title: Real-Time Tele-Mentored Low Cost "Point-of-Care US" in the Hands of Paediatricians in the Emergency Department: Diagnostic Accuracy Compared to Expert Radiologists.
abstract: BACKGROUND
  The use of point-of-care ultrasonography (POC US) in paediatrics is increasing. This study investigated the diagnostic accuracy of POC US in children accessing the emergency department (ED) when performed by paediatricians under the remote guidance of radiologists (TELE POC).
  
  
  METHODS
  Children aged 0 to 18 years accessing the ED of a third level research hospital with eight possible clinical scenarios and without emergency/severity signs at the triage underwent three subsequent US tests: by a paediatrician guided remotely by a radiologist (TELE POC); by the same radiologist (UNBLIND RAD); by an independent blinded radiologist (BLIND RAD). Tele-radiology was implemented using low cost "commercial off-the-shelf" (COTS) equipment and open-source software. Data were prospectively collected on predefined templates.
  
  
  RESULTS
  Fifty-two children were enrolled, for a total of 170 ultrasound findings. Sensitivity, specificity, positive and negative predictive values of TELE POC were: 93.8, 99.7, 96.8, 99.4 when compared to UNBLIND RAD and 88.2, 99.7, 96.8, 98.7 when compared to BLIND RAD. The inter-observers agreement between the paediatricians and either the unblind or blind radiologist was excellent (k = 0.93). The mean duration of TELE POC was 6.3 minutes (95% CI 4.1 to 8.5). Technical difficulties occurred in two (3.8%) cases. Quality of the transmission was rated as fair, good, very good and excellent in 7.7%, 15.4%, 42.3% and 34.6% of cases respectively, while in no case was it rated as poor.
  
  
  CONCLUSIONS
  POC US performed by paediatricians in ED guided via tele-radiology by an expert radiologist (TELE POC) produced reliable and timely diagnoses. Findings of this study, especially for the rarer conditions under evaluation, need further confirmation. Future research should investigate the overall benefits and the cost savings of using tele-ultrasound to perform US "at children's bedsides", under remote guidance of expert radiologists.
authors.affiliation: Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Via dell'istria 65/1, Trieste, Italy.
authors.forename: Floriana
authors.initials: F
authors.lastname: Zennaro
authors.affiliation: Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Via dell'istria 65/1, Trieste, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Neri
authors.affiliation: University of Trieste, Piazzale Europa 1, Trieste Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Nappi
authors.affiliation: Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Via dell'istria 65/1, Trieste, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Grosso
authors.affiliation: CRS4, Loc. Piscina Manna, Pula, Cagliari, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Triunfo
authors.affiliation: CRS4, Loc. Piscina Manna, Pula, Cagliari, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cabras
authors.affiliation: CRS4, Loc. Piscina Manna, Pula, Cagliari, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Frexia
authors.affiliation: Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Via dell'istria 65/1, Trieste, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Norbedo
authors.affiliation: Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Via dell'istria 65/1, Trieste, Italy.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Guastalla
authors.affiliation: Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Via dell'istria 65/1, Trieste, Italy.
authors.forename: Massino
authors.initials: M
authors.lastname: Gregori
authors.affiliation: Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Via dell'istria 65/1, Trieste, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Cattaruzzi
authors.affiliation: Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Via dell'istria 65/1, Trieste, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Sanabor
authors.affiliation: Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Via dell'istria 65/1, Trieste, Italy.
authors.forename: Egidio
authors.initials: E
authors.lastname: Barbi
authors.affiliation: Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Via dell'istria 65/1, Trieste, Italy.
authors.forename: Marzia
authors.initials: M
authors.lastname: Lazzerini
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003199:Computer Systems; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019095:Point-of-Care Systems; D011364:Professional Practice / Q000706:statistics & numerical data*; D019114:Remote Consultation / Q000295:instrumentation / Q000379:methods*; D012984:Software; D014463:Ultrasonography