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Using remote consultation to enhance diagnostic accuracy of bedside transthoracic echocardiography during COVID-19
Jing Lu1, Jun Lin2, Lixue Yin1,3,4
1School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Insights
Remote consultation over bedside transthoracic echocardiography (RC-B-TTE) significantly improved diagnostic accuracy for COVID-19 patients. This method is superior to on-site reports and should be adopted during pandemics.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Imaging
Background:
- Coronavirus disease 2019 (COVID-19) poses challenges for in-person medical evaluations.
- Echocardiography is crucial for assessing cardiac function, but direct patient contact increases infection risk.
Purpose of the Study:
- To evaluate the clinical significance and diagnostic accuracy of remote consultation over bedside transthoracic echocardiography (RC-B-TTE) for COVID-19 patients.
Main Methods:
- Frontline echocardiographers performed bedside transthoracic echocardiography (B-TTE) on 30 COVID-19 patients.
- Experienced consultants provided remote interpretations, blinded to on-site reports.
- A consensus-based "gold standard" was established to compare on-site reports (OSR) and remote consultation reports (RCR).
Main Results:
- On-site B-TTE reports (OSR) showed weak reliability for cardiac chamber dilation, hypertrophy, and pulmonary hypertension (Kappa <0.6).
- Recognition of major cardiac abnormalities by OSR was very weak (Kappa =0.304, 63.3% agreement).
- Misdiagnosis of major abnormalities occurred in 36.7% of OSR (11/30 cases).
Conclusions:
- Remote consultation over B-TTE demonstrated superior diagnostic accuracy compared to on-site interpretations.
- The RC-B-TTE protocol offers significant improvements and should be implemented in clinical practice during pandemics like COVID-19.
Objective:
The aim of this study was to evaluate the clinical significance of remote consultation over bedside transthoracic echocardiography (RC-B-TTE) for patients with coronavirus disease 2019 (COVID-19).
Methods:
Five frontline echocardiographers performed and interpreted B-TTE for 30 patients with COVID-19 in the isolation wards, and the on-site B-TTE reports (OSR) were generated. Then remote consultation over the 30 B-TTE studies was conducted by two experienced echocardiographic consultants while blinded to the OSR, and the corresponding remote consultation reports (RCR) were generated. Subsequently, the five frontline echocardiographers were convened together to discuss the difference between the OSR and RCR, and to confirm the correct interpretation and the misdiagnosis using a "majority-vote" consensus as the diagnostic "gold standard". Afterwards the reasons for the misdiagnosis were given by the frontline echocardiographers themselves. The inter-rater agreement between the OSR and the "gold standard" was assessed using Kappa coefficient and percent agreement.
Results:
Complete correctness of the 30 copies of the RCR were determined by the 5 frontline echocardiographers. The reliability of the OSR in the findings of cardiac chamber dilation, left ventricular hypertrophy and pulmonary hypertension were weak (Kappa <0.6). The reliability of the OSR in the recognition of major cardiac abnormalities was very weak (Kappa =0.304, percent agreement =63.3%). Misdiagnosis of major abnormalities was found in 11 copies of OSR (11/30, 36.7%).
Conclusions:
The protocol of RC-B-TTE has shown noticeable superiority in ameliorating diagnostic accuracy of echocardiography, which should be generalized to clinical practice during the COVID-19 or similar pandemic.
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