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Table 4 Trauma

From: Telemedicine in pre-hospital care: a review of telemedicine applications in the pre-hospital environment

Authors Journal/title Methodology Summary of findings Comment
Duchesne et al. [[40]] The Journal of Trauma 2008;64(1):92–97 Impact of telemedicine upon rural trauma care Comparative analysis of the outcomes before and after the introduction of telemedicine in the trauma management in rural hospitals Telemedicine improved trauma evaluation and management and led to reduction in hospital cost and mortality The use of historical controls in this study introduces bias that compromises the conclusions of the study
Saffle et al. [[41]] The Journal of Trauma 2009;67(2):358–365 Telemedicine evaluation of acute burns is accurate and cost-effective Retrospective comparative analysis of burns evaluation before and after the introduction of telemedicine 80 patients were recruited to the telemedicine arm, while 28 were recruited during the same period pre-telemedicine. Burns assessment by telemedicine is both accurate and low cost This study uses historical controls in its analysis. Its conclusion will require conformation by a large randomized control study
Boniface et al. [[42]] American Journal of Emergency Medicine 2011;29:477–481 Tele-ultrasound and paramedics: real-time remote physician guidance of the Focused Assessment With Sonography for Trauma examination Analysed whether paramedics could perform focused assessment with sonography for trauma (FAST) under remote guidance by an emergency physician 51 paramedics were able to complete FAST with 100% of the view under emergency physician guidance This is an observational study that demonstrates the feasibility of telemedicine-guided FAST by novice paramedics. Further studies will be needed to explore its accuracy
Charash et al. [[43]] Journal of Trauma 2011;71(1):49–54 Telemedicine to a moving ambulance improves outcome after trauma in simulated patients Prospective double-blind study of simulated trauma patients. The study compares the outcomes of trauma care in a moving ambulance between telemedicine group and non-telemedicine control Telemedicine to a moving ambulance improves care and successfully guide EMTs through needle thoracostomy and pericardiocentesis This is a well-designed simulation study that will require investigation with real-life scenarios to confirm their findings
Rogers et al. [[44]] The Journal of Trauma Injury, Infection, and Critical Care 2001;51:1037–1041 The use of telemedicine for real-time video consultation between trauma center and community hospital in a rural setting improves early trauma care: preliminary results Observational study analysing whether real-time telemedicine consult with a trauma surgeon by community hospital emergency department positively affects care 26 teleconsults were carried out by trauma surgeons over an 8-month period, and survey indicated that 80% felt telemedicine improved patient care This study is descriptive, and no conclusions were reached
Wallace et al. [[45]] Journal of Telemedicine and Telecare 2007;13:282–287 A cohort study of acute plastic surgery trauma and burn referrals using telemedicine Prospective cohort study comparing the management of patients referred to a burns unit with/without telemedicine (store-and-forward) Telemedicine group was more likely to be booked directly to day surgery without the need for initial assessment. Of the 34 responders to the survey, 31 thought telemedicine improved patient management The authors did not specify the method of selection of which facilities had telemedicine units installed. There is also very limited description of the facilities, making comparison very difficult
Tachakra et al. [[46]] Journal of Telemedicine and Telecare 2011;17:350–357 A comparison of telemedicine with face-to-face consultations for trauma management Case-control study comparing the diagnostic accuracy of telemedicine with face-to-face in minor trauma 200 patients were recruited for the study. There was a very high diagnostic accuracy both in the final diagnosis and in the clinical features Physicians involved were not blinded or randomized
Rörtgen et al. [[47]] Resuscitation 2013;84(1):85–92 Comparison of physician staffed emergency teams with paramedic teams assisted by telemedicine—a randomized, controlled simulation study Randomized controlled study comparing emergency physician team with telemedicine-assisted paramedic teams in management of four simulated clinical scenario Total of 31 scenarios were completed by both groups, and there was no statistical difference between the groups' performance Well-designed study that demonstrates feasibility and quality in a simulation
Tachakra et al. [[48]] Journal of Telemedicine and Telecare 2000;6:330–334 A follow-up study of remote trauma teleconsultations Retrospective review of patients in a minor trauma telemedicine programme for diagnostic accuracy and sequelae of initial trauma Diagnosis was wrong in 2% of patients that were managed with telemedicine. The results were similar with those of face-to-face Observational study