Remote just-in-time telementored trauma ultrasound: a double-factorial randomized controlled trial examining fluid detection and remote knobology control through an ultrasound graphic user interface display

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• 作者：Andrew W. Kirkpatrick ; M.D. ; F.R.C.S.C.^a ; ^b ; ^c ; ^d ; ^{andyyykirk@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; ^{andrew.kirkpatrick@albertahealthservices.ca" class="auth_mail" title="E-mail the corresponding author} ; Ian McKee^e ; Jessica L. McKee ; M.A. ; M.Sc.^f ; Irene Ma ; M.D. ; Ph.D. ; F.R.C.P.C.^g ; Paul B. McBeth ; M.D. ; M.A.Sc. ; F.R.C.S.C.^a ; ^b ; ^c ; Derek J. Roberts ; M.D. ; Ph.D.^b ; ^h ; Charles L. Wurster ; M.D.ⁱ ; Robbie Parfitt^j ; Chad G. Ball ; M.D. ; F.R.C.S.C.^a ; ^b ; Scott Oberg ; C.S.E.^k ; William Sevcik ; B.Ed. ; M.D. ; F.R.C.P.^e ; Douglas R. Hamilton ; M.D. ; Ph.D. ; FRCSC^g
• 关键词：Resuscitation ; Ultrasound ; Telemedicine ; Remote education ; Telesonography
• 刊名：The American Journal of Surgery
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：211
• 期：5
• 页码：894-902.e1
• 全文大小：605 K

文摘

Remote-telementored ultrasound involves novice examiners being remotely guided by experts using informatic-technologies. However, requiring a novice to perform ultrasound is a cognitively demanding task exacerbated by unfamiliarity with ultrasound-machine controls. We incorporated a randomized evaluation of using remote control of the ultrasound functionality (knobology) within a study in which the images generated by distant naive examiners were viewed on an ultrasound graphic user interface (GUI) display viewed on laptop computers by mentors in different cities.

Methods

Fire-fighters in Edmonton (101) were remotely mentored from Calgary (n = 65), Nanaimo (n = 19), and Memphis (n = 17) to examine an ultrasound phantom randomized to contain free fluid or not. Remote mentors (2 surgeons, 1 internist, and 1 ED physician) were randomly assigned to use GUI knobology control during mentoring (GUIK+/GUIK−).

Results

Remote-telementored ultrasound was feasible in all cases. Overall accuracy for fluid detection was 97% (confidence interval = 91 to 99%) with 3 false negatives (FNs). Positive/negative likelihood ratios were infinity/0.0625. One FN occurred with the GUIK+ and 2 without (GUIK−). There were no statistical test performance differences in either group (GUIK+ and GUIK−).

Conclusions

Ultrasound-naive 1st responders can be remotely mentored with high accuracy, although providing basic remote control of the knobology did not affect outcomes.