The role of low-bandwidth telemedicine in surgical prescreening.
OBJECTIVE
Low-bandwidth, Internet-based telemedicine is an inexpensive technology that could help deliver heath care in medically underserved areas. The purpose of this study was to evaluate the usefulness of low-bandwidth telemedicine in remote surgical evaluation.


METHODS
A group of surgeons and nurses traveled to Mombasa, Kenya to provide surgical assistance at the Coast Province General Hospital (CPGH). Before the visit of the surgical team, surgeons evaluated patients via low-bandwidth telemedicine. Prescreening was performed through use of an Internet-based desktop computer system that was supported technically by the Virginia Commonwealth University (VCU) Medical Informatics and Technology Applications Consortium (MITAC) telemedicine laboratory. Surgical patients were evaluated remotely regarding appropriateness of surgical intervention by reviewing e-mails that included the patient's age, history, physical examination, digital images of the patient, and digital images of pertinent radiographs.


RESULTS
Fifty-one patients, including 7 pediatric patients, were prescreened. Thirty-three of the 51 patients (65%) were deemed inappropriate for surgery before this trip because of advanced disease or absence of necessary local medical resources. Of the 18 patients determined to be appropriate candidates for surgery by remote prescreening, 18 (100%) were operated on successfully during the relief effort. Sixty patients including 9 (15%) pediatric patients underwent surgery over the course of 5 days in CPGH. Pediatric cases included various laparoscopic, oncologic, and soft tissue reconstruction.


CONCLUSIONS
Low-bandwidth, Internet-based telemedicine is a cost-effective technology that can efficiently and effectively prescreen surgical patients in remote areas.
Lee
Sophia
S
Medical Informatics and Technology Applications Consortium and Department of Surgery, Virginia Commonwealth University, Richmond, VA 23298 , USA.
Broderick
Timothy J
TJ
Haynes
Jeffrey
J
Bagwell
Charles
C
Doarn
Charles R
CR
Merrell
Ronald C
RC
D000328:Adult; D002648:Child; D003906:Developing Countries; D013502:General Surgery; D006801:Humans; D020407:Internet; D007630:Kenya; D019114:Remote Consultation; D013514:Surgical Procedures, Operative; D017216:Telemedicine; D014481:United States