Real-Time Tele-Mentored Low Cost “Point-of-Care US” in the Hands of Paediatricians in the Emergency Department: Diagnostic Accuracy Compared to Expert Radiologists

Background - The use of point-of-care ultrasonography (POC US) in paediatrics is increasing. This study investigated the diagnostic accuracy of POC US in children accessing the emergency department (ED) when performed by paediatricians under the remote guidance of radiologists (TELE POC). Methods - Children aged 0 to 18 years accessing the ED of a third level research hospital with eight possible clinical scenarios and without emergency/severity signs at the triage underwent three subsequent US tests: by a paediatrician guided remotely by a radiologist (TELE POC); by the same radiologist (UNBLIND RAD); by an independent blinded radiologist (BLIND RAD). Tele-radiology was implemented using low cost ªcommercial off-the-shelfº (COTS) equipment and open-source software. Data were prospectively collected on predefined templates. Results - Fifty-two children were enrolled, for a total of 170 ultrasound findings. Sensitivity, specificity, positive and negative predictive values of TELE POC were: 93.8, 99.7, 96.8, 99.4 when compared to UNBLIND RAD and 88.2, 99.7, 96.8, 98.7 when compared to BLIND RAD. The inter-observers agreement between the paediatricians and either the unblind or blind radiologist was excellent (k = 0.93). The mean duration of TELE POC was 6.3 minutes (95% CI 4.1 to 8.5). Technical difficulties occurred in two (3.8%) cases. Quality of the transmission was rated as fair, good, very good and excellent in 7.7%, 15.4%, 42.3% and 34.6% of cases respectively, while in no case was it rated as poor.

@Article{ZNNGTCFNGGCBL16,
  author       = {Zennaro, F. and Neri, E. and Nappi, F. and Grosso, D. and Triunfo, R. and Cabras, F. and Frexia, F. and Norbedo, S. and Guastalla, P. and Gregori, M. and Cattaruzzi, E. and Barbi, E. and Lazzerini, M.},
  title        = {Real-Time Tele-Mentored Low Cost “Point-of-Care US” in the Hands of Paediatricians in the Emergency Department: Diagnostic Accuracy Compared to Expert Radiologists},
  journal      = {PLoS ONE},
  number       = {10},
  volume       = {11},
  pages        = {1-14},
  month        = {october},
  year         = {2016},
  publisher    = {Public Library of Science},
  key          = {real-time telemedicine, ultrasonography, emergency},
  keywords     = {real-time telemedicine, ultrasonography, emergency},
  doi          = {10.1371/journal.pone.0164539},
  url          = {https://publications.crs4.it/pubdocs/2016/ZNNGTCFNGGCBL16},
}