Accuracy of Interpretation of Point of Care Ultrasound Images in Critically Ill Patients via Telemedicine

Abstract

Purpose: Point of care ultrasound (PCUS) enables accurate assessment and monitoring of critically ill patients, decreasing the need for patient mobilization and radiologic studies. The interpretation of PCUS images by a tele-ICU physician has not been studied. Our study attempts to establish the feasibilty of interpretation of PCUS exams by tele-ICU physicians. Methods: Thoracic, cardiac and lower extremity PCUS was performed by an intensivist on 18 patients in a community hospital's medical/surgical ICU. All ICU and tele-ICU physicians were trained in critical care ultrasonography. Independent real time interpretation of the ultrasound images by the bedside intensivist and the tele-ICU physician were compared. The recorded images were also interpreted by a third critical care physician blinded to the patient and interpretation by the tele-ICU. Results: A total of 18 lung and focused cardiac exams as well as 16 lower extremity compression ultrasound (le-CUS) studies were performed. Video quality was adequate for the tele-ICU physician to visualize the ultrasound screen through the camera while studies were being performed. 6 thoracic, 10 cardiac and 10 le-CUS studies were read as normal. 12 thoracic, 8 cardiac, 6 le-CUS studies revealed a pathologic finding . Pathologic findings included B-lines, lung consolidation, pleural effusions, pericardial effusions, reduced left ventricular function with segmental wall motion abnormalities and deep venous thrombosis. A 100% concordance was seen in the image interpretation by the bedside intensivist and the tele-ICU physician. When the recorded video clips were reviewed by the third blinded intensivist the concordance on study results was also 100%. Conclusions: A tele-ICU intensivist can accurately interpret PCUS images in critically ill patients. Clinical Implications: PCUS can be used successfully by a tele-ICU intensivist in the assessment and monitoring of critically ill patients. This has special importance in ICUs without 24 hour in-house intensivist staffing. If bedside providers including advanced-care practitioners, residents and non-intensivist physicians staffing these units can be trained to adequately acquire PCUS images, a tele-ICU physician with critical care ultrasound training can accurately interpret these exams and use the results to guide patient management. Furthermore the critical care ultrasonography skills of tele-ICU physicians can be used to enhance PCUS training and monitor the progress of the practitioners responsible for image acquisition at bedside.