Report of a National Neurosurgical Emergency Teleconsulting System

Gray, William Peter; Somers, Jack; Buckley, T. F.

doi:10.1097/00006123-199801000-00020

Cited by 20 publications

(10 citation statements)

References 11 publications

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“…25 Image transfer systems have been initiated across the world for many years specifically to address the need for neurosurgeons to evaluate images before the transfer of patients. 5,11,23,29 The effect of these systems, where available, has proved to be significantly beneficial in terms of mitigating cost of unnecessary transfer. One group in Italy found that only 23% of patients (with a mean GCS score of 11) who had images sent on a teleradiology system required transfer after the initial CT images were sent, and only 5% after follow-up CT. 24 A Level 2 trauma center in Israel found that with the implementation of teleradiology, 40% of patients with TBI were successfully treated at their facility, with only 2 patients requiring delayed transfer to a Level 1 center.…”

Section: Discussionmentioning

confidence: 99%

Low rate of delayed deterioration requiring surgical treatment in patients transferred to a tertiary care center for mild traumatic brain injury

Carlson

Ramirez²,

Kennedy³

et al. 2010

FOC

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Object Patients with mild traumatic brain injury (mTBI) only rarely need neurosurgical intervention; however, there is a subset of patients whose condition will deteriorate. Given the high resource utilization required for interhospital transfer and the relative infrequency of the need for intervention, this study was undertaken to determine how often patients who were transferred required intervention and if there were factors that could predict that need. Methods The authors performed a retrospective review of cases involving patients who were transferred to the University of New Mexico Level 1 trauma center for evaluation of mTBI between January 2005 and December 2009. Information including demographic data, lesion type, need for neurosurgical intervention, and short-term outcome was recorded. Results During the 4-year study period, 292 patients (age range newborn to 92 years) were transferred for evaluation of mTBI. Of these 292 patients, 182 (62.3%) had an acute traumatic finding of some kind; 110 (60.4%) of these had a follow-up CT to evaluate progression, whereas 60 (33.0%) did not require a follow-up CT. In 15 cases (5.1% overall), the patients were taken immediately to the operating room (either before or after the first CT). Only 4 patients (1.5% overall) had either clinical or radiographic deterioration requiring delayed surgical intervention after the second CT scan. Epidural hematoma (EDH) and subdural hematoma (SDH) were both found to be significantly associated with the need for surgery (OR 29.5 for EDH, 95% CI 6.6–131.8; OR 9.7 for SDH, 95% CI 2.4–39.1). There were no in-hospital deaths in the series, and 97% of patients were discharged with a Glasgow Coma Scale score of 15. Conclusions Most patients who are transferred with mTBI who need neurosurgical intervention have a surgical lesion initially. Only a very small percentage will have a delayed deterioration requiring surgery, with EDH and SDH being more concerning lesions. In most cases of mTBI, triage can be performed by a neurosurgeon and the patient can be observed without interhospital transfer.

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Section: Discussionmentioning

confidence: 99%

Low rate of delayed deterioration requiring surgical treatment in patients transferred to a tertiary care center for mild traumatic brain injury

Carlson

Ramirez²,

Kennedy³

et al. 2010

FOC

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“…Gray et al 4 evaluated a teleconsultation system based on optical scanning technology and reported transmission failures in 6%. Our system transfers original digital images.…”

Section: Discussionmentioning

confidence: 99%

“…Neurosurgical teleconsultation is among the more common applications of telemedicine. Several studies indicate that teleconsultations between a regional neurosurgical department and referring hospitals improve patient outcome, produce more appropriate patient transfers and are cost-effective [2][3][4][5][6][7][8][9][10][11] . Only a few studies have systematically evaluated response time 9 , influence on patient management 2,5,6,11 and benefits in routine clinical practice 8 .…”

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confidence: 99%

Neurosurgical teleconsultations in northern Norway

2004

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We carried out a prospective study of the effect of neurosurgical teleconsultations on patient management in northern Norway. The total number of teleradiology image transfers during an eight-month study period was 723. We recorded data on 99 (14%) of these teleconsultations, which concerned 92 patients; the remainder were transfers to other departments at our hospital and transfers of routine examinations from a small community hospital that did not have a radiologist. The neurosurgeon on call noted the clinical condition and response time for each consultation. The consequences of the teleconsultation and the eventual benefits of the image transfer were evaluated. All 10 referring hospitals in the region used the service. The median response time was 3 hours (range 1-21 hours) in emergency cases and 1 day (range 1-7 days) in ordinary consultations. The response time was significantly shorter for patients with head injuries (median 3 hours) than for those with intracranial tumours (median 24 hours). Image transfer was considered beneficial for the patient in 93% of the cases. Avoidance of unnecessary patient transfer, changes of treatment at the referring hospital on the advice of the neurosurgeon and initiation of emergency transfer occurred in 34%, 42% and 13% of cases, respectively. The results confirm that teleconsultations between referring hospitals and a regional neurosurgical service influence patient management and reduce the frequency of patient transfer.

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“…Follow up of head trauma through tele consultations has confirmed its usefulness 30 . Gray's reports [31][32][33] on the national neurosurgical tele radiology system in Ireland, is an example of how tele consultation can considerably extend the reach of a small number of neurosurgeons The system connected six major referring hospitals to the only two neurosurgical departments serving the entire population of 3.5 million people. The system was based on Personal Computer's interconnected by leased data circuits and ISDN lines.…”

Section: The Aragonda Storymentioning

confidence: 99%

Telemedicine in the management of head trauma: An overview

Ganapathy¹

2004

The Indian Journal of Neurotrauma

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This article reviews the successful utilization of telemedicine in managing head trauma. Telemedicine has made geography history and distance meaningless. It can be a major tool in providing expertise for the management of neurotrauma cases, in far away areas. With the digital divide reducing in India, telemedicine should be considered a method to overcome the shortage of neuro-traumatologists. Following a discussion of the relevance of telemedicine in the Indian context and after outlining the author's personal experience, the world literature is reviewed.

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Report of a National Neurosurgical Emergency Teleconsulting System

Abstract: The system is cost effective and simple to use, has gained widespread physician acceptance, and delivers an image quality superior to that of many commercially available systems.

Cited by 20 publications

References 11 publications

Low rate of delayed deterioration requiring surgical treatment in patients transferred to a tertiary care center for mild traumatic brain injury

Low rate of delayed deterioration requiring surgical treatment in patients transferred to a tertiary care center for mild traumatic brain injury

Neurosurgical teleconsultations in northern Norway

Telemedicine in the management of head trauma: An overview

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