Remote real-time supervision via tele-ultrasound in focused cardiac ultrasound: A single-blinded cluster randomized controlled trial
Remote real-time supervision via tele-ultrasound in focused cardiac ultrasound: A single-blinded cluster randomized controlled trial
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DOI：
10.1111/aas.13276
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发表时间：
2019-03-01
影响因子：
2.1
通讯作者：
Kirkegaard, Hans
中科院分区：
文献类型：
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作者：
Jensen, Stig H.;Weile, Jesper;Kirkegaard, Hans
背景通过远程超声的监督提出了一种补救措施，缺乏现场监督聚焦心脏超声，但其影响的知识在很大程度上是不存在的。我们的目的是调查远程监督的医生的电影环质量相比，非监督的医生和相比，专家。方法我们在丹麦西部的一个急诊科进行了一项单盲随机分组对照试验。具有基本超声能力的医生对入院患者进行了两次扫描。第一次扫描是无监督的，第二次是无监督（对照）或远程监督（干预）。最后，心脏聚焦超声专家对同一名患者进行了扫描。两名设盲的观察员对所有扫描记录的电影回放进行1-5级评分。结果是与线性混合效应模型相比的平均汇总扫描分级。结果每组10名医生扫描44例患者。根据平均汇总分级，在4 - 20的量表上，第二次非监督扫描分级为10.9（95% CI：10.2-11.7），而远程监督分级为12.6（95% CI：11.8-13.3）。从第一次到第二次扫描，远程监督的医生比非监督的医生更接近专家的质量9%（1.09; 95%CI：1.00-1.19; P = 0.041）。结论远程监督的医生比非监督的医生进行更好的质量扫描。本研究支持在现场监督不可用的情况下，具有基本聚焦超声能力的医生使用远程监督。
Background Supervision via tele-ultrasound presents a remedy for lacking on-site supervision in focused cardiac ultrasound, but knowledge of its impact is largely absent. We aimed to investigate tele-supervised physicians' cine-loop quality compared to that of non-supervised physicians and compared to that of experts. Methods We conducted a single-blinded cluster randomized controlled trial in an emergency department in western Denmark. Physicians with basic ultrasound competence scanned admitted patients twice. The first scan was non-supervised, and the second was non-supervised (control) or tele-supervised (intervention). Finally, experts in focused cardiac ultrasound scanned the same patient. Two blinded observers graded cine-loops recorded from all scans on a 1-5 scale. The outcome was the mean summarized scan gradings compared with a linear mixed-effects model. Results In each group, 10 physicians scanned 44 patients. From the mean summarized gradings, on a scale from 4 to 20, the second non-supervised scan grading was 10.9 (95% CI 10.2-11.7), whereas the tele-supervised grading was 12.6 (95% CI: 11.8-13.3). From the first to the second scan, tele-supervised physicians moved 9% (1.09; 95% CI: 1.00-1.19; P = 0.041) closer to the experts' quality than the non-supervised physicians. Conclusion Tele-supervised physicians performed scans of better quality than non-supervised physicians. The present study supports the use of tele-supervision for physicians with basic focused ultrasound competence in a setting where on-site supervision is unavailable.