Telemedicine Consultations for Children With Musculoskeletal Injuries: Data from the Turner National Medical Research Center of Сhildren’s Orthopedics and Trauma Surgery

Abstract

Background. Currently, the mortality rate of pediatric patients due to injuries surpasses mortality from other causes worldwide. The selection and timely transfer of the injured to specialized clinics are crucial elements of the healthcare system. Telemedicine consultations (TMC) are considered by several authors as an effective means to enhance the quality of trauma care and optimize patient routing processes.
 Aim of the study was to analyze the results of urgent and emergent telemedicine consultations and hospitalizations based on telemedicine consultations for children with musculoskeletal injuries.
 Methods. TMC requests from 2020 to 2022 were analyzed. When evaluating TMC requests, attention was given to the type of request (planned, urgent, emergent), the region from which the request originated, and the correspondence of the requests urgency category to the patients diagnosis. The study also involved an analysis of the injury structure, its severity according to the Injury Severity Score (ISS) at the time of trauma, and the timelines for requesting and transferring to the federal clinic from the moment of injury.
 Results. From 2020 to 2022, a total of 3745 requests for TMC were received. Among them, there were 572 urgent and emergent requests. A threefold increase in the number of TMC requests was observed over the span of three years. In the same period, 78 patients were transferred to the clinic. For 36 patients with combined and multiple injuries, the severity of trauma was assessed using the ISS scale. The average score was 31 (min 9; max 57). The average time for regional institutions to send a request from the moment of the patients hospitalization was 6.7 days. Hospitalization in the centers clinic from the moment of injury was 10.3 days (min 1; max 58).
 Conclusion. The study revealed the following issues that need to be addressed through further organizational steps: a high percentage of mismatch between the type of request and the actual clinical picture, delayed consultations, prolonged medical evacuation, and organizational aspects of medical evacuation.