title: A retrospective analysis of a pediatric tele-echocardiography service to treat, triage, and reduce trans-Pacific transport.
abstract: Introduction Tele-echocardiography can ensure prompt diagnosis and prevent the unnecessary transport of infants without critical congenital heart disease, particularly at isolated locations lacking access to tertiary care medical centers. Methods We retrospectively reviewed all infants who underwent tele-echocardiography at a remote 16-bed level IIIB NICU from June 2005 to March 2014. Tele-echocardiograms were completed by cardiac sonographers in Okinawa, Japan, and transmitted asynchronously for review by pediatric cardiologists in Hawaii. Results During the study period 100 infants received 192 tele-echocardiograms: 46% of infants had tele-echocardiograms completed for suspected patent ductus arteriosus, 28% for suspected congenital heart disease, 12% for possible congenital heart disease in the setting of likely pulmonary hypertension, and 10% for possible congenital heart disease in the setting of other congenital anomalies. Of these, 17 patients were aeromedically evacuated for cardiac reasons; 12 patients were transported to Hawaii, while five patients with complex heart disease were transported directly to the United States mainland for interventional cardiac capabilities not available in Hawaii. Discussion This study demonstrates the use of tele-echocardiography to guide treatment, reduce long and potentially risky trans-Pacific transports, and triage transports to destination centers with the most appropriate cardiac capabilities.
authors.affiliation: 1 Walter Reed National Military Medical Center, Department of Pediatrics, Division of Neonatology, Bethesda, USA.|2 Uniformed Services University of Health Sciences, Department of Pediatrics, Bethesda, USA.|3 779th Medical Operations Squadron, Maryland, USA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Rouse
authors.affiliation: 4 University of Washington, School of Medicine, Department of Pediatrics, Division of Pediatric Critical Care Medicine, Seattle, USA.
authors.forename: Brandon T
authors.initials: BT
authors.lastname: Woods
authors.affiliation: 5 Tripler Army Medical Center, Department of Pediatrics, Hawaii, USA.
authors.forename: C Becket
authors.initials: CB
authors.lastname: Mahnke
mesh_terms: D004452:Echocardiography / Q000379:methods*; D005260:Female; D006254:Hawaii; D006330:Heart Defects, Congenital / Q000175:diagnosis; D006801:Humans; D007223:Infant; D007564:Japan; D019114:Remote Consultation / Q000379:methods*; D012189:Retrospective Studies; D019035:Rural Health Services / Q000458:organization & administration; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D014218:Triage
keywords: ECMO; Transport; congenital heart disease; tele-echocardiography; telemedicine