Sable C, Roca T, Gold J, Gutierrez A, Gulotta E, Culpepper W
Children's National Medical Center, Washington, DC, USA.
Telemed J. 1999 Winter;5(4):339-47. doi: 10.1089/107830299311907.
Echocardiography is an important tool in the diagnosis and management of critically ill neonates. The authors hypothesized that live telemedicine guidance and interpretation of neonatal echocardiograms from underserved areas would improve management, prevent unnecessary transports, enhance sonographer proficiency, and result in monetary savings.
Using personal computers capable of real-time transmission of echocardiograms over three integrated services digital network (ISDN) telephone lines, pediatric cardiologists interpreted echocardiograms, suggested views to sonographers, and made recommendations to neonatologists 200 miles away. Analyses of accuracy, management, echocardiogram quality, time, and costs were carried out prospectively.
Sixty studies were transmitted over 7 months. Indications for echocardiography were suspected congenital heart disease (n = 29), suspected patent ductus arteriosus (PDA) (n = 27), and hemodynamic instability (n = 4). Diagnoses were critical congenital heart disease (n = 4), noncritical heart disease (n = 8), PDA (n = 21), ventricular dysfunction (n = 5), persistent pulmonary hypertension (n = 3), and normal (n = 19). Videotape review confirmed all telemedicine interpretations. The echocardiogram led to immediate change in management in 25 cases (42%), and echocardiogram quality was improved in 53 studies (88%). Time from request to completion of echocardiography was 43+/-30 min. Monetary savings from five avoided transports exceeded all expenses.
Live transmission of neonatal echocardiograms over three ISDN lines is diagnostic, improves patient care and echocardiography quality, and is cost effective.
超声心动图是危重新生儿诊断和管理的重要工具。作者推测，通过远程医疗对来自医疗服务不足地区的新生儿超声心动图进行实时指导和解读，将改善管理、避免不必要的转运、提高超声检查人员的熟练度并节省费用。
使用能够通过三条综合业务数字网（ISDN）电话线实时传输超声心动图的个人电脑，儿科心脏病专家对超声心动图进行解读，向超声检查人员建议检查视图，并向200英里外的新生儿科医生提出建议。前瞻性地进行了准确性、管理、超声心动图质量、时间和成本分析。
在7个月内传输了60份研究资料。超声心动图检查的指征包括疑似先天性心脏病（n = 29）、疑似动脉导管未闭（PDA）（n = 27）和血流动力学不稳定（n = 4）。诊断结果为严重先天性心脏病（n = 4）、非严重心脏病（n = 8）、PDA（n = 21）、心室功能障碍（n = 5）、持续性肺动脉高压（n = 3）和正常（n = 19）。录像回顾证实了所有远程医疗解读。超声心动图导致25例（42%）的管理立即改变，53份研究资料（88%）的超声心动图质量得到改善。从申请到完成超声心动图检查的时间为43±30分钟。避免的五次转运节省的费用超过了所有开支。
通过三条ISDN线路实时传输新生儿超声心动图具有诊断价值，可改善患者护理和超声心动图质量，且具有成本效益。
