Author + information
- Received August 8, 1995
- Revision received December 31, 1995
- Accepted January 23, 1996
- Published online June 1, 1996.
- James A. Trippi, MD,FACCa,∗,
- Kamthorn S. Lee, MD,FACCa,
- Greg Kopp, RDCSa,
- David Nelson, MSa and
- Richard Kovacs, MD,FACCa
- ↵∗Address for correspondence: Dr. James Trippi, 3171 North Meridian Street, Indianapolis, Indiana 46208.
Objectives. This study sought to assess the clinical utility of interpreting emergency echocardiograms after regular working hours through a telemedicine connection to on-call cardiologists.
Background. Physician interpretation of emergency echocardiograms is often delayed during weekends, evenings or night hours. This delay places undue responsibility on less qualified personnel to interpret echocardiograms of vital importance.
Methods. Digital quad-screen cine-loop format was transmitted over standard telephone lines. Clinical data and conventional and telemedicine interpretations were collected prospectively for 187 emergent or kemiemergent tele-echocardiograms after regular working hours.
Results. Indications for the echocardiogram included assessment of left ventricular function, ischemia, pericardial effusion, valvular disease, heart donor status and arrhythmia. Three off-site echocardiographers received the standard echocardiogram and spectral, gray-scale and color flow Doppler images in cine-loop format using a laptop computer. Laptop interpretation showed 19 technically limited studies, 153 abnormal studies and 54% with wall motion abnormalities. Overall mean agreement rate between telemedicine laptop interpretation and conventional workstation interpretation performed in blinded manner for serious disorders with classic echocardiographic findings (pulmonary hypertension, left ventricular thrombus, aortic dissection, severe valvular insufficiency and large pericardial effusion) was 99.0% (95% confidence interval [CI] 96% to 99%). For serious wall motion abnormalities, the agreement rate was 96.3% (95% CI 92% to 99%). The following mean times elapsed after completion of the echocardiogram: to laptop fax report, 2.14 h (range 10 min to 8 h); to dictation of videotape, 11.74 h (p < 0.001); to transcription of videotape dictation, 56.6 h (p < 0.0091).
Conclusions. After-hours emergency echocardiography tele-medecine using a laptop computer is more rapid than scheduled conventional interpretation from a videotape workstation, yet diagnostic accuracy is comparable.
☆ Financial support for this study was provided by The Showalter Fund, Indianapolis. This study was presented in part at the 67th Annual Scientific Sessions of the American Heart Association, Dallas Texas, November 1994.
- Received August 8, 1995.
- Revision received December 31, 1995.
- Accepted January 23, 1996.