University of Utah, Department of Surgery, Salt Lake City, UT.
University of Utah, Department of Pediatrics, Salt Lake City, UT.
J Pediatr Surg. 2021 Feb;56(2):385-389. doi: 10.1016/j.jpedsurg.2020.10.020. Epub 2020 Oct 25.
Previous research from our center has shown that 27% of the pediatric trauma transfers from referring facilities are potentially preventable. Our hospital is the only level 1 pediatric trauma center (PTC) in our state, and we are developing a pediatric trauma telehealth network to help keep certain injured children closer to home. We instituted a pediatric trauma telehealth program with a partnering community-based hospital in our state and aim to report our experience over the first year.
All pediatric trauma patients that presented to our partnering hospital from January 2019 to February 2020 were reviewed. Disposition was: a) telehealth consultation, b) admission to the children's unit without a telehealth consultation per our head trauma protocol, or c) transfer without telehealth consultation. Data on demographics, hospital course, and disposition were collected via chart review.
Eight patients underwent telehealth consults and another 8 patients were admitted to the partnering hospital's children's unit based on the head trauma protocol without a telehealth consult. Patient's ages ranged from 7 months to 15 years. Of the patients that underwent telehealth consult, 7 presented with a head injury and 1 presented with a rib fracture/small pneumothorax. The patient with a pneumothorax was observed for 6 h and discharged home after a repeat chest x-ray was stable. All 15 patients with head injuries were observed and discharged from either the emergency department or children's unit after passing concussion testing. No patients required transfer to our PTC after observation, and none were readmitted. Fifty-six patients were transferred without telehealth consultation, and 3 of these patients could potentially have avoided transfer with a telehealth consultation.
Telehealth in pediatric trauma can be a safe mechanism for preventing the transfer of patients that can be safely observed at a partnering hospital. From a facility that transfers an average of 30 trauma patients per year to our hospital, this program prevented 16 such transfers. Development of a head trauma protocol in collaboration with a pediatric neurosurgeon leads to an unexpected number of patients being admitted to the partnering hospital for observation without utilization of a telehealth consultation.
Retrospective study.
III.
我们中心的先前研究表明，转诊机构转送的儿科创伤患者中有 27%可能是可以预防的。我们医院是我们州唯一的一级儿科创伤中心（PTC），我们正在开发一个儿科创伤远程医疗网络，以帮助让某些受伤的孩子更接近他们的家。我们与我们州的一家社区合作医院建立了儿科创伤远程医疗计划，并旨在报告我们在第一年的经验。
回顾了 2019 年 1 月至 2020 年 2 月期间到我们合作医院就诊的所有儿科创伤患者。处理方式为：a）远程医疗咨询，b）根据我们的颅脑外伤协议不经远程医疗咨询直接入住儿科病房，或 c）不经远程医疗咨询直接转院。通过病历回顾收集人口统计学、住院过程和处理方式的数据。
8 名患者接受了远程医疗咨询，另外 8 名患者根据颅脑外伤协议不经远程医疗咨询直接入住合作医院的儿科病房。患者年龄从 7 个月到 15 岁不等。接受远程医疗咨询的患者中，7 人因头部受伤，1 人因肋骨骨折/小气胸就诊。气胸患者接受了 6 小时的观察，在重复胸部 X 光片稳定后出院回家。所有 15 名头部受伤的患者在通过脑震荡测试后，无论是在急诊科还是儿科病房观察后都出院了。观察后没有患者需要转到我们的 PTC，也没有患者再入院。未经远程医疗咨询就转院的有 56 名患者，其中 3 名患者如果进行远程医疗咨询，可能可以避免转院。
儿科创伤中的远程医疗是一种安全的机制，可以防止可以在合作医院安全观察的患者转院。从一个平均每年向我们医院转院 30 名创伤患者的机构来看，该计划防止了 16 名这样的转院。与一名儿科神经外科医生合作制定颅脑外伤协议，导致了许多患者意外地无需远程医疗咨询就被收入合作医院进行观察。
回顾性研究。
III。
