Prospective evaluation of the potential role of teleradiology in acute interhospital trauma referrals.
BACKGROUND
Teleradiology is one form of telemedicine that would allow the transmission of radiographs before the transfer of acutely traumatized patients between referring and receiving hospitals. The purpose of this study was to evaluate the potential impact of a prehospital teleradiology system on trauma patient management and transfer.


METHODS
Forty-four injured adults referred to a trauma center were included. The history, physical examination, and radiographic findings reported by the referring physician to the receiving physician were documented. The plain radiographs of the chest, pelvis, and cervical spine taken at the referring hospital were obtained after patient transfer. For each case, two reviewers blinded to the case (surgeon [S] and emergency department physician [E]) and one reviewer not blinded to the case were individually presented with the referring physician's report and the radiographs. The reviewers were surveyed as to the implications of viewing the plain radiographs taken at the referring hospital before patient transfer.


RESULTS
Overall, the blinded reviewers felt that viewing the radiographs before transfer would have influenced care in 40% and 38% of cases as judged by (S) and (E), respectively, with a crude agreement of 67.5% (kappa level, 0.32). The blinded reviewers (S and E) commonly noted the following four changes in management as a result of viewing the referred radiographs: requested further clinical history (S, 18%; E, 23%), suggested further pretransfer interventions (S, 38%; E, 30%), suggested further pretransfer diagnostic tests (S, 25%; E, 13%), and emphasized precautions during transfer (S, 28%; E, 30%). The nonblinded reviewer suggested potential influence in the management of at least 65% of the cases.


CONCLUSIONS
This study suggests that viewing the radiographs of acutely injured trauma patients has the potential to influence many aspects of the management of interhospital transfer.
Kirkpatrick
A W
AW
Vancouver Hospital & Health Sciences Centre, British Columbia, Canada. andykirk@istar.ca
Brenneman
F D
FD
McCallum
A
A
Breeck
K
K
Boulanger
B R
BR
D006801:Humans; D009864:Ontario; D010360:Patient Transfer; D011446:Prospective Studies; D011859:Radiography; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D019112:Teleradiology; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000000981:diagnostic imaging*