Objective:

Children in remote areas do not have immediate access to echo technicians and cardiologists. This can result in delay in initiation of medical intervention, unnecessary patient transport, and increased medical expenditures. Telementoring involves remote guidance of a trainee who is geographically separated from the trainer. We report a pilot study to evaluate the impact of telementoring on delivery of pediatric cardiac critical care in rural area.

Design: Prospective Study

Methodology:

Children from 1 month to 12 years of age suspected to be having cardiac problems admitted in PICU during August 2004 to July 2005 (1 year) were studied. Cardiologist from Narayana Hrudayalaya, Bangalore guided and interpreted echocardiograms from our hospital, transmitted in real-time using the ISDN (128 kbps) telephone line. Echo-technician trained in echocardiography performed the echocardiography. Analysis of accuracy, change in patient treatment and patient referral patterns were studied prospectively.

Results:

Total of 51 children with suspected cardiac problems were studied during one year period. Cardiac diagnoses included VSD (9). TOF (5), TGA (4), DORV (5), Complex CHD (3) TA (2), TAPVC (2) and ASD (2). Additional diagnoses included Scorpion Sting Myocarditis (2) Scorpion Sting Myocarditis with left ventricular thrombus (1), primary pulmonary hypertension (1). Viral myocarditis and cardiomyopathy (5) and Pericardial effusion in 2. Tele-echocardiography required early referral of 22 children for surgery and for further evaluation of 9 children. There was a change in medical treatment in 11 and no changes in treatment in 9. Out of 31 children referred, 12 underwent successful surgery and the rest refused due to financial reasons. Follow up direct echocardiography was possible in 33 children. The diagnosis changed in only one child.

Conclusion:

Real-time transmission of pediatric echocardiograms from peripheral hospitals over ISDN is accurate the has the potential to improve patient care, prevent unnecessary transports, positive impact on early referral and reduce economical burden on parents.

NCPCC 2005 - Conference Abstracts. Pediatric Oncall [serial online] 2006 [cited 15 May 2006(Supplement 5)];3. Available from:
http://www.pediatriconcall.com/fordoctor/Conference_abstracts/
Telementoring.asp