Telemedicine for Neurotrauma Prevents Unnecessary Transfers: An Update from a Nationwide Program in Albania and Analysis of 590 Patients

BACKGROUND: The telemedicine program in Albania includes a specialized teleneurotrauma program. There is only 1 national trauma center with neurosurgery capability in the capital city of Tirana. Patients with isolated head or spine injury who require consultation with neurosurgeons located at the National Trauma Center receive telemedicine consultation. The aim of this follow-up study was to evaluate the effectiveness of a nationwide teleneurotrauma network in preventing unnecessary transfers for neurotrauma. METHODS: Retrospective analysis was performed of prospectively collected data on all telemedicine consultations for isolated neurotrauma from March 2014 to February 2018. All teleconsultations were coded using the International Classification of Diseases, Tenth Revision coding system (codes S00, S01-S010). RESULTS: Of 590 teleconsultations for neurotrauma, most patients (76%) were male (median age 46.5 years; range, 1-93 years); 403 (68.31%; mean age 45.12 years) did not require a transfer to the tertiary center, and 187 (mean age 42.47 years) were transferred. An average 12.5 (monthly average range, 8.5-16) patients were seen monthly with a steady increase to a mature telemedicine program at the present time. Most teleconsultations (70.67%) occurred during business hours (8:00 AM 4:30 PM); 173 (29.32%) occurred at night and on weekends. Analysis by diagnosis indicated that most cases of low severity were not transferred, whereas higher severity cases were twice as likely to be transferred (P < 0.05). CONCLUSIONS: Structured and coordinated telemedicine for neurotrauma increases access to care for neurosurgery patients in countries that do not have widespread neurosurgery services. Nearly 70% of patients may be treated locally by nonneurosurgeons.