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

Overview

• This study evaluated whether remote assistance improves the accuracy and efficiency of point-of-care ultrasound (POCUS) exams in horses during emergency evaluations at a large animal hospital.
• Researchers compared outcomes between POCUS exams done with remote expert guidance and those without such assistance.

Study Design and Methods

• The study was prospective, randomized, and controlled, conducted over 18 months at a tertiary care large animal emergency service.
• Adult horses presenting with respiratory or gastrointestinal issues were enrolled and randomly assigned to one of two groups:
  • POCUS-R group: Ultrasound exams performed with real-time remote assistance from an expert.
  • POCUS group: Ultrasound exams performed without any remote help.
• Key outcomes measured included the accuracy of the diagnosis, how long the ultrasound exams took, and whether the horse survived until discharge.
• Clinicians’ perceptions of using teleultrasound were also gathered through surveys to understand benefits and challenges.

Results

• A total of 29 horses were included: 13 in the POCUS-R group and 16 in the POCUS group.
• Duration of ultrasound:
  • Exams in the remote-assisted group (POCUS-R) tended to take longer than those without assistance.
  • The hazard ratio of 0.43 suggested remote assistance slowed exam completion (statistically significant with P = .03).
• Diagnostic accuracy:
  • No significant difference was found in whether the final diagnosis was part of the differential diagnoses list between groups.
  • The number of differential diagnoses listed was also similar between groups.
• Survival:
  • Survival rates until discharge were comparable between horses in both groups.
• Clinician perceptions:
  • Most frequently reported benefit was educational, as remote assistance provided learning opportunities.
  • Main negatives included logistical difficulties, technical problems with equipment, and inconvenience related to study participation.

Conclusions and Implications

• Remote assistance via teleultrasound did not improve the diagnostic accuracy or survival outcomes in this study setting.
• The increased time required and technical/logistical challenges limited the acceptance and adoption of teleultrasound by clinicians.
• Despite the lack of evident clinical improvement, educational benefits were noted, suggesting potential for use in training contexts.
• The authors recommend further studies with larger sample sizes to better define if remote assistance can improve clinical outcomes in point-of-care ultrasound exams for large animals.