Telesonography in emergency medicine: A systematic review

Genevieve Marsh-Feiley, Leila Eadie, Philip Wilson, Genevieve Marsh-Feiley, Leila Eadie, Philip Wilson

Abstract

Ultrasound is an efficacious, versatile and affordable imaging technique in emergencies, but has limited utility without expert interpretation. Telesonography, in which experts may remotely support the use of ultrasound through a telecommunications link, may broaden access to ultrasound and improve patient outcomes, particularly in remote settings. This review assesses the literature regarding telesonography in emergency medicine, focussing on evidence of feasibility, diagnostic accuracy and clinical utility. A systematic search was performed for articles published from 1946 to February 2017 using the Cochrane, Medline, EMBASE, and CINAHL databases. Further searches utilising Scopus, Google Scholar, and citation lists were conducted. 4388 titles were identified and screened against inclusion criteria which resulted in the inclusion of 28 papers. These included feasibility, diagnostic accuracy and clinical pilot studies. Study design, methodology and quality were heterogeneous. There was good evidence of feasibility from multiple studies. Where sufficient bandwidth and high quality components were used, diagnostic accuracy was slightly reduced by image transmission. There was evidence of clinical utility in remote hospitals and low-resource settings, although reliability was infrequently reported. Further exploratory research is required to determine minimum requirements for image quality, bandwidth, frame rate and to assess diagnostic accuracy. Clinical trials in remote settings are justifiable. Telecommunication options will depend on local requirements; no one system conveys universal advantages. The methodological quality of research in this field must improve: studies should be designed to minimise bias, and must include details of their methods to allow replication. Analysis of cost effectiveness and sustainability should be provided.

Conflict of interest statement

Competing Interests: LE’s salary was paid from funding for the SatCare trial into remotely supported prehospital ultrasound, provided by the European Space Agency in collaboration with ViaSat (contract SC16005). These funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. PRISMA flow diagram.
Fig 1. PRISMA flow diagram.
Flow diagram demonstrating the selection of studies included in this review [13].
Fig 2. Critical appraisal results.
Fig 2. Critical appraisal results.
Articles were marked as high, unclear, low risk or item not applicable according to 41 items, in the 7 domains described previously. Please see S5 Table for a domain specific representation of the risk of bias for each study.

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