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Fetal diagnosis of congenital heart disease by telemedicine
  1. Brian A McCrossan1,
  2. Andrew J Sands1,
  3. Theresa Kileen2,
  4. Chris R Cardwell3,
  5. Frank A Casey1
  1. 1Department of Paediatric Cardiology, Royal Belfast Hospital for Sick Children, Belfast, UK
  2. 2Department of Radiology, Altnagelvin Area Hospital, Derry, UK
  3. 3Centre for Public Health, The Queen's University of Belfast, Belfast, UK
  1. Correspondence to Dr Brian A McCrossan, Department of Paediatric Cardiology, Royal Belfast Hospital for Sick Children, Falls Road, Belfast BT 12 6BE, UK; brianmccrossan{at}doctors.org.uk

Abstract

Objectives This study aimed to evaluate the feasibility, accuracy and user acceptability of performing remote fetal echocardiograms (FEs).

Setting A regional fetal cardiology unit and a district general hospital (DGH).

Design A prospective study over 20 months. An initial FE was performed by a radiographer in the DGH (D1) followed by a second FE transmitted to the regional centre, in real time, via a telemedicine link with live guidance by a fetal cardiologist (D2). A FE was performed later at the regional centre (D3, reference standard). Structured questionnaires were employed to evaluate the technical quality of each tele-link and the radiographers' confidence at performing FE.

Results 69 remote FEs were performed and showed 58 normal hearts and 11 with congenital heart disease (CHD). D2 was accurate in 97% of cases compared with D3 (κ score=0.89) indicating excellent agreement. All tele-links connected at first attempt with a mean study time = 13.9 min. Overall tele-link quality was rated highly (median=4/5). In 94% of tele-links, at least 11/12 components of the FE were confidently assessed. The mean composite radiographer's questionnaire score increased significantly during the study period (p<0.05).

Conclusions To date this is the largest study of its kind. CHD can be confidently diagnosed and excluded by remote FE. Radiographers report increased confidence and proficiency following involvement in real-time telemedicine. This application of telemedicine could improve access to fetal cardiology and support radiographers screening for CHD.

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Footnotes

  • Competing interests None.

  • Funding Research was provided by the Royal Belfast Hospital for Sick Children.

  • Ethics approval This study was conducted with the approval of the COREC – Peterborough committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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