Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, CA.
Department of Medicine, Stanford University Medical Center, Palo Alto, CA.
J Pediatr. 2021 May;232:140-146. doi: 10.1016/j.jpeds.2021.01.004. Epub 2021 Jan 13.
To test feasibility of tele-clinic visits using parentally acquired vital signs and focused echocardiographic images in patients with Marfan syndrome.
We included patients with Marfan syndrome aged 5-19 years followed in our clinic. We excluded patients with Marfan syndrome and history of previous aortic root (AoR) surgery, cardiomyopathy, arrhythmia, or AoR ≥4.5 cm. We trained parents in-person to acquire focused echocardiographic images on their children using a hand-held device as well as how to use a stadiometer, scale, blood pressure (BP) machine, and a digital stethoscope. Before tele-clinic visits, parents obtained the echocardiographic images and vital signs. We compared tele-clinic and on-site clinic visit data. Parental and clinic echocardiograms were independently analyzed.
Fifteen patient/parent pairs completed tele-clinic visits, conducted at a median of 7.0 (IQR 3.0-9.9) months from the in-person training session. Parents took a median of 70 (IQR 60-150) minutes to obtain the height, weight, heart rate, BP, cardiac sounds, and echocardiographic images before tele-clinic visits. Systolic BP was greater on-site than at home (median +13 mm Hg, P = .014). Height, weight, diastolic BP, heart rate, and AoR measurements were similar.
This study provides information for implementing tele-clinic visits using parentally acquired vital signs and echocardiographic images in patients with Marfan syndrome. The results show that tele-clinic visits are feasible and that parents were able to obtain focused echocardiographic images on their children.
ClinicalTrials.gov: NCT03581682.
测试通过父母获取的生命体征和心脏超声图像进行远程就诊在马凡综合征患者中的可行性。
我们纳入了在我们诊所就诊的年龄在 5-19 岁的马凡综合征患者。我们排除了有马凡综合征病史且既往行主动脉根部（AoR）手术、心肌病、心律失常或 AoR≥4.5cm 的患者。我们对父母进行了面对面培训，教他们如何使用手持设备为孩子获取心脏超声图像，以及如何使用测高仪、秤、血压（BP）机和数字听诊器。在远程就诊前，父母获取了超声心动图图像和生命体征。我们比较了远程就诊和现场就诊的数据。父母和诊所的超声心动图由独立的分析人员进行分析。
15 对患者/父母完成了远程就诊，从面对面培训课程到远程就诊的中位时间为 7.0（IQR 3.0-9.9）个月。父母在远程就诊前中位需要 70（IQR 60-150）分钟来获取身高、体重、心率、BP、心音和超声心动图图像。收缩压在现场就诊时高于家中（中位数相差 13mmHg，P=0.014）。身高、体重、舒张压、心率和 AoR 测量值相似。
本研究为使用父母获取的生命体征和超声心动图图像在马凡综合征患者中实施远程就诊提供了信息。结果表明，远程就诊是可行的，并且父母能够为其孩子获取有针对性的超声心动图图像。
ClinicalTrials.gov：NCT03581682。
