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Use of Telemedicine During Interhospital Transport of Children With Operative Intracranial Hemorrhage*

Jackson, Eric M., MD1; Costabile, Philomena M., BSN, RN2,3; Tekes, Aylin, MD4; Steffen, Katherine M., MD5; Ahn, Edward S., MD1,4; Scafidi, Susanna, MD6; Noje, Corina, MD3,6

doi: 10.1097/PCC.0000000000001706
Neurocritical Care

Objectives: To analyze the impact of an intervention of using telemedicine during interhospital transport on time to surgery in children with operative intracranial hemorrhage.

Design: We performed a retrospective chart review of children with intracranial hemorrhage transferred for emergent neurosurgical intervention between January 1, 2011 and December 31, 2016. We identified those patients whose neuroimaging was transmitted via telemedicine to the neurosurgical team prior to arrival at our center and then compared the telemedicine and nontelemedicine groups. Mann-Whitney U and Fisher exact tests were used to compare interval variables and categorical data.

Setting: Single-center study performed at Johns Hopkins Hospital.

Patients: Patients less than or equal to 18 years old transferred for operative intracranial hemorrhage.

Interventions: Pediatric transport implemented routine telemedicine use via departmental smart phones to facilitate transfer of information and imaging and reduce time to definitive care by having surgical services available when needed.

Measurements and Main Results: Fifteen children (eight in telemedicine group; seven in nontelemedicine group) met inclusion criteria. Most had extraaxial hemorrhage (87.5% telemedicine group; 85.7% nontelemedicine group; p = 1.0), were intubated pre transport (62.5% telemedicine group; 71.4% nontelemedicine group; p = 1.0), and arrived at our center’s trauma bay during night shift or weekend (87.5% telemedicine group; 57.1% nontelemedicine group; p = 0.28). Median trauma bay Glasgow Coma Scale scores did not differ (eight in telemedicine group; seven in nontelemedicine group; p = 0.24). Although nonsignificant, when compared with the nontelemedicine group, the telemedicine group had decreased rates of repeat preoperative neuroimaging (37.5% vs 57%; p = 0.62), shorter median times from trauma bay arrival to surgery (33 min vs 47 min; p = 0.22) and from diagnosis to surgery (146.5 min vs 157 min; p = 0.45), shorter intensive care stay (2.5 vs 5 d) and hospitalization (4 vs 5 d), and higher home discharge rates (87.5% vs 57.1%; p = 0.28).

Conclusions: Telemedicine use during interhospital transport appears to expedite definitive care for children with intracranial hemorrhage requiring emergent neurosurgical intervention, which could contribute to improved patient outcomes.

1Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.

2Nursing, The Johns Hopkins Hospital, Baltimore, MD.

3Pediatric Transport, The Johns Hopkins Hospital, Baltimore, MD.

4Division of Pediatric Radiology and Pediatric Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD.

5Pediatrics, Lucile Packard Children’s Hospital, Stanford University School of Medicine, Palo Alto, CA.

6Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

*See also p. 1084.

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Dr. Ahn received funding from Aesculap. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies