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Effect of teleradiology upon pattern of transfer of head injured patients from a rural general hospital to a neurosurgical referral centre

Hillel Yaffe Medical Center, Hadera, Israel

Correspondence to:
Correspondence to:
Dr Itamar Ashkenazi
Surgery B Department, Trauma Unit, Hillel Yaffe Medical Center, Hadera, POB 169, 38100 Israel; i_ashkenazi{at}yahoo.com

Objective: To assess the effect of teleradiology upon the need for transfer of head injured victims requiring hospitalisation but referred initially to a rural level 2 trauma centre without neurosurgical capacity.

Methods: Head injured patients requiring hospitalisation, admitted to a rural level 2 trauma centre between August 2003 and August 2005, were identified. A digitalised copy of the computed tomographic (CT) scan was transferred to the neurosurgical referral centre via teleradiology and was available for review by the neurosurgeon on-call, who then, together with the trauma surgeon in the rural level 2 trauma centre, decided whether to transfer the patient to the neurosurgical referral centre.

Results: Of 209 trauma victims with neurosurgical pathology in need of hospitalisation, 126 (60.2%) were immediately transferred while 83 (39.7%) of the patients were hospitalised in the rural level 2 trauma centre for observation. Two (2.4%) failed the intent to treat locally. One patient, suffering from multi-trauma, was stabilised after damage control laparotomy only to succumb to an enlarging epidural haematoma. Another patient was transferred 2 days after admission because of difficulty in clinical evaluation due to a previously existing neurological disorder, but no active treatment was necessary. All other 81 patients recovered uneventfully.

Conclusions: Selective head injured patients with pathological CT scan may be safely managed in level 2 trauma centres. A committed trauma team in the rural trauma centre, neurosurgical consultation and availability of a teleradiology system are requisites. Currently existing transfer criteria should be carefully re-evaluated.

Abbreviations: ATLS, Advanced Trauma Life Support; CT, computed tomography; GCS, Glasgow Coma Scale; HYMC, Hillel Yaffe Medical Center; ISS, Injury Severity Score

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