction measure.

Mandate a pre-connection test — it is the single largest modifiable predictor of failure
Tell families to use a computer rather than a phone where they have one
Have a fallback telephone or in-person slot rather than losing the assessment
Track who fails to connect; the sociodemographic pattern is an access problem, not a technology one
Budget around 28 minutes, not less — this is not a faster consultation

Why it matters

The barrier to paediatric teleconsultation turns out to be logistics, not clinical adequacy.

The statistics, in plain English

An odds ratio of 6.21 with a confidence interval from 3.05 to 12.66 is a large and well-established effect — the pre-connection test is not a marginal gain. This was observational, so families who complete a test may differ from those who do not, but the mechanism is direct enough that the association is credible.