Neurosurgery · 2025
Neurosurgical Teleconsultation Safety for Mild Traumatic Brain Injuries and Low-Grade Blunt Cerebrovascular Injuries.
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Hamo Mohammad A, Sun Yifei, Jarrell Matthew, Atchley Travis, Laskay Nicholas M B, Estevez-Ordonez Dagoberto, Liptrap Elizabeth J
Аннотация
BACKGROUND AND OBJECTIVES: Mild traumatic brain injuries, stable spine fractures, and low-grade blunt cerebrovascular injuries are frequent at level I trauma centers and often prompt neurosurgery consultation, regardless of clinical status. We evaluated the safety and utility of virtual consultations (teleconsultations [TECs]) in the management of these injuries.
METHODS: We performed a retrospective review of 260 patients admitted to a level I trauma center from 2020 to 2022. Groups were divided by consultation type, with 210 in-person consultations and 48 TECs. Propensity score matching, accounting for covariates, was performed to maintain unbiased comparability based on observed characteristics. With a 4:1 matching ratio, 165 in-person consultations were compared with 48 TECs. Outcome differences between groups were assessed by χ 2 test based on neurological and/or neurosurgical re-evaluation. Univariate and multivariate regression models were used to determine predictive value of patient characteristics and outcomes.
RESULTS: Of the total matched 213 injuries, the average age was 55 years for the in-person cohort and 59 for the TECs ( P = .3). Gender distribution was similar in both groups. Rates of neurosurgical re-evaluation (18%) and neurological decline (3.29%) were similar, and no patients experienced permanent neurological injury or death. Higher Glasgow Coma scale scores were associated with decreased likelihood of re-evaluation ( P = .02) or neurological decline ( P < .001). No predictive factors were identified in the TEC group.
CONCLUSION: Neurosurgical TEC may be effective in management and treatment of nonoperative mild traumatic brain injury and low-grade blunt cerebrovascular injuries. Future multicenter studies should evaluate TEC safety and generalizability across diverse clinical settings.
METHODS: We performed a retrospective review of 260 patients admitted to a level I trauma center from 2020 to 2022. Groups were divided by consultation type, with 210 in-person consultations and 48 TECs. Propensity score matching, accounting for covariates, was performed to maintain unbiased comparability based on observed characteristics. With a 4:1 matching ratio, 165 in-person consultations were compared with 48 TECs. Outcome differences between groups were assessed by χ 2 test based on neurological and/or neurosurgical re-evaluation. Univariate and multivariate regression models were used to determine predictive value of patient characteristics and outcomes.
RESULTS: Of the total matched 213 injuries, the average age was 55 years for the in-person cohort and 59 for the TECs ( P = .3). Gender distribution was similar in both groups. Rates of neurosurgical re-evaluation (18%) and neurological decline (3.29%) were similar, and no patients experienced permanent neurological injury or death. Higher Glasgow Coma scale scores were associated with decreased likelihood of re-evaluation ( P = .02) or neurological decline ( P < .001). No predictive factors were identified in the TEC group.
CONCLUSION: Neurosurgical TEC may be effective in management and treatment of nonoperative mild traumatic brain injury and low-grade blunt cerebrovascular injuries. Future multicenter studies should evaluate TEC safety and generalizability across diverse clinical settings.