| Abstract | OBJECTIVES: This study sought to assess the clinical utility of interpreting emergency echocardiograms after regular working hours through a telemedicine connection to on-call cardiologists. BACKGROUND: Physician interpretation of emergency echocardiograms is often delayed during weekends, evenings, or night hours. This delay places undue responsibility on less qualified personnel to interpret echocardiograms of vital importance. METHODS: Digital quad-screen cine-loop format was transmitted over standard telephone lines. Clinical data and conventional and telemedicine interpretations were collected prospectively for 187 emergent or semiemergent tele-echocardiograms after regular working hours. RESULTS: Indications for the echocardiogram included assessment of left ventricular function, ischemia, pericardial effusion, valvular disease, heart donor status, and arrhythmia. Three off-site echocardiographers received the standard echocardiogram and spectral, gray-scale, and color flow Doppler images in cine-loop format using a laptop computer. Laptop interpretation showed 19 technical limited studies, 153 abnormal studies, and 54 percent with wall motion abnormalities. Overall mean agreement rate between telemedicine laptop interpretation and conventional workstation interpretation performed in blinded manner for serious disorders with classic echocardiographic findings (pulmonary hypertension, left ventricular thrombus, aortic dissection, severe valvular insufficiency and large pericardial effusion) was 99.0 percent (95 percent confidence interval [CI] 96 to 99 percent). The following mean times elapsed after completion of the echocardiogram: to laptop fax report, 2.14 h (range 10 min to 8 h); to dictation of videotape, 11.74 h (p < 0.001); to transcription of videotape dictation 56.6 h (p < 0.0001). CONCLUSION: After-hours emergency echocardiography telemedicine using a laptop computer is more rapid than scheduled conventional interpretation from a videotape workstation, yet diagnostic accuracy is comparable. |