Ellis Michael J, Boles Susan, Derksen Vickie, Dawyduk Brenda, Amadu Adam, Stelmack Karen, Kowalchuk Matthew, Russell Kelly
a Department of Surgery , University of Manitoba , Canada.
b Pediatrics and Child Health , University of Manitoba , Canada.
Int J Circumpolar Health. 2019 Dec;78(1):1573163. doi: 10.1080/22423982.2019.1573163.
Pediatric concussion patients living in northern communities in Canada can face unique challenges accessing primary and specialized healthcare. In this study we report the clinical characteristics, healthcare utilization, outcomes and estimated cost avoidance associated with a pilot pediatric concussion telemedicine program established between a multi-disciplinary pediatric concussion program in Winnipeg, Manitoba and a hospital in Thompson, Manitoba. From October 1- July 1, 2018, 20 patients were evaluated; mean age 13.1 years, 15 (75%) males and 14 (70%) self-identified as Indigenous. Injury mechanisms included hockey (50%), falls (35%) and assaults (15%). Median time from referral to initial consultation was 2.0 days. After screening by the neurosurgeon, 90% of patients underwent initial consultation via real-time videoconferencing with 80% managed exclusively through telemedicine. At the end of the study, 90% met the criteria for clinical recovery, one remained in treatment and one was discharged to a headache neurologist. Sixty-six telemedicine encounters were completed including 57 videoconferencing appointments and 9 telephone follow-ups representing an estimated cost avoidance of $40,972.94. This study suggests telemedicine may be a useful approach to assist pediatric concussion programs with delivering timely, safe and cost-effective care to patients living in medically underserviced remote and northern communities in Canada.
生活在加拿大北部社区的小儿脑震荡患者在获得初级和专科医疗保健方面可能面临独特的挑战。在本研究中，我们报告了在曼尼托巴省温尼伯市的一个多学科小儿脑震荡项目与曼尼托巴省汤普森市的一家医院之间建立的一个试点小儿脑震荡远程医疗项目的临床特征、医疗保健利用情况、治疗结果以及估计的成本节约情况。从2018年10月1日至7月1日，对20名患者进行了评估；平均年龄13.1岁，15名（75%）为男性，14名（70%）自认为是原住民。受伤机制包括曲棍球运动（50%）、跌倒（35%）和袭击（15%）。从转诊到初次会诊的中位时间为2.0天。经神经外科医生筛查后，90%的患者通过实时视频会议进行了初次会诊，其中80%仅通过远程医疗进行管理。在研究结束时，90%的患者达到临床康复标准，1名患者仍在接受治疗，1名患者被转至头痛神经科医生处。共完成了66次远程医疗会诊，包括57次视频会议预约和9次电话随访，估计节约成本40972.94美元。这项研究表明，远程医疗可能是一种有用的方法，可协助小儿脑震荡项目为生活在加拿大医疗服务不足的偏远和北部社区的患者提供及时、安全且具有成本效益的护理。
