Emergency Department Telemedicine is Used for More Severely Injured Rural Trauma Patients, but Does Not Decrease Transfer: A Cohort Study

Abstract

Objectives

Traumatic injury is a leading cause of death in the U.S., and rural populations are at increased risk of injury and death. Rural residents have limited access to trauma care, and telemedicine has been proposed as one strategy to improve the provision of trauma care locally. The objective of this study was to describe patient-level factors associated with telemedicine consultation in North Dakota critical access hospital emergency departments (EDs), and to measure the association between telemedicine consultation and inter-hospital transfer.

Methods

Observational cohort study of all adult (age≥18 y) trauma patients treated in North Dakota critical access hospital EDs with an active telemedicine subscription between 2008-2014. Trauma cases were identified from the North Dakota Trauma Registry, and telemedicine-enabled care was determined using a probabilistic linking algorithm with the call records of the predominant telemedicine network in North Dakota. Multivariable generalized estimating equations were used to identify factors associated with telemedicine consultation and to measure the association between telemedicine consultation and inter-hospital transfer, adjusting for patient, injury, and hospital factors.

Results

Of the 9,281 North Dakota trauma patients seen in critical access hospitals, 2,837 were treated in an ED with an active telemedicine subscription. Telemedicine was consulted for 11% of all trauma patients in telemedicine-capable EDs. Factors associated with telemedicine consultation included higher injury severity score, penetrating injuries, burns, hypotension, tachycardia, and ambulance transport. Adjusting for severity of illness, injury mechanism, and type of injury, telemedicine use was not associated with inter-hospital transfer (aOR 1.28, 95%CI 0.94-1.75).

Conclusion

ED-based telemedicine consultation is requested for the most severely injured rural trauma patients, especially with those with penetrating trauma, burns, and abnormal presenting vital signs. Telemedicine consultation was not independently associated with increased probability of transfer. Future work should evaluate how telemedicine impacts the timeliness of care and specific care interventions.

This article is protected by copyright. All rights reserved.

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2el57M0