Remote help with POCUS-should we do it?

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

Laurence Leduc, Claire Underwood, Darko Stefanovski, Samuel Hurcombe, Cristobal Navas de Solis

Background
Point-of-care ultrasonography (POCUS) is increasingly used in equine emergency settings for evaluating gastrointestinal and cardiorespiratory conditions. Remote assistance using telemedicine has shown promise in human medicine for enhancing image quality and diagnostic accuracy, but its effectiveness in veterinary medicine—especially in acute care equine scenarios—has not been fully assessed. The study aimed to evaluate whether remote specialist assistance during POCUS examinations would improve diagnostic accuracy, clinical outcomes, and user confidence.

Methods
A randomized, controlled clinical trial was conducted at a tertiary equine hospital. Adult horses presenting with gastrointestinal or respiratory signs were assigned to receive POCUS either with remote assistance (POCUS-R) or without (POCUS). House officers performed ultrasounds using a handheld device, and in the POCUS-R group, a remote expert assisted in real-time via a telehealth interface. Outcomes measured included diagnostic accuracy (presence and rank of final diagnosis in differential lists), exam duration, survival to discharge, and user perceptions. Statistical analysis included Cox regression, Mann-Whitney tests, Poisson regression, and Fisher’s exact tests. A power analysis suggested that 150 cases would be needed for conclusive results, but only 29 were enrolled.

Results
Of the 29 enrolled cases (13 POCUS-R, 16 POCUS), no significant differences were found between groups in terms of diagnostic accuracy, number of differential diagnoses, or survival to discharge. The duration of ultrasound exams was significantly longer in the POCUS-R group. Educational value was the most commonly cited benefit, while technical and logistical issues, including poor internet connectivity and increased time burden, were the most noted drawbacks. Remote assistance did not alter the number of follow-up sonograms or hospitalization days.

Limitations
The study was underpowered due to low enrollment, limiting its ability to detect meaningful differences in diagnostic accuracy or clinical outcomes. Only a small number of thoracic sonograms were included, restricting generalizability to non-abdominal scans. Some horses lacked definitive diagnoses or necropsies, and most sonograms were conducted under the supervision of board-certified specialists, which may have reduced the perceived utility of remote assistance.

Conclusions
Remote assistance for POCUS was feasible but not widely adopted in the academic referral hospital setting, likely due to logistical constraints and limited perceived need among experienced clinicians. Although diagnostic accuracy was not demonstrably improved, the educational value of teleultrasound was positively received. Broader application may be more successful in general practice or non-urgent scenarios where time pressures are less acute.

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