Teleultrasound: A Validation Study [15P

Abstract

INTRODUCTION: Ultrasound serves an important role in the prenatal diagnosis of fetal anomalies. There has been an increase in the use of teleultrasound protocols for fetal anatomical surveys. Despite the rising popularity of this modality, there are no large studies comparing the sensitivity and specificity of teleultrasound to on-site ultrasound. METHODS: This is a retrospective noninferiority study comparing teleultrasound to on-site ultrasound. We included all ultrasound studies performed for anatomical survey. We excluded those performed at < 17 weeks' gestation and on patients with multiple gestations. Every study was interpreted by a Maternal-Fetal Medicine specialist. Prenatal diagnoses were compared to postnatal diagnoses obtained from a mandatory statewide birth defects surveillance registry. RESULTS: During the study period, 5,430 ultrasounds met the inclusion criteria; there were 2,341 studies in the teleultrasound group and 3,089 studies in the on-site ultrasound group. The sensitivity, specificity and accuracy of teleultrasound were 53.96%, 98.14% and 95.51% respectively. The sensitivity, specificity and accuracy of on-site ultrasound were 68.29%, 92.95% and 90.16% respectively. We compared the two groups using the Farrington-Manning score test for noninferiority with a 0.15 noninferiority margin and 90% confidence interval. The proportion differences for sensitivity, specificity and accuracy were -0.1433 (CI -0.2240 – 0.0626), 0.0518 (CI 0.0369 – 0.0668) and 0.0535 (CI 0.0381 – 0.0689). CONCLUSION: The sensitivity of teleultrasound is inferior to that of on-site ultrasound. Teleultrasound is less likely to detect fetal anomalies, but is comparable to on-site ultrasound in identifying the specific anomaly. In addition, teleultrasound is comparable to on-site ultrasound in identifying non-anomalous fetuses.