Fetal diagnosis of congenital heart disease by telemedicine.

Department of Paediatric Cardiology, Royal Belfast Hospital for Sick Children, Falls Road, Belfast BT 12 6BE, UK.
Archives of Disease in Childhood - Fetal and Neonatal Edition (Impact Factor: 3.86). 05/2011; 96(6):F394-7. DOI: 10.1136/adc.2010.197202
Source: PubMed

ABSTRACT This study aimed to evaluate the feasibility, accuracy and user acceptability of performing remote fetal echocardiograms (FEs).
A regional fetal cardiology unit and a district general hospital (DGH).
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.
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).
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.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The use of telemedicine has grown across several medical fields, due to the increasing number of "e-patients". This narrative review gives an overview of the growing use of telemedicine in different medical specialties, showing how its use can improve medical care. A PubMed/Medline, Embase, Web of Science, and Scopus search was performed using the following keywords: telemedicine, teleconsultation, telehealth, e-health, and e-medicine. Selected papers from 1996 to 2014 were chosen on the basis of their content (quality and novelty). Telemedicine has already been applied to different areas of medical practice, and it is as effective as face-to-face medical care, at least for the diagnosis and treatment of some pathological conditions. Telemedicine is time- and cost-effective for both patients and health care professionals, encouraging its use on a larger scale. Telemedicine provides specialist medical care to patients who have poor access to hospitals, and ensures continuity of care and optimal use of available health resources. The use of telemedicine opens new perspectives for patients seeking a medical second opinion for their pathology, since they can have remote access to medical resources that would otherwise require enormous costs and time.
    Patient Preference and Adherence 01/2015; 9:65-75. · 1.49 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Congenital heart defects (CHDs) affect approximately three to eight out of 1000 live births and are a leading cause of fetal and postnatal mortality. Over the past 30 years, fetal echocardiography has emerged as an accurate tool to diagnose CHDs, and high-experience groups dealing with high-risk patients currently report detection rates of approximately 80–90% for major defects. However, the performance of obstetric ultrasound applied to the general obstetric population is still discouraging, with detection rates of 30–40% of major CHDs. Therefore, it is necessary to improve the results of obstetric ultrasound screening for CHDs. In this article, the authors describe current and future strategies that may be helpful, such as the uniform application of published guidelines for performing the so-called basic and extended-basic cardiac scan through comprehensive training, the implementation of new indications for performing fetal echocardiography and the use of new technologies such as 3D–4D scanning or telemedicine–internet remote consultation.
    Expert Review of Obstetrics &amp Gynecology 01/2014; 7(6).
  • [Show abstract] [Hide abstract]
    ABSTRACT: We verified the feasibility of telediagnosis of fetal disease by (i) grading telediagnosis by a pediatric cardiologist into five confidence levels; and (ii) comparison of fetal telediagnosis with hands-on fetal diagnosis or postnatal diagnosis. In 114 patients suspected of having heart disease (real time, n = 15; recorded image transmission, n = 99), 79 patients were in level 5 (excellent), 17 in level 4 (good), eight in level 3 (fair), 10 in level 2 (poor), and no patients in level 1 (bad). The average was 4.5, and in 96 patients (84% of all) telediagnosis was accurate (above 4), whereas in 18 patients it was inaccurate (level 2 or 3). In re-examination of 25 patients, telediagnosis was confirmed in patients in level 4 and 5, whereas heart disease was missed in patients in levels 2 or 3. The correct diagnosis matched the high confidence level of a specialist based on recognizable transmitted images.
    Pediatrics International 04/2014; 56(2). · 0.73 Impact Factor