title: Clinical application of real-time tele-ultrasonography in diagnosing pediatric acute appendicitis in the ED.
abstract: OBJECTIVE
  We investigated the effectiveness of tele-mentored ultrasonography between emergency medicine (EM) residents and remote experts in diagnosing acute appendicitis.
  
  
  METHODS
  This prospective observational study was performed in an academic emergency department. Beginning in June 2014, the EM residents performed the initial ultrasonography for suspected pediatric acute appendicitis; then, the remote experts observed/mentored the residents' practice using the tele-ultrasonography system; and finally, an onsite expert verified the diagnosis. The diagnostic confidence of each examiner (resident, remote expert, and onsite expert) was rated on a 5-point Likert scale. The appendix identification rate and the diagnostic values; sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each type of examination were calculated.
  
  
  RESULTS
  A total of 115 pediatric cases with suspected acute appendicitis, including 36 with pathology-confirmed acute appendicitis, between June 2014 and February 2015 were enrolled in this study. In 9 of the 115 (7.8%) cases, a non-appendicitis diagnosis was determined in the absence of the successful identification of a normal appendix upon resident examination. Of these, seven appendices were identified upon expert tele-ultrasonography. The diagnostic values for expert tele-ultrasonography were higher (sensitivity: 1.000, specificity: 0.975, PPV: 0.947, NPV: 1.000) than those for resident-performed ultrasonography (sensitivity: 0.917, specificity: 0.899, PPV: 0.805, NPV: 0.959) and similar to those for onsite expert-performed ultrasonography (sensitivity: 1.000, specificity: 0.987, PPV: 0.973, NPV: 1.000).
  
  
  CONCLUSIONS
  Tele-ultrasonography with tele-mentoring between EM residents and experienced mentors was effectively applied in diagnosing pediatric acute appendicitis in an emergency clinical setting.
authors: Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Republic of Korea.
authors: Changsun
authors: C
authors: Kim
authors: Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Republic of Korea. Electronic address: olivertw@hanyang.ac.kr.
authors: Bo Seung
authors: BS
authors: Kang
authors: Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Republic of Korea.
authors: Hyuk Joong
authors: HJ
authors: Choi
authors: Department of Emergency Medicine, Seoul Hospital, Hanyang University College of Medicine, Republic of Korea.
authors: Tae Ho
authors: TH
authors: Lim
authors: Department of Emergency Medicine, Seoul Hospital, Hanyang University College of Medicine, Republic of Korea.
authors: Jaehoon
authors: J
authors: Oh
authors: School of Electrical Engineering, Ulsan University, Republic of Korea.
authors: Youngjoon
authors: Y
authors: Chee
mesh_terms: D000208:Acute Disease; D001064:Appendicitis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D002648:Child; D002983:Clinical Competence; D003199:Computer Systems; D003937:Diagnosis, Differential; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods; D008297:Male; D008611:Mentors; D011446:Prospective Studies; D019114:Remote Consultation / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D056910:Republic of Korea; D000068997:Smartphone; D014463:Ultrasonography