Feasibility of tele-guided patient-administered lung ultrasound in heart failure

Exploring the Feasibility of At-Home Lung Ultra-Portable Ultrasound: Parent-Performed Pediatric Lung Imaging

OBJECTIVE

To determine if caregivers would be able to successfully perform in home lung ultrasounds on their children without direct supervision after undergoing a basic tutorial that would allow for expert interpretation.

METHODS

A prospective exploratory single-center cohort study was conducted on patients (0-18 years) presenting to a pediatric emergency department with a respiratory complaint or COVID-related illness. Caregivers underwent a brief hands-on session and were instructed to scan the lungs daily for 7 days. Images were assessed using a modified POCUS IQ score. Descriptive statistics were used to describe the data and bivariate analysis was used to compare groups.

RESULTS

Eighteen patients were enrolled; the average age of the parent scanner was 31.9 years and 78% were female. Of all participants, 77.8% scanned on day one. Parents were able to successfully perform some part of the daily scan session for an average of 3.8 out of 7 days. The average POCUS IQ score overall was 6.7 (out of 12).

CONCLUSION

Our study demonstrates the feasibility and acceptability of caregiver ability to obtain adequate lung ultrasound images, at home under no guidance, using the Butterfly iQ probe. Further studies are needed to investigate the accessibility of ultra-portable ultrasound and the ability to integrate with the at-home hospital model, specifically in the pediatric population.

Self-administered at-home lung ultrasound with remote guidance in patients without clinical training

BACKGROUND

Access to timely and accurate diagnostic imaging is essential for high-quality healthcare. Point-of-care ultrasound has been shown to be accessible and effective in many aspects of healthcare, including assessing changes in lung pathology. However, few studies have examined self-administered at-home lung ultrasound (SAAH-LUS), in particular performed by non-clinical patients (NCPs).

RESEARCH QUESTION

Are NCPs able to perform SAAH-LUS using remote teleguidance and produce interpretable images?

STUDY DESIGN

Patients were enrolled to the study in a mix of in-person and virtual recruitment, and shipped a smartphone as well as a point of care ultrasound device. Tele-guidance was provided by a remote physician using software integrated with the point of care ultrasound device, allowing real-time remote visualization and guidance of a patient scanning their own chest. A post-intervention survey was conducted to assess patient satisfaction, feasibility, and acceptability of SAAH-LUS. Two POCUS expert reviewers reviewed the scans for interpretability, and inter-rater agreement between the two reviewers was also computed.

RESULTS

Eighteen patients successfully underwent 7-14 days of daily telemedicine in parallel to daily SAAH-LUS. Across 1339 scans obtained from ten different lung zones, the average proportion of interpretability was 96% with a chance-corrected agreement, or Cohen's kappa, reported as κ = 0.67 (significant agreement). 100% of NCPs surveyed found SAAH-LUS to be a positive experience, particularly for its ease of operation and ability to increase access to healthcare services.

INTERPRETATION

This study demonstrates that NCPs can obtain interpretable LUS images at home, highlighting the potential for SAAH-LUS to increase diagnostic capacity, particularly for rural and remote regions where complex imaging and healthcare providers are difficult to obtain. Trial registration The clinical trials has been registered (clinicaltrials.gov).

REGISTRATION NUMBER

NCT04967729.