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: 3.12). 05/2011; 96(6):F394-7. DOI: 10.1136/adc.2010.197202
Source: PubMed


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.

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Available from: Brian A Mccrossan, Jun 02, 2015

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