Latifi Rifat, Olldashi Fatos, Dogjani Agron, Dasho Erion, Boci Arian, El-Menyar Ayman
Department of Surgery, Westchester Medical Center Health Network and New York Medical College, Valhalla, New York, USA; International Virtual Hospital Foundation, Tucson, Arizona, USA; Integrated Telemedicine and e-Health Program of Albania, Tirana, Albania.
Department of Neurosurgery, University Hospital of Trauma, Tirana, Albania.
World Neurosurg. 2018 Apr;112:e747-e753. doi: 10.1016/j.wneu.2018.01.146. Epub 2018 Feb 2.
Use of telemedicine for neurotrauma when performed by neurosurgeons is an innovative care option for traumatic brain injury patients, particularly in countries with limited neurosurgery expertise resources. In recent years, Albania has developed a robust telemedicine program and teleneurotrauma is the flagship of the program. We aimed to evaluate the outcomes of the first neurotrauma patients managed via telemedicine in Albania.
A retrospective analysis of prospectively collected data on all telemedicine consultations for isolated neurotrauma was performed from 2014 through 2016. Patient demographics, mechanism of injury, modes of teleneurotrauma consultation (store-and-forward vs. live video consultation), outcomes of teleconsultation (whether the patient was transferred or kept at the regional hospital), operative procedures for those transferred, length of hospital stay, and discharge status were analyzed.
Of the 146 teleconsultations for neurotrauma, asynchronous technology (store-and-forward) accounted for the majority of teleconsultations (84%), while the live plus store-and-forward technique was employed in 15% of cases. Median time of response to teleconsultation was 20 minutes. Sixty-six percent of patients remained at the referring hospital for further observation and did not require transfer to a trauma center. Of the patients transferred to the tertiary care, 91% were treated nonoperatively, 85% percent were discharged to home, 9% were transferred to another hospital, and 6% died in the hospital.
Telemedicine for neurotrauma, when structured appropriately and led by neurosurgeons, is a valuable service for the entire country, prevents unnecessary transfers to trauma center, and saves resources, particularly in low- and middle-income countries.
由神经外科医生进行的远程医疗用于神经创伤治疗，对于创伤性脑损伤患者而言是一种创新的护理选择，尤其是在神经外科专业资源有限的国家。近年来，阿尔巴尼亚已制定了一项强大的远程医疗计划，远程神经创伤是该计划的旗舰项目。我们旨在评估阿尔巴尼亚首批通过远程医疗管理的神经创伤患者的治疗结果。
对2014年至2016年期间前瞻性收集的所有孤立性神经创伤远程医疗会诊数据进行回顾性分析。分析患者人口统计学资料、损伤机制、远程神经创伤会诊模式（存储转发与实时视频会诊）、远程会诊结果（患者是被转院还是留在地区医院）、转院患者的手术操作、住院时间和出院状态。
在146例神经创伤远程会诊中，异步技术（存储转发）占大多数远程会诊（84%），而15%的病例采用了实时加存储转发技术。远程会诊的中位响应时间为20分钟。66%的患者留在转诊医院进行进一步观察，无需转至创伤中心。在转至三级医疗机构的患者中，91%接受了非手术治疗，85%出院回家，9%转至另一家医院，6%在医院死亡。
由神经外科医生适当组织实施的神经创伤远程医疗，对整个国家来说是一项有价值的服务，可避免不必要地转至创伤中心，并节省资源，尤其是在低收入和中等收入国家。
