title: Impact of telemedicine upon rural trauma care.
abstract: OBJECTIVE
  Only preliminary reports have evaluated the impact of telemedicine in trauma care. This study will analyze outcomes before (pre-TM) and after (post-TM) implementation of telemedicine in the management of rural trauma patients initially treated at local community hospitals (LCH) before trauma center (TC) transfer.
  
  
  METHODS
  Seven rural hospital emergency departments in Mississippi were equipped with dual video cameras with remote control capability. All trauma patients initially treated at these LCH with TC consultation were reviewed. Data included patient demographics, Injury Severity Score, institutional volume of patients, mode of transportation, length of stay in LCH, transfer time (TT), mortality, and hospital cost. Patients were grouped in the pre-TM and post-TM periods. Statistical testing was with two-sample Student's t test or chi analysis as appropriate.
  
  
  RESULTS
  During 5 years, 814 traumatically injured patients (pre-TM, n = 351; post-TM, n = 463) presented to the LCH. In the pre-TM period, 351 patients were transferred directly from the LCH for definitive management to the TC. In the post-TM period, 463 virtual consults were received, of which 51 patients were triaged to the TC. There were no differences in patient age, sex, or mode of transportation. When comparing post-TM with pre-TM era, patients had a higher Injury Severity Score (18 vs. 10, p < 0.001); less incidence of blunt trauma 35 (68%) versus 290 (82%), p < 0.05; a decrease in length of stay at LCH 1.5 hours versus 47 hours, p < 0.001; as well as TT LCH to TC 1.7 hours versus 13 hours, p < 0.001. After arrival to TC during the post-TM era patients received more units of packed red bed cell 13 units versus 5 units, p < 0.001 but without difference in mortality 4 (7.8%) versus 17 (4.8%), when compared with pre-TM era. Of statistical significance there was a dramatic decrease in hospital cost when comparing post-TM and pre-TM eras ($1,126,683 vs. $7,632,624, p < 0.001).
  
  
  CONCLUSIONS
  Telemedicine significantly improved rural LCH evaluation and management of trauma patients. More severely injured trauma patients were identified and more rapidly transferred to the TC. Total TC hospital costs were significantly decreased without significant changes in TC mortality. Introduction of telemedicine consultation to rural LCH emergency departments expanded LCH trauma capabilities and conserved TC resources, which were directed to more severely injured patients.
authors.affiliation: Section of Trauma and Critical Care Surgery and Preventive Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA. jduchesn@tulane.edu
authors.forename: Juan C
authors.initials: JC
authors.lastname: Duchesne
authors.forename: Amber
authors.initials: A
authors.lastname: Kyle
authors.forename: Jon
authors.initials: J
authors.lastname: Simmons
authors.forename: Saleem
authors.initials: S
authors.lastname: Islam
authors.forename: Robert E
authors.initials: RE
authors.lastname: Schmieg
authors.forename: Jake
authors.initials: J
authors.lastname: Olivier
authors.forename: Norman E
authors.initials: NE
authors.lastname: McSwain
mesh_terms: D004636:Emergency Service, Hospital; D005260:Female; D006764:Hospitals, Community; D006780:Hospitals, Rural; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008922:Mississippi; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer; D019035:Rural Health Services; D017216:Telemedicine; D014194:Traumatology / Q000379:methods; D049269:Videoconferencing; D014947:Wounds and Injuries / Q000628:therapy*