Emergency echocardiography telemedicine

An efficient method to provide 24-hour consultative echocardiography

James A. Trippi, Kamthorn S. Lee, Greg Kopp, David Nelson, Richard Kovacs

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

Objectives. This study sought to assess the clinical utility of interpreting emergency echocardiograms after regular working hours through a telemedicine connection to on-call cardiologists. Background. Physician interpretation of emergency echocardiograms is often delayed during weekends, evenings or night hours. This delay places undue responsibility on less qualified personnel to interpret echocardiograms of vital importance. Methods. Digital quad-screen cine-loop format was transmitted over standard telephone lines. Clinical data and conventional and telemedicine interpretations were collected prospectively for 187 emergent or semiemergent tele-echocardiograms after regular working hours. Results. Indications for the echocardiogram included assessment of left ventricular function, ischemia, pericardial effusion, valvular disease, heart donor status and arrhythmia. Three off-site echocardiographers received the standard echocardiogram and spectral, gray-scale and color flow Doppler images in cine-loop format using a laptop computer. Laptop interpretation showed 19 technically limited studies, 153 abnormal studies and 54% with wall motion abnormalities. Overall mean agreement rate between telemedicine laptop interpretation and conventional workstation interpretation performed in blinded manner for serious disorders with classic echocardiographic findings (pulmonary hypertension, left ventricular thrombus, aortic dissection, severe valvular insufficiency and large pericardial effusion) was 99.0% (95% confidence interval [CI] 96% to 99%). For serious wall motion abnormalities, the agreement rate was 96.3% (95% CI 92% to 99%). The following mean times elapsed after completion of the echocardiogram: to laptop fax report, 2.14 h (range 10 min to 8 h); to dictation of videotape, 11.74 h (p < 0.001); to transcription of videotape dictation, 56.6 h (p < 0.0001). Conclusions. After-hours emergency echocardiography telemedicine using a laptop computer is more rapid than scheduled conventional interpretation from a videotape workstation, yet diagnostic accuracy is comparable.

Original languageEnglish
Pages (from-to)1748-1752
Number of pages5
JournalJournal of the American College of Cardiology
Volume27
Issue number7
DOIs
StatePublished - Jun 1996

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Telemedicine
Videotape Recording
Echocardiography
Emergencies
Pericardial Effusion
Telefacsimile
Confidence Intervals
Heart Valve Diseases
Left Ventricular Function
Pulmonary Hypertension
Telephone
Dissection
Cardiac Arrhythmias
Thrombosis
Ischemia
Color
Tissue Donors
Physicians

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Emergency echocardiography telemedicine : An efficient method to provide 24-hour consultative echocardiography. / Trippi, James A.; Lee, Kamthorn S.; Kopp, Greg; Nelson, David; Kovacs, Richard.

In: Journal of the American College of Cardiology, Vol. 27, No. 7, 06.1996, p. 1748-1752.

Research output: Contribution to journalArticle

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abstract = "Objectives. This study sought to assess the clinical utility of interpreting emergency echocardiograms after regular working hours through a telemedicine connection to on-call cardiologists. Background. Physician interpretation of emergency echocardiograms is often delayed during weekends, evenings or night hours. This delay places undue responsibility on less qualified personnel to interpret echocardiograms of vital importance. Methods. Digital quad-screen cine-loop format was transmitted over standard telephone lines. Clinical data and conventional and telemedicine interpretations were collected prospectively for 187 emergent or semiemergent tele-echocardiograms after regular working hours. Results. Indications for the echocardiogram included assessment of left ventricular function, ischemia, pericardial effusion, valvular disease, heart donor status and arrhythmia. Three off-site echocardiographers received the standard echocardiogram and spectral, gray-scale and color flow Doppler images in cine-loop format using a laptop computer. Laptop interpretation showed 19 technically limited studies, 153 abnormal studies and 54{\%} with wall motion abnormalities. Overall mean agreement rate between telemedicine laptop interpretation and conventional workstation interpretation performed in blinded manner for serious disorders with classic echocardiographic findings (pulmonary hypertension, left ventricular thrombus, aortic dissection, severe valvular insufficiency and large pericardial effusion) was 99.0{\%} (95{\%} confidence interval [CI] 96{\%} to 99{\%}). For serious wall motion abnormalities, the agreement rate was 96.3{\%} (95{\%} CI 92{\%} to 99{\%}). The following mean times elapsed after completion of the echocardiogram: to laptop fax report, 2.14 h (range 10 min to 8 h); to dictation of videotape, 11.74 h (p < 0.001); to transcription of videotape dictation, 56.6 h (p < 0.0001). Conclusions. After-hours emergency echocardiography telemedicine using a laptop computer is more rapid than scheduled conventional interpretation from a videotape workstation, yet diagnostic accuracy is comparable.",
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