Eder Patrick A, Reime Birgit, Wurmb Thomas, Kippnich Uwe, Shammas Layal, Rashid Asarnusch
Zentrum für Telemedizin Bad Kissingen, Bad Kissingen, Germany.
Faculty of Health Safety Society, Furtwangen University, Furtwangen, Germany.
Methods Inf Med. 2018 Nov;57(5-06):231-242. doi: 10.1055/s-0039-1681089. Epub 2019 Mar 15.
Trauma is a global burden. Emergency medical services (EMS) provide care for individuals who have serious injuries or suffered a major trauma.
This paper provides a comprehensive overview of telemedicine applications in prehospital trauma care.
We conducted a systematic review according to PRISMA guidelines. We identified articles by electronic database search (PubMed, EMBASE, the Cochrane Library, CINAHL, SpringerLink, LIVIVO, DARE, IEEE Xplore, Google Scholar and ScienceDirect) using keywords related to prehospital settings, ambulance, telemedicine and trauma. Search terms and inclusion criteria were specified a priori by the PICOS template and revised throughout a configurative approach iteratively, to outline the complexity and variety of different telemedical concepts.
A final sample of 15 records was systematically selected. Most interventions were piloted and/or evaluated in Germany for trauma victims in prehospital settings. Six studies were simulated scenarios. Telemedical assistance (TMA) via real-time telemetry systems (RTS), enabling video and audio conferencing between EMS by tele-emergency physicians (TEP) were associated with a higher treatment quality and a shorter time-to-treatment in invasive procedures. By initiating in-hospital preparations based on telemedical prehospital notification (TPN), loss of information during the clinical handover was reduced and in-hospital protocols were activated with high accuracy. Remotely guided ultrasound (Tele-Ultrasound) by TEP showed an overall high diagnostic accuracy in simulations. Technical solutions were reliable, seemed practical and auspicious.
The review indicates that TMA and TPN are accompanying telemedical concepts in out-of-hospital trauma care. Well-designed populated studies are needed to fully assess the effect of telemedicine in acute trauma care. Therefore, evidence regarding the effectiveness of telemedicine in prehospital setting for trauma patients is still limited.
创伤是一项全球性负担。紧急医疗服务（EMS）为重伤或遭受重大创伤的个体提供护理。
本文全面概述了远程医疗在院前创伤护理中的应用。
我们根据PRISMA指南进行了系统评价。我们通过电子数据库搜索（PubMed、EMBASE、Cochrane图书馆、CINAHL、SpringerLink、LIVIVO、DARE、IEEE Xplore、谷歌学术和ScienceDirect），使用与院前环境、救护车、远程医疗和创伤相关的关键词来识别文章。搜索词和纳入标准由PICOS模板预先确定，并通过配置方法进行迭代修订，以勾勒出不同远程医疗概念的复杂性和多样性。
系统地选取了15条记录作为最终样本。大多数干预措施在德国针对院前环境中的创伤受害者进行了试点和/或评估。六项研究为模拟场景。通过实时遥测系统（RTS）提供的远程医疗协助（TMA），使远程急诊医生（TEP）能够在EMS之间进行视频和音频会议，这与更高的治疗质量以及侵入性手术中更短的治疗时间相关。通过基于远程医疗院前通知（TPN）启动院内准备工作，减少了临床交接期间的信息丢失，并以高精度启动了院内方案。TEP进行的远程引导超声检查（远程超声）在模拟中显示出总体较高的诊断准确性。技术解决方案可靠，看起来实用且前景良好。
该评价表明，TMA和TPN是院外创伤护理中的伴随远程医疗概念。需要精心设计的大量研究来全面评估远程医疗在急性创伤护理中的效果。因此，关于远程医疗在创伤患者院前环境中的有效性的证据仍然有限。
