Effect of teleradiology upon pattern of transfer of head injured patients from a rural general hospital to a neurosurgical referral centre

Abstract

Objective: To assess the effect of teleradiology upon the need for transfer of head injured victims requiring hospitalisation but referred initially to a rural level 2 trauma centre without neurosurgical capacity. Methods: Head injured patients requiring hospitalisation, admitted to a rural level 2 trauma centre between August 2003 and August 2005, were identified. A digitalised copy of the computed tomographic (CT) scan was transferred to the neurosurgical referral centre via teleradiology and was available for review by the neurosurgeon on-call, who then, together with the trauma surgeon in the rural level 2 trauma centre, decided whether to transfer the patient to the neurosurgical referral centre. Results: Of 209 trauma victims with neurosurgical pathology in need of hospitalisation, 126 (60.2%) were immediately transferred while 83 (39.7%) of the patients were hospitalised in the rural level 2 trauma centre for observation. Two (2.4%) failed the intent to treat locally. One patient, suffering from multi-trauma, was stabilised after damage control laparotomy only to succumb to an enlarging epidural haematoma. Another patient was transferred 2 days after admission because of difficulty in clinical evaluation due to a previously existing neurological disorder, but no active treatment was necessary. All other 81 patients recovered uneventfully. Conclusions: Selective head injured patients with pathological CT scan may be safely managed in level 2 trauma centres. A committed trauma team in the rural trauma centre, neurosurgical consultation and availability of a teleradiology system are requisites. Currently existing transfer criteria should be carefully reevaluated.

Interhospital Transfer of Neurosurgical Patients to a High-Volume Tertiary Care Center

“…Teleradiology may also allow select patients to be treated at level 2 trauma centers and to avoid unnecessary transfer to a higher level of care. 25,26 Incorporating teleradiology and other digital technologies into the transfer process can increase the efficiency of transfer and patient care while ultimately improving patient outcomes.…”

Management of Patients With Traumatic Intracranial Injury in Hospitals Without Neurosurgical Service

“…The use of the PACS for on-line distribution of radiologic examination is practiced for over a decade for a variety of purposes including trauma. [3][4][5] The third model is based on a clinicalradiologic algorithm that allow the trauma attending surgeon to avoid transferring the patient with CT finding of ICB, providing two basic conditions: alert patient with GCS Ն13 and a low-risk ICB per CT. The low-risk ICB was defined as an injury with low potential for deterioration.…”

Emergency Medical Service Concepts in Tehran, Iran

“…Providing prompt services has a crucial impact on the trauma patient and causes a reduction in mortality and hospital cost (12) and reduces expensive transfer of trauma patients (13). Considering that a significant number of Tehran EMS calls are related to trauma (approximately 27%), the use of modern technologies, like ultrasound and tele-radiology for early recognition and improving prehospital management of traumatic patients is recommended.…”