RANDOMIZED TRIAL ON IMPROVING INTER-HOSPITAL NEUROSURGICAL CONSULTATION BY TELE-RADIOLOGY

Abstract

Neurosurgical service requires team work and highly specialized resources. Acute neurosurgical emergencies are traditionally referred from district general hospital (DGH) to the Neurosurgical Unit (NSU) by telephone consultation. Initial experience had proved that tele-radiology could improve diagnostic accuracy and reduce unnecessary transfer but clinical outcome improvement was not demonstrated.(1) We compare the traditional telephone consultation with tele-radiology. Patients with acute neurosurgical conditions in a DGH need consultation to NSU were included. These patients were divided into Head Injury, Stroke and Miscellaneous groups. They were further randomized to telephone or tele-radiology consultation mode in different groups. There were totally 375 patients recruited and randomized from the period between 1 October 1998 to 30 June 2000. The time requested for referral to decision made were 35 minutes and 60 minutes respectively, but similar in head injury subgroup. The total numbers of patient needed transfer to PWH were fewer in tele-radiology group (telephone: 80 vs. tele-radiology: 61). The diagnostic accuracy was also higher in tele-radiology group due to the visual aids from the transferred image. The overall outcome assessed on 6 months and showed that patients in tele-radiology group have better outcome score. In summary, this is a first randomized control study to confirm clinical benefits of tele-radiology on managing inter-hospital neurosurgical patients. (1) Does Teleradiology Improve Inter-hospital Management of Head-Injury. KYC Goh, KY Tsang and WS Poon, Can J Neurol Sci 1997; 24: 235–239.