Impact of telemedicine upon rural trauma care
Impact of telemedicine upon rural trauma care
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DOI：
10.1097/ta.0b013e31815dd4c4
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发表时间：
2008-01-01
影响因子：
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通讯作者：
McSwain, Norman E.
中科院分区：
文献类型：
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作者：
Duchesne, Juan C.;Kyle, Amber;McSwain, Norman E.
目的：只有初步报告评估了远程医疗在创伤护理中的影响。本研究将分析结果前（前TM）和后（后TM）实施远程医疗的管理，最初在当地社区医院（LCH）创伤中心（TC）transfer.Methods：七个农村医院急诊科在密西西比配备了双摄像头与远程控制能力。所有的创伤患者最初在这些LCH与TC咨询进行了审查。数据包括患者的人口统计学资料，损伤严重程度评分，机构的病人数量，交通方式，在LCH的停留时间，转移时间（TT），死亡率和住院费用。将患者分组为TM前和TM后阶段。统计学检验采用双样本学生t检验或卡方（2）analysis as appropriate.Results：在5年期间，814例创伤性损伤患者（TM前，n = 351; TM后，n = 463）到LCH就诊。在前TM期间，351例患者直接从LCH转移到TC进行最终管理。在TM后期间，共收到463例虚拟咨询，其中51例患者被分流到TC。患者年龄、性别或运输方式无差异。当比较后TM与前TM时代，患者有较高的损伤严重程度评分（18 vs. 10，p < 0.001）;钝性创伤发生率较低35（68%）vs. 290（82%），p < 0.05;在LCH的住院时间较47小时缩短1.5小时，p < 0.001;以及TT LCH至TC 1.7小时与13小时，p < 0.001。在后TM时代到达TC后，患者接受了更多单位的红细胞压积（13单位对5单位，p < 0.001），但与前TM时代相比，死亡率4（7.8%）对17（4.8%）没有差异。具有统计学意义的是，当比较后TM和前TM时代时，医院成本显著降低（1，126，683美元对7，632，624美元，p < 0.001）。更严重的创伤患者被确定，并更迅速地转移到TC。TC住院总费用显著降低，而TC死亡率无显著变化。农村LCH急诊科引入远程医疗咨询，扩大了LCH创伤能力，节省了TC资源，这些资源针对更严重的受伤患者。
Objectives: Only preliminary reports have evaluated the impact of telemedicine in trauma care. This study will analyze outcomes before (pre-TM) and after (post-TM) implementation of telemedicine in the management of rural trauma patients initially treated at local community hospitals (LCH) before trauma center (TC) transfer.Methods: Seven rural hospital emergency departments in Mississippi were equipped with dual video cameras with remote control capability. All trauma patients initially treated at these LCH with TC consultation were reviewed. Data included patient demographics, Injury Severity Score, institutional volume of patients, mode of transportation, length of stay in LCH, transfer time (TT), mortality, and hospital cost. Patients were grouped in the pre-TM and post-TM periods. Statistical testing was with two-sample Student's t test or chi(2) analysis as appropriate.Results: During 5 years, 814 traumatically injured patients (pre-TM, n = 351; post-TM, n = 463) presented to the LCH. In the pre-TM period, 351 patients were transferred directly from the LCH for definitive management to the TC. In the post-TM period, 463 virtual consults were received, of which 51 patients were triaged to the TC. There were no differences in patient age, sex, or mode of transportation. When comparing post-TM with pre-TM era, patients had a higher Injury Severity Score (18 vs. 10, p < 0.001); less incidence of blunt trauma 35 (68%) versus 290 (82%), p < 0.05; a decrease in length of stay at LCH 1.5 hours versus 47 hours, p < 0.001; as well as TT LCH to TC 1.7 hours versus 13 hours, p < 0.001. After arrival to TC during the post-TM era patients received more units of packed red bed cell 13 units versus 5 units, p < 0.001 but without difference in mortality 4 (7.8%) versus 17 (4.8%), when compared with pre-TM era. Of statistical significance there was a dramatic decrease in hospital cost when comparing post-TM and pre-TM eras ($1,126,683 vs. $7,632,624, p < 0.001).Conclusion: Telemedicine significantly improved rural LCH evaluation and management of trauma patients. More severely injured trauma patients were identified and more rapidly transferred to the TC. Total TC hospital costs were significantly decreased without significant changes in TC mortality. Introduction of telemedicine consultation to rural LCH emergency departments expanded LCH trauma capabilities and conserved TC resources, which were directed to more severely injured patients.