Teleradiology avoids unnecessary trauma transport

Two recent offshore studies address the role of teleradiology in avoiding unnecessary transport of neurosurgical patients.

A French paper looks at indications for transfer of neurosurgical patients from Level 2 trauma centers in light of the shortage of neurosurgical ICU beds in most medical jurisdictions that makes it impossible to admit all patients with severe brain injuries (Ann Fr Anesth Reanim 2007;26(10):873-877).

"Ideally, the best strategy is to admit the patient with severe head injury directly to a neurosurgical center," said Dr. Nicolas Bruder of the département d'anesthésie-réanimation, CHU Timones Adultes, in Marseille. "When this is not possible, teleradiology is the best method to avoid unnecessary transportation or deleterious delays before transfer."

In an era of decreasing medical budgets, technological improvements such as teleradiology that are designed to enhance medical cooperation should be encouraged, according to Bruder.

A study from Israel assessed the effect of teleradiology on the need to transfer head trauma patients requiring hospitalization but referred to a rural Level 2 trauma center without neurosurgical capacity (Emerg Med J 2007;24(8):550-552).

"Our hospital is one of the busiest trauma centers in the country without a neurosurgical unit," said Dr. Itamar Ashkenazi of the Hillel Yaffe Medical Center in Hadera. "Since the institution of telecommunications and 24-hour consultation with neurosurgeons, the number of interhospital transfers has diminished, without compromising outcomes for head-injured patients."

In the past, patients with head injuries were first stabilized, then transferred for treatment to a hospital with neurosurgical capacity. This protocol resulted in a large financial burden on the transferring institution.

The study followed 209 head trauma victims with neurosurgical pathology in need of hospitalization. Of these, 126 (60.2%) were immediately transported to one of six Level 1 trauma centers in the country, while 83 (39.7%) remained in Hadera's rural Level 2 trauma center for observation.

Study results showed 81 of the 83 patients retained in Hadera recovered uneventfully.

"Carefully selected head trauma patients can be safely managed in a Level 2 trauma center, provided a reliable teleradiology system is available around the clock for neurosurgical consultation, there are strict criteria for patient selection, and the trauma team in the Level 2 center is highly committed," Ashkenazi said.

The promise of teleradiology, when incorporated into the system of interhospital consultations, allows more rational use of resources and significantly reduces costs by reducing the number of unnecessary patient transfers, Ashkenazi said.