title: Effect of teleradiology upon pattern of transfer of head injured patients from a rural general hospital to a neurosurgical referral centre.
abstract: OBJECTIVE
  To assess the effect of teleradiology upon the need for transfer of head injured victims requiring hospitalisation but referred initially to a rural level 2 trauma centre without neurosurgical capacity.
  
  
  METHODS
  Head injured patients requiring hospitalisation, admitted to a rural level 2 trauma centre between August 2003 and August 2005, were identified. A digitalised copy of the computed tomographic (CT) scan was transferred to the neurosurgical referral centre via teleradiology and was available for review by the neurosurgeon on-call, who then, together with the trauma surgeon in the rural level 2 trauma centre, decided whether to transfer the patient to the neurosurgical referral centre.
  
  
  RESULTS
  Of 209 trauma victims with neurosurgical pathology in need of hospitalisation, 126 (60.2%) were immediately transferred while 83 (39.7%) of the patients were hospitalised in the rural level 2 trauma centre for observation. Two (2.4%) failed the intent to treat locally. One patient, suffering from multi-trauma, was stabilised after damage control laparotomy only to succumb to an enlarging epidural haematoma. Another patient was transferred 2 days after admission because of difficulty in clinical evaluation due to a previously existing neurological disorder, but no active treatment was necessary. All other 81 patients recovered uneventfully.
  
  
  CONCLUSIONS
  Selective head injured patients with pathological CT scan may be safely managed in level 2 trauma centres. A committed trauma team in the rural trauma centre, neurosurgical consultation and availability of a teleradiology system are requisites. Currently existing transfer criteria should be carefully re-evaluated.
authors.affiliation: Surgery B Department, Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel. i_ashkenazi@yahoo.com
authors.forename: Itamar
authors.initials: I
authors.lastname: Ashkenazi
authors.forename: Jacob
authors.initials: J
authors.lastname: Haspel
authors.forename: Ricardo
authors.initials: R
authors.lastname: Alfici
authors.forename: Boris
authors.initials: B
authors.lastname: Kessel
authors.forename: Tawfik
authors.initials: T
authors.lastname: Khashan
authors.forename: Meir
authors.initials: M
authors.lastname: Oren
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000628:therapy*; D005260:Female; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007557:Israel; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D019112:Teleradiology / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000706:statistics & numerical data*