Evaluation of remote assistance for point-of-care ultrasonography in a large animal hospital: a controlled randomized trial.

Abstract

To assess whether remote assistance is beneficial to the accuracy of point-of-care ultrasound (POCUS) examinations during equine emergency evaluations. Adult horses presenting to a tertiary care large animal emergency service for respiratory or gastrointestinal clinical signs. Prospective, randomized, controlled, clinical study. Cases were assigned to receive POCUS with remote assistance ("POCUS-R" group) or POCUS with no assistance ("POCUS" group). Accuracy of diagnosis, duration of sonograms and survival to discharge were the objective outcomes compared between groups. Perceptions about the use of teleultrasound were gathered using a survey. 29 cases were enrolled in the study over an 18-month period. Based on Cox regression estimates, sonogram duration was likely to be longer in the POCUS-R group (n = 13) relative to the POCUS group (16) hazard ratio 0.43 (95% CI, 0.9 to 0.2; P = .03). Whether the final diagnosis was included in the differential diagnosis list, number of diagnoses in the differential list and survival were not different between groups. Educational benefits were the most frequently mentioned benefit by clinician users while logistical and technical problems related to the use of the equipment and inconvenience of enrollment in the study was the most common negative aspect. Teleultrasound was generally not well adopted by users likely due to inconvenience and time constraints. Further work is indicated to assess differences in clinical outcomes in a setting that would allow a larger sample size to increase statistical power.