Prospective evaluation of the potential role of teleradiology in acute interhospital trauma referrals

Background: Teleradiology is one form of telemedicine that would allow the transmission of radiographs before the transfer of acutely traumatized pati ents between referring and receiving hospitals. The purpose of this study w as to evaluate the potential impact of a prehospital teleradiology system o n trauma patient management and transfer. Methods: Forty-four injured adults referred to a trauma center were include d. The history, physical examination, and radiographic findings reported by the referring physician to the receiving physician were documented. The pl ain radiographs of the chest, pelvis, and cervical spine taken at the refer ring hospital were obtained after patient transfer. For each case? two revi ewers blinded to the case (surgeon [S] and emergency department physician [ E]) and one reviewer not blinded to the case were individually presented wi th the referring physician's report and the radiographs. The reviewers were surveyed as to the implications of viewing the plain radiographs taken at the referring hospital before patient transfer. Results: Overall, the blinded reviewers felt that viewing the radiographs b efore transfer would have influenced care in 40% and 38% of cases as judged by (S) and (E), respectively, with a crude agreement of 67.5% (kappa level , 0.32), The blinded reviewers (S and E) commonly noted the following four changes in management as a result of viewing the referred radiographs: requ ested further clinical history (S, 18%; E, 23%), suggested further pretrans fer interventions (S? 38%; E, 30%), suggested further pretransfer diagnosti c tests (S, 25%; El 13%), and emphasized precautions during transfer (S, 25 %; E, 30%). The nonblinded reviewer suggested potential influence in the ma nagement of at least 65% of the cases. Conclusion: This study suggests that viewing the radiographs of acutely inj ured trauma patients has the potential to influence many aspects of the man agement of interhospital transfer.