Remote just-in-time telementored trauma ultrasound: a double-factorial randomized controlled trial examining fluid detection and remote knobology control through an ultrasound graphic user interface display.
BACKGROUND
Remote-telementored ultrasound involves novice examiners being remotely guided by experts using informatic-technologies. However, requiring a novice to perform ultrasound is a cognitively demanding task exacerbated by unfamiliarity with ultrasound-machine controls. We incorporated a randomized evaluation of using remote control of the ultrasound functionality (knobology) within a study in which the images generated by distant naive examiners were viewed on an ultrasound graphic user interface (GUI) display viewed on laptop computers by mentors in different cities.


METHODS
Fire-fighters in Edmonton (101) were remotely mentored from Calgary (n = 65), Nanaimo (n = 19), and Memphis (n = 17) to examine an ultrasound phantom randomized to contain free fluid or not. Remote mentors (2 surgeons, 1 internist, and 1 ED physician) were randomly assigned to use GUI knobology control during mentoring (GUIK+/GUIK-).


RESULTS
Remote-telementored ultrasound was feasible in all cases. Overall accuracy for fluid detection was 97% (confidence interval = 91 to 99%) with 3 false negatives (FNs). Positive/negative likelihood ratios were infinity/0.0625. One FN occurred with the GUIK+ and 2 without (GUIK-). There were no statistical test performance differences in either group (GUIK+ and GUIK-).


CONCLUSIONS
Ultrasound-naive 1st responders can be remotely mentored with high accuracy, although providing basic remote control of the knobology did not affect outcomes.
['Kirkpatrick|Andrew W|AW|', 'McKee|Ian|I|', 'McKee|Jessica L|JL|', 'Ma|Irene|I|', 'McBeth|Paul B|PB|', 'Roberts|Derek J|DJ|', 'Wurster|Charles L|CL|', 'Parfitt|Robbie|R|', 'Ball|Chad G|CG|', 'Oberg|Scott|S|', 'Sevcik|William|W|', 'Hamilton|Douglas R|DR|']
D001826:Body Fluids D016001:Confidence Intervals D004311:Double-Blind Method D004632:Emergency Medical Services D061388:Firefighters D006801:Humans D008348:Manikins D011446:Prospective Studies D019114:Remote Consultation D013647:Task Performance and Analysis D017216:Telemedicine D014463:Ultrasonography D014947:Wounds and Injuries
Ultrasound Remote education Resuscitation Telemedicine Telesonography