Makkar Abhishek, Milsten Jennifer, McCoy Mike, Szyld Edgardo G, Lapadula Maria C, Ganguly Abhrajit, DeShea Lise A, Ponniah Umakumaran
Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA.
Telemed J E Health. 2021 Oct;27(10):1136-1142. doi: 10.1089/tmj.2020.0440. Epub 2021 Jan 15.
Introduction:The nationwide shortage of pediatric cardiologists in medically underserved areas poses a challenge to congenital heart disease (CHD) screening requiring echocardiography, resulting in transfer of neonates to regional Level III/IV Neonatal Intensive Care Units (NICUs). This study aimed to evaluate the accuracy, safety, and cost-effectiveness of tele-echocardiography for advanced CHD screening at a Level II NICU managed by a hybrid telemedicine system.
Methods:Retrospective chart review of infants requiring tele-echocardiography at a Level II NICU. Patient demographics, echocardiography indications, and findings were analyzed. Agreement between tele-echocardiography and conventional echocardiography findings was assessed. Transport cost savings were calculated based on preventable transfers to Level IV NICU. Descriptive statistics were computed for demographic and clinical variables.
Results:Over 5 years, 52 infants were screened for CHD. Thirty-two infants (62%) had findings consistent with minor CHD or normal neonatal transitional physiology. Twenty infants (38%) had abnormal findings requiring follow-up with either a conventional echocardiography as inpatient at the regional Level IV NICU or as outpatient after discharge. Only 5 infants (10%) required transfer to a Level IV NICU for CHD management, whereas 15 infants (29%) were scheduled for outpatient follow-up. Strong agreement was noted between tele-echocardiography and conventional echocardiography findings. No case of critical congenital heart disease (CCHD) was missed. Tele-echocardiography saved $260,000 in transport costs.
Conclusions:Tele-echocardiography can be accurate, safe, and effective in CHD screening, preventing unnecessary transfer of most infants to regional Level III/IV NICUs, saving transfer costs.
医疗服务不足地区全国范围内儿科心脏病专家短缺，这对需要超声心动图检查的先天性心脏病（CHD）筛查构成挑战，导致新生儿被转至地区三级/四级新生儿重症监护病房（NICU）。本研究旨在评估由混合远程医疗系统管理的二级NICU中远程超声心动图用于晚期CHD筛查的准确性、安全性和成本效益。
对在二级NICU需要进行远程超声心动图检查的婴儿进行回顾性病历审查。分析患者人口统计学、超声心动图检查指征及结果。评估远程超声心动图与传统超声心动图检查结果之间的一致性。基于可避免转至四级NICU计算转运成本节省情况。计算人口统计学和临床变量的描述性统计数据。
在5年多时间里，对52例婴儿进行了CHD筛查。32例婴儿（62%）的检查结果与轻度CHD或正常新生儿过渡生理状态相符。20例婴儿（38%）有异常检查结果，需要在地区四级NICU住院进行传统超声心动图检查或出院后门诊随访。仅5例婴儿（10%）因CHD管理需要转至四级NICU，而15例婴儿（29%）安排了门诊随访。远程超声心动图与传统超声心动图检查结果之间一致性良好。未漏诊任何一例危重先天性心脏病（CCHD）。远程超声心动图节省了26万美元的转运成本。
远程超声心动图在CHD筛查中可以准确、安全且有效，可防止大多数婴儿不必要地转至地区三级/四级NICU，节省转运成本。
