Fetal diagnosis of congenital heart disease by telemedicine. Issue 6 (17th May 2011)

• Record Type: Journal Article
• Authors: McCrossan, Brian A; Sands, Andrew J; Kileen, Theresa; Cardwell, Chris R; Casey, Frank A
• Is Part Of: Archives of disease in childhood. Volume 96:Issue 6(2011)
• Page Start: F394
• Page End: F397
• Publication Date: 2011-05-17
• Subjects: Infants -- Diseases -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.920105
• DOI: 10.1136/adc.2010.197202
• Languages: English
• ISSNs: 1359-2998

Abstract

Abstract : Objectives: This study aimed to evaluate the feasibility, accuracy and user acceptability of performing remote fetal echocardiograms (FEs). Setting: A regional fetal cardiology unit and a district general hospital (DGH). Design: A prospective study over 20 months. An initial FE was performed by a radiographer in the DGH (D1) followed by a second FE transmitted to the regional centre, in real time, via a telemedicine link with live guidance by a fetal cardiologist (D2). A FE was performed later at the regional centre (D3, reference standard). Structured questionnaires were employed to evaluate the technical quality of each tele-link and the radiographers' confidence at performing FE. Results: 69 remote FEs were performed and showed 58 normal hearts and 11 with congenital heart disease (CHD). D2 was accurate in 97% of cases compared with D3 (κ score=0.89) indicating excellent agreement. All tele-links connected at first attempt with a mean study time = 13.9 min. Overall tele-link quality was rated highly (median=4/5). In 94% of tele-links, at least 11/12 components of the FE were confidently assessed. The mean composite radiographer's questionnaire score increased significantly during the study period (p<0.05). Conclusions: To date this is the largest study of its kind. CHD can be confidently diagnosed and excluded by remote FE. Radiographers report increased confidence and proficiency following involvement in real-time telemedicine. This application of telemedicine could improve access to fetal cardiology and support radiographers screening for CHD.