Remote telemedical interpretation of neonatal echocardiograms: impact on clinical management in a primary care setting.
OBJECTIVE
The purpose of this study was to evaluate the utility of telemedical echocardiographically assisted neonatal cardiovascular evaluation in a primary care setting.


BACKGROUND
Neonates with congenital heart disease are frequently born far from pediatric subspecialty centers and can be clinically unstable at presentation. Recent advances in telecommunication technology have made it possible to transmit echocardiographic images over long distances. This technology may be beneficial to newborns with heart defects who are born in primary care centers.


METHODS
A retrospective review of all telemedical echocardiograms obtained from neonates (aged 1 day to 30 days) was performed. A telemedical link was created using a T-1 transmission line and a standard voice telephone line between the Mayo Clinic, Rochester, Minnesota (pediatric cardiology site), and the Altru Clinic, Grand Forks, North Dakota (primary care site), which is a general pediatric practice 400 miles from Rochester. Neonates with possible cardiac disorders were identified by the general pediatricians, who then requested telemedical echocardiography.


RESULTS
The 133 neonates had 161 T-1 echocardiograms. Median patient age was two days (range, one day to 29 days). One hundred thirty-two of 133 initial echocardiograms (99%) were obtained because of urgent indications. Transmitted images provided adequate diagnostic information in all patients. Seventy-nine neonates (59%) had a change in medical management or required cardiology follow-up. An immediate change in management occurred in 32 patients (24%), including seven in whom emergency transfer was either arranged or avoided.


CONCLUSIONS
Telemedical echocardiography provides accurate diagnostic data in neonates. Rapid telediagnosis facilitates appropriate care of sick neonates with possible congenital heart disease in the primary care setting. Unnecessary long-distance transfers can be avoided with this technology.
Randolph
G R
GR
Section of Pediatric Cardiology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA.
Hagler
D J
DJ
Khandheria
B K
BK
Lunn
E R
ER
Cook
W J
WJ
Seward
J B
JB
O'Leary
P W
PW
D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006770:Hospitals, Group Practice; D006801:Humans; D007231:Infant, Newborn; D008910:Minnesota; D009658:North Dakota; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer; D010372:Pediatrics / Q000379:methods / Q000592:standards; D011320:Primary Health Care; D019114:Remote Consultation; D012189:Retrospective Studies; D019035:Rural Health Services; D019112:Teleradiology; D014463:Ultrasonography