Impact of telemedicine on diagnosis, clinical management and outcomes in rural trauma patients: A rapid review

Lapointe, Luc; Lavallee-Bourget, Marie-Helene; Pichard-Jolicoeur, Alexia; Turgeon-Pelchat, Catherine; Fleet, Richard

doi:10.4103/cjrm.cjrm_8_19

Cited by 25 publications

(18 citation statements)

References 48 publications

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“…However, rural residents are at proportionally higher risk for trauma and trauma-related death than urban dwellers. 64 , 65 Given that some rural communities are far from a designated trauma centre, it would have been informative to include survey questions relative to the distance or the delay experts believed that direct transport to a trauma centre would be acceptable and preferable. Furthermore, the generalizability of our results to other countries and health care settings may be limited, as resources and trauma system organizations vary between countries.…”

Section: Discussionmentioning

confidence: 99%

A Canadian consensus-based list of urgent and specialized in-hospital trauma care interventions to assess the accuracy of prehospital trauma triage protocols: a modified Delphi study

Mercier

Nadeau

Sage

et al. 2023

cjs

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Background: Injury severity scales have traditionally been used to assess the performance of prehospital trauma triage protocols, but they correlate weakly with the urgent needs of specialized trauma care interventions. This study aimed to develop a list of in-hospital urgent and specialized trauma care interventions that require direct transport to the highest-level trauma centre within the catchment area. Methods: Based on a list of potential participants we obtained using data on training, experience, geographic location, affiliations and role within key trauma organizations, we recruited multidisciplinary trauma experts (including prehospital, emergency, surgery and intensive care clinicians, epidemiologists and clinician/decision-makers) from across Canada to complete a 3-round modified Delphi survey. We conducted a literature review of the criteria used to define urgent and specialized trauma care, and included all diagnostic and therapeutic interventions presented in previously published studies in the list of interventions to present to the panellists. The final list was determined by our advisory committee, 5 clinicians with experience in trauma care. Participants were asked to rate their level of agreement for potentially including the 38 items as urgent and specialized trauma care interventions on a 9-point Likert scale. Interventions were retained if more than 67% of participants moderately or strongly agreed (7–9 on the Likert scale). Interventions that did not reach consensus were presented again in the subsequent round. Results: Twenty-three panellists were recruited. The response rate was 91%, 96% and 83% for the 3 rounds. After the Delphi process, 30 of the 38 interventions, including endotracheal intubation, blood product administration and angioembolization, and abdominal, thoracic, neurosurgical, spinal and/or orthopedic operations (excluding hip or limb surgery, and toe or finger amputation), were selected. Hospital admission to the intensive care unit and/or for observation of brain, spinal, thoracic or abdominal injuries were also retained. Conclusion: We developed a Canadian consensus-based list of urgent and specialized in-hospital trauma care interventions requiring direct transportation to a major trauma centre. This list should help standardize assessments of current protocols and derive new triage tools.

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Section: Discussionmentioning

confidence: 99%

A Canadian consensus-based list of urgent and specialized in-hospital trauma care interventions to assess the accuracy of prehospital trauma triage protocols: a modified Delphi study

Mercier

Nadeau

Sage

et al. 2023

cjs

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“…36 The addition of video when evaluating trauma, burn, and neurosurgical patients being considered for transfer can save millions of dollars and requires little to no change in workload for providers. [37][38][39] Given the emphasis on decreasing the cost of care across the USA, it is prudent that we consider the potential benefits of including telemedicine evaluations for patients requiring consultation with a pediatric surgeon, including those where transfer to another facility is being considered.…”

Section: Discussionmentioning

confidence: 99%

State of telemedicine use in pediatric surgery in the USA—where we stand and what we can gain from the COVID-19 pandemic: a scoping review

Metzger

Jatana

Apfeld

et al. 2021

World Jnl Ped Surgery

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BackgroundWithin the last decade, the use of telemedicine within in primary care in the USA has greatly expanded; however, use remains uncommon in surgical specialties. The spread of Coronavirus disease 2019 (COVID-19) prompted healthcare institutions to limit in-person contact, resulting in an increase in telemedicine across all specialties, including pediatric surgery. The aims of this review were to evaluate potential barriers that limited the use of telemedicine in pediatric surgery prior to the COVID-19 period and to define how best to incorporate its use into a pediatric surgical practice going forward.MethodsA scoping review was performed to identify gaps in the literature pertaining to the use of telemedicine within general pediatric surgery in the USA prior to the outbreak of COVID-19. Next, a focused evaluation of the legislative and organizational policies on telemedicine was performed. Lastly, findings were summarized and recommendations for future research developed in the context of understanding and overcoming barriers that have plagued widespread adoption in the past.ResultsDespite evidence of telemedicine being safe and well received by adult surgical patients, a total of only three studies representing original research on the use of telemedicine within pediatric surgery were identified. Legislative and organizational policies regarding telemedicine have been altered in response to COVID-19, likely resulting in an increase in the use of telemedicine among pediatric surgeons.ConclusionsTelemedicine offers a safe and effective option for patients seeking an alternative to the in-person clinic appointment. The increased utilization of telemedicine during the COVID-19 pandemic will provide an opportunity to learn how best to leverage the technology to decrease disparities and to overcome previous barriers.

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“…Also, the COVID-19 outbreak and other possible future pandemics force the system to this adaptation. 13,[21][22][23] The number of burn centers is limited and these centers serve a large region. Eliminating burn patients for transfer to a burn center will help to reduce the workload of transfer services and the emergency departments.…”

Section: Discussionmentioning

confidence: 99%

Telemedicine for the management of pediatric burn patients admitted to emergency services

Esberk

Daş

2021

J Telemed Telecare

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Introduction Telemedicine when properly implemented can be used to facilitate consultations from physicians with little or no burn experience by providing access to qualified physicians in burn care to reduce the workload in emergency departments or elsewhere. In this study, the role of telemedicine in the management and triage of pediatric burn patients admitted to the emergency department of a tertiary care hospital is investigated. Methods This cross-sectional study was conducted between 1 January 2019 and 31 December 2020 and a total of 210 patients were enrolled in the study. Patients were initially evaluated in the emergency room by a pediatrician and consulted by an experienced burn specialist using lesion images. An in-person assessment of the patients was performed by another burn specialist according to the clinical decision made via telemedicine. The data of both assessments and clinical data of the patients were examined. Results The mean age of our patients was 3.35 ± 3.7 years. Most of the burns were scalds with hot liquids (71%). After the consultations, 73 patients were discharged from the emergency room. The rest were decided as follow-up at the burn outpatient clinic ( n = 99) or hospitalization ( n = 35) and in-person assessment was performed for these patients. The inter-rater reliability value for “clinical decision” was almost perfect (Cohen's kappa value is 0.923). Also, the level of concordance between the two assessments was very high for burned total body surface area (interclass correlation coefficient = 0.999). Conclusion In the management and triage of pediatric burn patients admitted to the emergency department, telemedicine and in-person examination resulted in almost perfect agreement in terms of clinical decision and total body surface area. Legal arrangements and regulatory changes are essential to support the safe and wide adoption of telemedicine, which is a reliable method in emergency room settings.

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Impact of telemedicine on diagnosis, clinical management and outcomes in rural trauma patients: A rapid review

Cited by 25 publications

References 48 publications

A Canadian consensus-based list of urgent and specialized in-hospital trauma care interventions to assess the accuracy of prehospital trauma triage protocols: a modified Delphi study

A Canadian consensus-based list of urgent and specialized in-hospital trauma care interventions to assess the accuracy of prehospital trauma triage protocols: a modified Delphi study

State of telemedicine use in pediatric surgery in the USA—where we stand and what we can gain from the COVID-19 pandemic: a scoping review

Telemedicine for the management of pediatric burn patients admitted to emergency services

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