Inter-facility transfer of patients with traumatic intracranial hemorrhage and GCS 14–15: The pilot study of a screening protocol by neurosurgeon to avoid unnecessary transfers. (November 2020)

• Record Type: Journal Article
• Authors: Alan, Nima; Kim, Song; Agarwal, Nitin; Clarke, Jamie; Yealy, Donald M.; Cohen-Gadol, Aaron A.; Sekula, Raymond F.
• Is Part Of: Journal of clinical neuroscience. Volume 81(2020)
• Page Start: 246
• Page End: 251
• Publication Date: 2020-11
• Subjects: Head trauma -- Neurosurgery -- TBI -- Telemedicine -- Transfer; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2020.09.050
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Telemedicine is an emerging field with diverse applications. Mild TBI patients may be candidates for screening before inter-facility transfer. Avoiding unnecessary hospital transfers can better optimize resource utilization. Abstract: We sought to evaluate feasibility and cost-reduction potential of a pilot screening program involving neurosurgeon tele-consultation for inter-facility transfer decisions in TBI patients with GCS 14–15 and abnormal CT head at a community hospital. The authors performed a retrospective comparative analysis of two patient cohorts during the pilot at a large hospital system from 2015 to 2017. In "screened" patients (n = 85), images and examination were reviewed remotely by a neurosurgeon who made recommendations regarding transfer to a level 1 trauma center. In the "unscreened" group (n = 39), all patients were transferred. Baseline patient characteristics, outcomes, and costs were reviewed. Patient demographics were similar between cohorts. Traumatic subarachnoid hemorrhage was more common in screened patients (29.4% vs 12.8%, P = 0.02). The presence of midline shift >5 mm was comparable between groups. Among screened patients, 5 were transferred (5.8%) and one required evacuation of chronic subdural hematoma. In unscreened patients, 7 required evacuation of subdural hematoma. None of the screened patients who were not transferred deteriorated. Screened patients had significantly reduced average total cost compared to unscreened patients ($2, 003 vs. $4, 482, P = 0.03) despite similar lengths of stay (2.6 vs. 2.7 days, P = 0.85). In non-surgical patients, costs were less in the screened group ($2, 025 vs. $2, 939), although statistically insignificant (P = 0.38). In this pilot study, remote review of images and examination by a neurosurgeon was feasible to avoid unnecessary transfer of patients with traumatic intracranial hemorrhage and GCS 14–15. The true potential in cost-reduction will be realized in system-wide large-scale implementation.