• Changsun Kim, Bo Seung Kang, Hyuk Joong Choi, Tae Ho Lim, Jaehoon Oh, and Youngjoon Chee.
• Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Republic of Korea.
• Am J Emerg Med. 2015 Oct 1;33(10):1354-9.

PurposeWe investigated the effectiveness of tele-mentored ultrasonography between emergency medicine (EM) residents and remote experts in diagnosing acute appendicitis.MethodsThis prospective observational study was performed in an academic emergency department. Beginning in June 2014, the EM residents performed the initial ultrasonography for suspected pediatric acute appendicitis; then, the remote experts observed/mentored the residents' practice using the tele-ultrasonography system; and finally, an onsite expert verified the diagnosis. The diagnostic confidence of each examiner (resident, remote expert, and onsite expert) was rated on a 5-point Likert scale. The appendix identification rate and the diagnostic values; sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each type of examination were calculated.ResultsA total of 115 pediatric cases with suspected acute appendicitis, including 36 with pathology-confirmed acute appendicitis, between June 2014 and February 2015 were enrolled in this study. In 9 of the 115 (7.8%) cases, a non-appendicitis diagnosis was determined in the absence of the successful identification of a normal appendix upon resident examination. Of these, seven appendices were identified upon expert tele-ultrasonography. The diagnostic values for expert tele-ultrasonography were higher (sensitivity: 1.000, specificity: 0.975, PPV: 0.947, NPV: 1.000) than those for resident-performed ultrasonography (sensitivity: 0.917, specificity: 0.899, PPV: 0.805, NPV: 0.959) and similar to those for onsite expert-performed ultrasonography (sensitivity: 1.000, specificity: 0.987, PPV: 0.973, NPV: 1.000).ConclusionTele-ultrasonography with tele-mentoring between EM residents and experienced mentors was effectively applied in diagnosing pediatric acute appendicitis in an emergency clinical setting.Copyright © 2015 Elsevier Inc. All rights reserved.

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