Abstract
With the benefit of continuous development of networking technology, the current inter‐hospital patients care can also be improved. The aim of this study was to examine the role of video consultation against conventional modes of telemedicine technologies in managing inter‐hospital referral of neurosurgical patients, especially in terms of diagnostic accuracy, impact of early management and long‐term outcome.Data were collected prospectively from a district hospital (UCH) and a tertiary neurosurgical center (PWH). Totally 282 patients requiring neurosurgical consultation as decided by the doctors in the district hospital were stratified into three groups: head injury (A), stroke (B) and others (C). They were further randomized to three modes of consultation [Telephone consultation (I), teleradiology plus telephone consultation (II), and video consultation (III)] within each group.There are total 72 patients in group A (22.5%), 140 patients in group B (49.6) and 70 patients in group C (24.9). After randomization, patient numbers in mode I, II and III are 98, 98 and 86 respectively. The failure rate of carry out the consultation were low in mode I (1%) and II (3%), but high in mode III (61.6%). The average time from referral to decision make are 25.8 min, 43.2 min and 57 min in mode I, II and III respectively. The mean time need for receiving consultation image are slightly longer in mode III then mode II (54.6 min vs 52.8 min), but the time need to make up decision is much shorten (10.2 min vs 21 min). The diagnostic accuracy and the outcome in one and six month are also analyzed. Comparison of early management benefit of video consultation against conventional telephone consultation is made.The time need for CT image transfer and high failure rate of carry out video consultation still remain the major problems on data interpretation. Early CT scanning and consultation are emphasized. On site research assistant to carry out the randomization and arranging video consultation will improve future study.
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