Evaluation of safety, effectiveness and reproducibility of telemedicine for neurosurgical screening

ABSTRACT Objective: To ascertain the safety, effectiveness and reproducibility of screening potential neurosurgical patients by means of smartphones. Methods: This is a retrospective and multicentric study. Data were collected from the medical records of patients subjected to real emergency neurosurgical evaluations and compared with assessments by neurosurgeons using smartphones to determine the feasibility of identifying changes in cranial computed tomography scans, potentially serious conditions of patients, and the need for transfer to reference centers. Results: We analyzed 232 cases. The main diagnosis was traumatic brain injury, with 119 cases (51.3%). Of this, 105 (45.3%) patients were discharged immediately after the assessment. The telemedicine evaluators presented 95.69% accuracy in the identification of changes in computed tomography scans, with 0.858 concordance. Accuracy in the identification of severity was 95.26%, with 0.858 concordance. As for procedure, the concordance among evaluators was 0.672, increasing to 100% in cases that required surgical treatment. Conclusion: Our study indicated that the use of telemedicine for screening patients with acute neurological disorders was safe, effective and reproducible. Implementation of the method shows a promising potential to improve the patient's outcome by reducing unnecessary transfers and decreasing the time elapsed until a specialist can be consulted.

摘要 研究目的：明确采用智能手机筛查潜在神经外科患者方案的安全性、有效性与可重复性。研究方法：本研究为回顾性多中心研究，数据采集自接受真实急诊神经外科评估的患者病历资料，将其与神经外科医师使用智能手机开展的评估结果进行比对，以验证该方案在识别头颅计算机断层扫描（computed tomography，CT）影像变化、患者潜在重症病情以及转诊至参考中心必要性方面的可行性。研究结果：本研究共纳入232例病例进行分析，主要诊断为创伤性脑损伤，共计119例（51.3%）；其中105例（45.3%）患者在评估完成后直接出院。远程医疗评估者对CT影像变化的识别准确率达95.69%，组间一致性系数为0.858；对病情严重程度的识别准确率为95.26%，组间一致性系数同样为0.858。就操作流程而言，评估者间的一致性系数为0.672，在需手术治疗的病例中，该一致性可提升至100%。研究结论：本研究证实，采用远程医疗手段筛查急性神经系统疾病患者的方案具备安全性、有效性与可重复性。该方案的推广应用可通过减少不必要的转诊、缩短专科会诊等待时间，进而改善患者预后，具有良好的应用前景。