Hashmi Zain G, Rokayak Omar, Boggs Krislyn M, Zachrison Kori S, Espinola Janice A, Jarman Molly P, Jansen Jan O, Locke Jayme E, Kerby Jeffrey D, Camargo Carlos A
Division of Trauma and Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham.
Center for Injury Science, University of Alabama at Birmingham.
JAMA Surg. 2024 Dec 1;159(12):1383-1391. doi: 10.1001/jamasurg.2024.3758.
Nearly 30 million predominantly rural US residents lack timely access to trauma care expertise available at level I or II trauma centers. Telehealth is an established approach to improve access to health care expertise using remote consultation; however, the prevalence of use of telehealth in trauma (teletrauma) across the US is not known.
To examine the prevalence of, trends in, and factors associated with teletrauma use and adoption among US emergency departments (EDs).
DESIGN, SETTING, AND PARTICIPANTS: This survey study included data from the National Emergency Department Inventory (NEDI)-USA survey from January 1, 2016, to December 31, 2020. Each year, a 1-page survey was sent to the directors of nonfederal, nonspecialty EDs by mail and email up to 3 times; nonresponders were further contacted via telephone to complete the survey. Data were analyzed from January to March 2023.
The primary outcome was self-reported ED use of teletrauma for each year studied. Additional measures included data regarding self-reported use of any other telehealth service and ED characteristics. Multivariable logistic regression analyses were performed to assess ED characteristics associated with teletrauma use in 2020 and teletrauma adoption between 2017 and 2020.
Of 5586 EDs in the US in 2020, 4512 had available teletrauma survey data (80.8% response rate); 379 (8.4%) of these EDs reported teletrauma use. In contrast, 2726 (60.4%) reported use of any other telehealth service. Teletrauma use (among EDs with any telehealth use) ranged between 0% in Alabama; Connecticut; Washington, DC; Indiana; New Jersey; Nevada; Oklahoma; Oregon; Rhode Island; and South Carolina to more than 60% in Arkansas (39 of 64 [60.9%]), South Dakota (31 of 41 [75.6%]), and North Dakota (30 of 35 [85.7%]). Factors associated with teletrauma use included rural location (odds ratio [OR], 2.44; 95% CI, 1.77-3.36), critical access hospital (OR, 2.67; 95% CI, 1.83-3.88), and basic stroke hospital vs nonstroke hospital (OR, 1.74; 95% CI, 1.32-2.30) designations. Factors associated with adoption of teletrauma by 2020 included critical access hospital (OR, 1.98; 95% CI, 1.35-2.90) and basic stroke hospital vs nonstroke hospital (OR, 1.42; 95% CI, 1.04-1.94) designation.
This survey study found that teletrauma use lagged significantly behind use of other telehealth services in US EDs in 2020. While most EDs using teletrauma were located in rural areas, there was significant state-level variation in teletrauma use. Future research is needed on how teletrauma is being used and to identify barriers to its wider implementation.
近3000万主要居住在美国农村地区的居民无法及时获得一级或二级创伤中心提供的创伤护理专业服务。远程医疗是一种通过远程会诊来改善医疗专业服务可及性的既定方法；然而，美国各地创伤领域远程医疗（远程创伤）的使用普及率尚不清楚。
研究美国急诊科远程创伤使用和采用情况的普及率、趋势及相关因素。
设计、设置和参与者：这项调查研究纳入了2016年1月1日至2020年12月31日美国国家急诊科库存（NEDI）-美国调查的数据。每年通过邮件和电子邮件向非联邦、非专科急诊科主任发送一份1页的调查问卷，最多发送3次；对于未回复者，通过电话进一步联系以完成调查。数据于2023年1月至3月进行分析。
主要结局是所研究各年份急诊科自我报告的远程创伤使用情况。其他测量指标包括自我报告的任何其他远程医疗服务使用情况及急诊科特征的数据。进行多变量逻辑回归分析以评估与2020年远程创伤使用以及2017年至2020年远程创伤采用相关的急诊科特征。
2020年美国5586家急诊科中，4512家有可用的远程创伤调查数据（回复率80.8%）；其中379家（8.4%）急诊科报告使用了远程创伤。相比之下，2726家（60.4%）报告使用了任何其他远程医疗服务。远程创伤使用情况（在使用任何远程医疗服务的急诊科中）在阿拉巴马州、康涅狄格州、华盛顿特区、印第安纳州、新泽西州、内华达州、俄克拉何马州、俄勒冈州、罗德岛州和南卡罗来纳州为0%，在阿肯色州（64家中的39家[60.9%]）、南达科他州（41家中的31家[75.6%]）和北达科他州（35家中的30家[85.7%]）超过60%。与远程创伤使用相关的因素包括农村地区（比值比[OR]，2.44；95%置信区间[CI]，1.77 - 3.36）、急救医院（OR，2.67；95% CI，1.83 - 3.88）以及基础卒中医院与非卒中医院（OR，1.74；95% CI，1.32 - 2.30）的指定。与到2020年采用远程创伤相关的因素包括急救医院（OR，1.98；95% CI，1.35 - 2.90）以及基础卒中医院与非卒中医院（OR，1.42；95% CI，1.04 - 1.94）的指定。
这项调查研究发现，2020年美国急诊科的远程创伤使用显著落后于其他远程医疗服务的使用。虽然大多数使用远程创伤的急诊科位于农村地区，但远程创伤使用在州层面存在显著差异。未来需要研究远程创伤的使用方式，并确定其更广泛实施的障碍。
