title: Effect of teleradiology upon pattern of transfer of head injured patients from a rural general hospital to a neurosurgical referral centre: follow-up study.
abstract: BACKGROUND
  The optimal management strategy for patients with head injury admitted to a non-specialist hospital is uncertain. The aim of this study was to evaluate the outcomes of victims of head injury requiring hospitalisation but initially admitted to a rural level II trauma centre without a neurosurgical facility but with a system for neurosurgical consultation via teleradiology.
  
  
  METHODS
  Patients admitted for head injury during 2006-2011 were included. Late transfer of patients initially hospitalised in the level II trauma centre was evaluated for treatment failure, defined as clinical or radiological deterioration.
  
  
  RESULTS
  Five hundred and sixty-two patients were initially hospitalised in the level II trauma centre. Evaluation of late transfers showed that only 23 (4.1%) represented real treatment failures due to clinical or radiological deterioration. The clinical course was altered by primary intent to hospitalise patients in the level II trauma centre in only one patient.
  
  
  CONCLUSIONS
  Selected patients with head trauma who have a pathological CT scan may be safely managed in level II trauma centres following neurosurgical consultation using teleradiology. Review of treatment failures is necessary to ensure proper ongoing management of a system in which neurosurgical patients are selectively transferred to trauma centres with neurosurgical capacity.
authors.affiliation: Hillel Yaffe Medical Center, Hadera, Israel.
authors.forename: I
authors.initials: I
authors.lastname: Ashkenazi
authors.affiliation: Hillel Yaffe Medical Center, Hadera, Israel.
authors.forename: A R
authors.initials: AR
authors.lastname: Zeina
authors.affiliation: Hillel Yaffe Medical Center, Hadera, Israel.
authors.forename: B
authors.initials: B
authors.lastname: Kessel
authors.affiliation: Israel National Center for Trauma & Emergency Medicine Research, Gertner Institute, Tel Hashomer, Israel.
authors.forename: K
authors.initials: K
authors.lastname: Peleg
authors.affiliation: Israel National Center for Trauma & Emergency Medicine Research, Gertner Institute, Tel Hashomer, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Givon
authors.affiliation: Hillel Yaffe Medical Center, Hadera, Israel.
authors.forename: T
authors.initials: T
authors.lastname: Khashan
authors.affiliation: Hillel Yaffe Medical Center, Hadera, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Dudkiewicz
authors.affiliation: Hillel Yaffe Medical Center, Hadera, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Oren
authors.affiliation: Hillel Yaffe Medical Center, Hadera, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Alfici
authors.affiliation: Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: O
authors.initials: O
authors.lastname: Olsha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006769:Hospitals, General / Q000706:statistics & numerical data; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006801:Humans; D015601:Injury Severity Score; D007557:Israel; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D019112:Teleradiology / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers / Q000706:statistics & numerical data*; D017211:Treatment Failure; D055815:Young Adult
keywords: Trauma, head; risk management