Echocardiography Learning by Pediatricians While Screening Congenital Heart Disease with the Aid of Telemedicine

Abstract

Background: Congenital heart disease (CHD) affects 1% of all newborns and is a major public health problem. Most children with CHD benefit from early diagnosis to optimize management. However, in many places there are no specialized professionals to do so. Introduction: A screening method for CHD was developed between two states in Northeast Brazil. It was based upon the performance of an echocardiogram by local pediatricians with support of pediatric cardiologists through telemedicine. Objective: To determine if the continuous performance of examinations together with online supervision increased the level of understanding of the pediatricians about the echocardiograms. Methods: Pediatricians received online support to perform echocardiograms for 7 years (2012-2018). Although the project aimed to teach them to acquire images and send to the cardiologists for analysis and interpretation, they were encouraged to describe their own diagnostic impressions. The level of agreement between pediatricians and cardiologists was calculated. Results: A large number (n = 3,951) echocardiograms was analyzed. From them, 2,818 were classified as abnormal, inconclusive, or normal by both the pediatricians and the cardiologists. The 7-year analysis demonstrated an overall agreement of 63.7%. As for the final diagnosis, it was possible to compare 1,457 echocardiograms. The combined analysis of the 7 years demonstrated agreement in 62.2%. Discussion: The screening of CHD under online support led to more in-depth learning of echocardiography by the pediatricians. This approach potentialized the accuracy of the screening through the years. Conclusion: By enrolling in a telemedicine-based screening program, the pediatricians' degree of understanding of echocardiography increased considerably.

Real-Time Remote-Mentored Echocardiography in Management of Newborns with Critical Congenital Heart Defects

“…In previous studies, pediatricians [3][4][5], neonatologists [6], and adult sonographers [7,9,12,14] with training in the imaging of infants performed the echocardiograms. The significance of echocardiographic or sonographic experience in remote-mentored neonatal echocardiography has not been previously evaluated.…”

“…To meet this challenge, remote-mentored echocardiography could be a possible solution. Previous studies have demonstrated an accuracy of around 50%-60% of pediatrician-performed echocardiography, compared to standard pediatric cardiologist echocardiography in larger centers, including both false positive and negative diagnoses of CCHD [3][4][5][6]. Remote-mentored echocardiography is reported to increase diagnostic accuracy to above 90%, only missing minor CHD, typically clinically insignificant ventricular septal defects, or mild pulmonary valvular stenosis.…”

“…Remote-mentored echocardiography is reported to increase diagnostic accuracy to above 90%, only missing minor CHD, typically clinically insignificant ventricular septal defects, or mild pulmonary valvular stenosis. Previous publications all report an excellent ability to identify CCHD by remote mentoring [3][4][5][6][7]. Newborns need transportation for echocardiography to obtain a diagnosis in centers without remote consultation services or in-house pediatric cardiologists.…”

“…Several publications report a significant reduction in unnecessary transport with the use of remote mentoring, which is beneficial for the sick newborn and cost-saving for the healthcare system [3][4][5]8]. Previous remote-mentoring publications include neonatologists, pediatricians or sonographers of adult cardiology to perform echocardiography [3][4][5][6][7][8][9][10][11][12]. These mentees either received preparative training in imaging CHD or a significant training volume during the data collection.…”

Training basic echocardiography to pediatric residents: need of the hour

“…16 There have been efforts to assist pediatricians in performing echocardiography by telemedicine also. 17,18 For Paediatric residents, the first year of the Junior residency program seems the right time to make them learn skills of basic echocardiography. After this training and practice of this skill subsequently over the rest of the 3-year Junior residency program, they are expected to easily identify the pediatric cardiac problems, at the end of their tenure.…”