ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic has made it difficult for physicians to follow their usual diagnostic processes. We present the case of a 25-year-old man with adjustment disorder who developed dyspnoea. He was concerned about COVID-19, but his test result was negative. After excluding COVID-19, the physician concluded that his symptoms were related to his psychiatric condition. However, the patient was diagnosed with pulmonary thromboembolism by another physician. To avoid missing a diagnosis, physicians must practice zero-based thinking, regardless of COVID-19 concerns, and not be distracted from the patient's core problems. LEARNING POINTS: During the COVID-19 pandemic, significant diagnostic errors can occur because physicians are so concerned about COVID-19 that they may ignore other diagnoses.To avoid missing a life-threatening condition during the COVID-19 pandemic, physicians must consider zero-based thinking, regardless of COVID-19 concerns, and not be distracted from the patient's core problems.Measuring vital signs after a short walk can be helpful for investigating suspected pulmonary thromboembolism.
ABSTRACT
The utility of remote auscultation was unknown. This study aimed to evaluate internet-connected real-time remote auscultation using cardiopulmonary simulators. In this open-label randomized controlled trial, the physicians were randomly assigned to the real-time remote auscultation group (intervention group) or the classical auscultation group (control group). After the training session, the participants had to classify the ten cardiopulmonary sounds in random order as the test session. In both sessions, the intervention group auscultated with an internet-connected electronic stethoscope. The control group performed direct auscultation using a classical stethoscope. The total scores for correctly identified normal or abnormal cardiopulmonary sounds were 97/100 (97%) in the intervention group and 98/100 (98%) in the control group with no significant difference between the groups (p > 0.99). In cardiac auscultation, the test score in the control group (94%) was superior to that in the intervention group (72%, p < 0.05). Valvular diseases were not misclassified as normal sounds in real-time remote cardiac auscultation. The utility of real-time remote cardiopulmonary auscultation using an internet-connected electronic stethoscope was comparable to that of classical auscultation. Classical cardiac auscultation was superior to real-time remote auscultation. However, real-time remote cardiac auscultation is useful for classifying valvular diseases and normal sounds.
ABSTRACT
BACKGROUND: The urgent need for telemedicine has become clear in the COVID-19 pandemic. To facilitate telemedicine, the development and improvement of remote examination systems are required. A system combining an electronic stethoscope and Bluetooth connectivity is a promising option for remote auscultation in clinics and hospitals. However, the utility of such systems remains unknown. OBJECTIVE: This study was conducted to assess the utility of real-time auscultation using a Bluetooth-connected electronic stethoscope compared to that of classical auscultation, using lung and cardiology patient simulators. METHODS: This was an open-label, randomized controlled trial including senior residents and faculty in the department of general internal medicine of a university hospital. The only exclusion criterion was a refusal to participate. This study consisted of 2 parts: lung auscultation and cardiac auscultation. Each part contained a tutorial session and a test session. All participants attended a tutorial session, in which they listened to 15 sounds on the simulator using a classic stethoscope and were told the correct classification. Thereafter, participants were randomly assigned to either the real-time remote auscultation group (intervention group) or the classical auscultation group (control group) for test sessions. In the test sessions, participants had to classify a series of 10 lung sounds and 10 cardiac sounds, depending on the study part. The intervention group listened to the sounds remotely using the electronic stethoscope, a Bluetooth transmitter, and a wireless, noise-canceling, stereo headset. The control group listened to the sounds directly using a traditional stethoscope. The primary outcome was the test score, and the secondary outcomes were the rates of correct answers for each sound. RESULTS: In total, 20 participants were included. There were no differences in age, sex, and years from graduation between the 2 groups in each part. The overall test score of lung auscultation in the intervention group (80/110, 72.7%) was not different from that in the control group (71/90, 78.9%; P=.32). The only lung sound for which the correct answer rate differed between groups was that of pleural friction rubs (P=.03); it was lower in the intervention group (3/11, 27%) than in the control group (7/9, 78%). The overall test score for cardiac auscultation in the intervention group (50/60, 83.3%) was not different from that in the control group (119/140, 85.0%; P=.77). There was no cardiac sound for which the correct answer rate differed between groups. CONCLUSIONS: The utility of a real-time remote auscultation system using a Bluetooth-connected electronic stethoscope was comparable to that of direct auscultation using a classic stethoscope, except for classification of pleural friction rubs. This means that most of the real world's essential cardiopulmonary sounds could be classified by a real-time remote auscultation system using a Bluetooth-connected electronic stethoscope. TRIAL REGISTRATION: UMIN-CTR UMIN000040828; https://tinyurl.com/r24j2p6s and UMIN-CTR UMIN000041601; https://tinyurl.com/bsax3j5f.