Remote out-of-hours ultrasound live supervision in pediatrics – improvement of diagnostics and training

Abstract

Purpose Ultrasound (US) is the preferred imaging modality in pediatrics for diagnostic and therapeutic issues. The absence of radiation and the constant on-site accessibility make it the ideal tool for children. However, despite remarkable technical advances in resolution and applicability, many sophisticated medical questions still require profound expertise on the part of the examiner, thus often hampering fast decisions particularly outside regular working hours.

Materials and Methods This single-center study, at a university children’s hospital evaluated the use of US during emergency service. A four-week documentation period was followed by a subsequent eight-week supervision period with live supervision availability on demand guided by a remote US expert. The demand for expert support, diagnosis, grading of urgency, duration and success of examination, and satisfaction of both examiners were analyzed.

Results 108 patients (mean age 9.7 years) were included. In 38% of cases, US was supervised on demand with a definite diagnosis in 92.6% of cases (25/27). Image quality and technical performance were graded sufficient in 100% of cases. Supervised compared to non-supervised US examinations were prolonged (14.4 min vs. 7.1 min, p<0.001), were more prevalent within the first 24 h in the hospital (70% vs. 56.8%, p=0.06), and were classified more frequently as emergency (22.2% vs. 2.3%; p=0.015). All participants classified the availability of US supervision as decisively helpful.

Conclusion Remote live supervised pediatric US was feasible and effective. It combined timely, high-quality diagnostics even in the case of challenging medical questions with simultaneous US training.

Zusammenfassung

Hintergrund Pädiatrischer Ultraschall (US) ist die bevorzugte Bildgebung für diagnostische und therapeutische Fragen und aufgrund von Strahlenfreiheit und ständiger Verfügbarkeit vor Ort ideal. Trotz großer technischer Fortschritte bei Bildauflösung und Anwendung erfordern schwierige Fragen eine profunde Expertise, was eine zeitnahe Diagnostik, vor allem im Notdienst, oft erschwert.

Materialien und Methoden Eine unizentrische Studie an einer Universitäts-Kinderklinik bezüglich US-Untersuchungen im Notdienst wurde ausgewertet. Einer 4-wöchigen Beobachtungsphase folgte eine 8-wöchige Supervisionsphase mit Möglichkeit zur Anforderung einer Live-Supervision aus der Ferne durch einen US-Experten. Analysiert wurden der Bedarf an fachlicher Unterstützung, die Diagnose, die Dringlichkeit, die Dauer, der Erfolg sowie die Zufriedenheit der Untersucher.

Ergebnisse 108 Kinder (Ø 9,7 Jahre) wurden eingeschlossen. 38% aller US-Untersuchungen wurden auf Wunsch live supervidiert und dabei in 92,6% (25/27) der Fälle eine Diagnose gestellt. Die Bildqualität und die technische Umsetzung waren immer ausreichend. Supervidierte Untersuchungen dauerten länger (14,4 min vs. 7,1 min, p<0.001), erfolgten häufiger innerhalb 24h Klinikaufenthalt (70% vs. 56,8%, p=0.06) und wurden häufiger als Notfall eingestuft (22,2% vs. 2,3%; p=0.015). Die Supervisionsmöglichkeit wurde von allen Teilnehmern als entscheidend hilfreich eingeordnet.

Schlussfolgerung Live aus der Distanz supervidierter pädiatrischer US war effektiv, ermöglichte eine zeitnahe, qualitativ hochwertige Diagnostik auch bei schwierigen medizinischen Fragestellungen und war zeitgleich hilfreich für die US-Ausbildung.

Keywords

ultrasound - children - live stream - remote - ultrasound training

Publikationsverlauf

Eingereicht: 07. Dezember 2023

Angenommen nach Revision: 02. September 2024

Accepted Manuscript online:
25. September 2024

Artikel online veröffentlicht:
04. November 2024

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