Authors: Alyson Stagg, Therese M. Giglia, Monique M. Gardner, Rachel J. Shustak, Shobha S. Natarajan, David A. Hehir, Anita L. Szwast, Jonathan J. Rome, Chitra Ravishankar, Tamar J. Preminger
Abstract: Infants with staged surgical palliation for congenital heart disease are at high-risk for interstage morbidity and mortality. Interstage telecardiology visits (TCV) have been effective in identifying clinical concerns and preventing unnecessary emergency department visits in this high-risk population. We aimed to assess the feasibility of implementing auscultation with digital stethoscopes (DSs) during TCV and the potential impact on interstage care in our Infant Single Ventricle Monitoring & Management Program.
Results: From July 2021 through June 2022, 16 patients were examined with a DS during 52 TCVs (median: 3 TCVs/patient; range: 1–8 TCVs/patient). The quality of heart sounds and murmur auscultation was judged as “very clear” or “moderately clear” with excellent inter-rater agreement (98%). In all visits, providers agreed that incorporation of the DS was helpful in medical decision-making and agreed that using DSs enhanced the overall quality of the TCV. Use of the DS provided additional significant information in 12% of TCVs (6/52) as compared to our routine TCV; in 2 cases this expedited life-saving care. There were no missed events or deaths. Furthermore, there were no false positives where the DS led to patients being directed to the ED unnecessarily.