远程医疗与检眼镜检查用于早产儿视网膜病变诊断的速度比较。
Speed of telemedicine vs ophthalmoscopy for retinopathy of prematurity diagnosis.
作者信息
Richter Grace M, Sun Grace, Lee Thomas C, Chan R V Paul, Flynn John T, Starren Justin, Chiang Michael F
机构信息
Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
出版信息
Am J Ophthalmol. 2009 Jul;148(1):136-42.e2. doi: 10.1016/j.ajo.2009.02.002. Epub 2009 Apr 18.
PURPOSE
To compare the speed of retinopathy of prematurity (ROP) diagnosis using standard indirect ophthalmoscopy with that of telemedicine.
DESIGN
Prospective, comparative study.
METHODS
Three study examiners (2 pediatric retinal specialists [R.V.P.C., T.C.L.] and 1 pediatric ophthalmologist [M.F.C.]) conducted ROP diagnosis via standard indirect ophthalmoscopy and telemedicine. Each examiner performed: 1) standard ophthalmoscopy on 72 to 150 consecutive infants at his respective institution and 2) telemedical diagnosis on 125 consecutive deidentified retinal image sets from infants from an at-risk population. Time for ophthalmoscopic diagnosis was measured in 2 ways: 1) time spent by the examiner at the infant's bedside and 2) mean total time commitment per infant. Time for telemedicine diagnosis was recorded by computer time stamps in the web-based system. For each examiner, nonparametric statistical analysis (Mann-Whitney U test) was used to compare the distribution of times for examination by ophthalmoscopy vs telemedicine.
RESULTS
Mean (+/- standard deviation [SD]) times for ophthalmoscopic diagnosis ranged from 4.17 (+/- 1.34) minutes to 6.63 (+/- 2.28) minutes per infant. Mean (+/- SD) times for telemedicine diagnosis ranged from 1.02 (+/- 0.27) minutes to 1.75 (+/- 0.80) minutes per infant. Telemedicine was significantly faster than ophthalmoscopy (P < .0001). The total time commitment by ophthalmologists performing bedside ophthalmoscopy for ROP diagnosis, including travel and communication with families and hospital staff, was 10.08 (+/- 2.53) minutes to 14.42 (+/- 2.64) minutes per infant.
CONCLUSIONS
The ophthalmologist time requirement for telemedical ROP diagnosis is significantly less than that for ophthalmoscopic diagnosis. Additional time requirements associated with bedside ROP diagnosis increased this disparity. Telemedicine has potential to alleviate the time commitment for ophthalmologists who manage ROP.
目的
比较使用标准间接检眼镜进行早产儿视网膜病变（ROP）诊断的速度与远程医疗诊断的速度。
设计
前瞻性比较研究。
方法
三名研究检查人员（2名小儿视网膜专家[R.V.P.C., T.C.L.]和1名小儿眼科医生[M.F.C.]）通过标准间接检眼镜和远程医疗进行ROP诊断。每位检查人员进行：1）在其各自机构对72至150名连续婴儿进行标准检眼镜检查，以及2）对来自高危人群婴儿的125组连续匿名视网膜图像集进行远程医疗诊断。检眼镜诊断时间通过两种方式测量：1）检查人员在婴儿床边花费的时间，以及2）每名婴儿的平均总时间投入。远程医疗诊断时间由基于网络的系统中的计算机时间戳记录。对于每位检查人员，使用非参数统计分析（曼-惠特尼U检验）比较检眼镜检查与远程医疗检查时间的分布。
结果
每名婴儿检眼镜诊断的平均（±标准差[SD]）时间为4.17（±1.34）分钟至6.63（±2.28）分钟。每名婴儿远程医疗诊断的平均（±SD）时间为1.02（±0.27）分钟至1.75（±0.80）分钟。远程医疗明显比检眼镜检查快（P <.0001）。眼科医生进行床边ROP诊断的总时间投入，包括前往医院、与家属和医院工作人员沟通，每名婴儿为10.08（±2.53）分钟至14.42（±2.64）分钟。
结论
远程医疗ROP诊断对眼科医生的时间要求明显低于检眼镜诊断。与床边ROP诊断相关的额外时间要求增加了这种差距。远程医疗有潜力减轻管理ROP的眼科医生的时间投入。
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