Emergency Department Telemedicine Is Used for More Severely Injured Rural Trauma Patients, but Does Not Decrease...

Area of Science:

• Emergency Medicine
• Health Services Research
• Rural Health

Background:

• Traumatic injury is a significant cause of death in the US, with rural populations facing higher risks.
• Limited access to trauma care in rural areas necessitates innovative solutions like telemedicine.
• Telemedicine offers a potential strategy to enhance local trauma care delivery.

Purpose of the Study:

• To identify patient-level factors associated with telemedicine consultations in North Dakota critical-access hospital emergency departments.
• To determine the relationship between telemedicine consultation and interhospital transfer for trauma patients.

Main Methods:

• An observational cohort study analyzed adult trauma patients in North Dakota critical-access hospitals (2008-2014).
• Trauma cases were sourced from the North Dakota Trauma Registry.
• Telemedicine use was identified via probabilistic linking with network call records; multivariable generalized estimating equations were employed.

Main Results:

• Of 9,281 trauma patients, 2,837 were in facilities with telemedicine; 11% received telemedicine consultation.
• Factors associated with telemedicine use included higher Injury Severity Score, penetrating injuries, burns, hypotension, and ambulance transport.
• Telemedicine consultation was not significantly associated with interhospital transfer (aOR=1.28, 95% CI=0.94-1.75).

Conclusions:

• Telemedicine in rural emergency departments is utilized for the most severely injured trauma patients, particularly those with penetrating trauma, burns, or abnormal vital signs.
• Telemedicine consultation did not independently increase the likelihood of interhospital transfer.
• Further research should investigate telemedicine's impact on the timeliness and specific interventions in trauma care.