Saffle Jeffrey R, Edelman Linda, Theurer Louanna, Morris Stephen E, Cochran Amalia
Department of Surgery, University of Utah Health Center, Salt Lake City, Utah 84132, USA.
J Trauma. 2009 Aug;67(2):358-65. doi: 10.1097/TA.0b013e3181ae9b02.
As the number of US burn centers has declined, access to burn care is increasingly limited. Inexperience in burn wound assessment by referring physicians often results in overtriage or undertriage. In an effort to improve access to burn care in our region, we instituted a program of telemedicine evaluation of acute burns.
We created a telemedicine network linking our burn center to three hospitals located 298 to 350 air miles away. Participants agreed to perform telemedicine consultation for acutely burned patients admitted to their emergency departments. We compared consults and referrals from these facilities during the period July 2005 to August 2007 (TELE) to those during a 2-year period before instituting telemedicine (PRE-TELE).
During the TELE period, 80 patients were referred, of whom 70 were seen acutely by telemedicine, compared with 28 PRE-TELE referrals. The groups did not differ in age or burn size. Only 31 patients seen by telemedicine received emergency air transport (44.3%), compared with 100% of PRE-TELE patients (p < 0.05). Nine other TELE patients were transported by family; 30 other patients were treated locally. Ten remaining patients were transported without telemedicine evaluation. TELE patients transported by air had somewhat larger burn sizes (9.0% vs. 6.5% total body surface area; p = NS) and longer length of stay (13.0 days vs. 8.0 days; p = NS) than PRE-TELE patients. Burn size estimates by burn center physicians made either by telemedicine or direct inspection correlated closely but both differed significantly from those of referring physicians. Providers and patients expressed a high level of satisfaction with the telemedicine experience.
Acute evaluation of burn patients can be performed accurately by telemedicine. This can reduce undertriage or overtriage for air transport, improve resource utilization, and both enhance and extend burn center expertise to many rural communities at low cost.
随着美国烧伤中心数量的减少，烧伤护理的可及性日益受限。转诊医生在烧伤创面评估方面缺乏经验，常常导致过度分诊或分诊不足。为改善本地区烧伤护理的可及性，我们启动了一项急性烧伤远程医疗评估项目。
我们创建了一个远程医疗网络，将我们的烧伤中心与距离298至350航空英里的三家医院相连。参与者同意为入住其急诊科的急性烧伤患者进行远程医疗会诊。我们将2005年7月至2007年8月期间（远程医疗阶段）这些机构的会诊和转诊情况与实施远程医疗前两年期间（远程医疗前阶段）的情况进行了比较。
在远程医疗阶段，有80名患者被转诊，其中70名通过远程医疗进行了急性诊治，而远程医疗前阶段有28名转诊患者。两组在年龄或烧伤面积方面无差异。通过远程医疗诊治的患者中只有31人接受了紧急空中转运（44.3%），而远程医疗前阶段的患者这一比例为100%（p<0.05）。另外9名远程医疗阶段的患者由家属转运；还有30名患者在当地接受治疗。其余10名患者未经过远程医疗评估就被转运了。通过空中转运的远程医疗阶段患者的烧伤面积略大（分别为9.0%和6.5%的体表面积；p=无统计学意义），住院时间也更长（分别为13.0天和8.0天；p=无统计学意义）。烧伤中心医生通过远程医疗或直接检查做出的烧伤面积估计相关性密切，但均与转诊医生的估计有显著差异。提供者和患者对远程医疗体验表示高度满意。
通过远程医疗可以准确地对烧伤患者进行急性评估。这可以减少空中转运的分诊不足或过度分诊，提高资源利用率，并以低成本将烧伤中心的专业知识扩展到许多农村社区。
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