Is regionalization of trauma care using telemedicine feasible and desirable?

BACKGROUND: The judgement and skill of an experienced surgeon are crucial i ngredients during trauma resuscitation, so that errors of omission, commiss ion, and misprioritization can be avoided. Trauma represents a potential pa radigm application for telemedicine owing to its ubiquitous and urgent natu re and the limited availability of specialized care. METHODS: A two-phase project was performed, using an Advanced Trauma Life S upport (ATLS)-based evaluation tool. In phase I, we reviewed 24 videotaped trauma resuscitations on a single pass. Clinical data thus observed were co mpared with the clinical chart for agreement. In phase II, we performed rea l time, remote, initial evaluations of 17 trauma victims. RESULTS: In phase I, 19 of 44 variables had agreement rates >90%, 10 had ag reement rates between 70% and 90%. In phase II, agreement rates were simila r to those in phase I, with improved accuracy in documenting initial and se condary vital signs and the secondary physical examination. CONCLUSION: Remote evaluation of trauma victims is feasible. Accurate clini cal data can be recorded, tasks delegated, and therapeutic measures advised using telemedicine. This can make expert trauma care available to hospital s without advanced trauma systems and potentially reduce cost, prevent unne cessary transfers, and promote early transfer when indicated. (C) 2001 by E xcerpta Medica, Inc.