Scientific letter
Evaluation of a Telemedicine Program in Severe Trauma. Preliminary Results
Evaluación de un programa de telemedicina en trauma grave. Resultados preliminares
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Preliminary Results" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "412" "paginaFinal" => "413" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Antonia Sonia Salas Díaz, Manuel Jesús Saavedra Chacón, José Miguel Ramos Durán, José David Romero Gallego" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Antonia Sonia" "apellidos" => "Salas Díaz" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 1 => array:4 [ "nombre" => "Manuel Jesús" "apellidos" => "Saavedra Chacón" "email" => array:1 [ 0 => "manuel_jsc@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "José Miguel" "apellidos" => "Ramos Durán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "José David" "apellidos" => "Romero Gallego" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Cirugía General y del Aparato Digestivo, Área de Gestión Sanitaria del Campo de Gibraltar, Cádiz, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Comité de Trauma Grave en el Área de Gestión Sanitaria del Campo de Gibraltar, Cádiz, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evaluación de un programa de telemedicina en trauma grave. Resultados preliminares" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1170 "Ancho" => 1625 "Tamanyo" => 183721 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Algorithm of the consulted and referred patients.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Telemedicine is defined by the World Health Organization as “healing at a distance”. It has developed as a result of the application of information and communication technologies during diagnosis, follow-up and treatment, as well as the teaching and transference of medical data when distance and/or time separate participants. The aim of this study is to describe our initial experience with a telemedicine program, connecting with our reference center for the treatment of patients with severe trauma.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We performed a descriptive analysis of a series of patients treated from February 2015 to March 2016, requiring activation of the severe trauma protocol established in our Healthcare Management Area for Campo de Gibraltar, Spain, in 2011. We assessed the number of patients diagnosed who required referrals to medical specialties that do not exist at our hospital, which are classified by the Andalusian Public Healthcare System (<span class="elsevierStyleItalic">Sistema Sanitario Público Andaluz</span>, SSPA) as level 3 trauma, including: vascular, thoracic, cardiac and plastic surgery; interventional radiology; and neurosurgery.</p><p id="par0015" class="elsevierStylePara elsevierViewall">During the study period, the severe trauma care protocol was activated on 159 occasions, which was included on the registry reports approved by the multiple trauma patient care committee and completed at each activation. Teleconsultations with specialists at the reference hospital were used on 16 occasions (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Under the guidance of these specialists, 16 patients were stabilized at our medical center, 4 of whom were transferred to the reference hospital. Therefore, 12 patients remained at our hospital until discharge and transfer was avoided. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows details of the 16 telemedicine cases. At the bottom of the table, we explain the reasons that led to transfer/no transfer of the patients to another hospital in cases that could cause confusion.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">After a regional meeting and with the agreement of professionals involved in trauma, contact was established with specialists at reference hospitals, heads of trauma units and local coordinators of severe trauma care at each hospital, under the regional direction of EPES/061. The directors of the Accident Plan and the Integrated Healthcare Plan for Severe Trauma were informed at a regional commission meeting. The subdirectors for Information Technologies and Communication of the SSPA confirmed the feasibility of the project. All the professionals at our hospital involved in the management of severe trauma made their private telephone numbers available, with full provision for image-sharing and direct communication.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patient consent for recording images was obtained verbally during the videotaping itself.</p><p id="par0035" class="elsevierStylePara elsevierViewall">One of the great benefits of the utilization of technology in medicine is to be able to conduct consultations between professionals at a distance in real time. This method is ideal for use in emergency departments because of the speed and synchronous communication between medical professionals.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–4</span></a> This statement has held true in our experience with telemedicine, as we have felt supported by specialists at any time of the day or night, even though they are at a distance.</p><p id="par0040" class="elsevierStylePara elsevierViewall">After completing trauma training courses such as ATLS and DSTC, telemedicine assists general surgeons to evolve in their daily practice of severe trauma treatment through tele-tutoring until their learning curve is completed. There are reports in the literature that the learning curve is more vertical with this method compared to more traditional ones,<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5–8</span></a> a fact that we have been able to verify in our limited experience.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The technical limitations of hospitals make it difficult for telemedicine to become a tool to improve severe trauma management. This limitation is theoretical, since sufficient technology is available.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Smartphones, for instance, are accessible to the majority of the population and are a technical solution in places with no other equipment. In our hospital, as there is no telemedicine system in place, we use our personal phones with the encrypted WhatsApp<span class="elsevierStyleSup">®</span> messaging app and FaceTime<span class="elsevierStyleSup">®</span> from Apple<span class="elsevierStyleSup">®</span>. It is therefore the lack of motivation and knowledge, coupled with legislative/legal concerns that have not been addressed, that cause resistance to the diffusion of telemedicine and is a source of controversy.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The literature shows the advantages of telemedicine applied in our specialty, with an emphasis on reducing the number of unnecessary patient transfers. Considering the current financial problems of our healthcare system, and in keeping with the principle of equity in medical care, we believe that telemedicine is a great alternative for populations far from reference centers.</p><p id="par0055" class="elsevierStylePara elsevierViewall">These are the preliminary results of a project that was initiated one year ago at our hospital. We feel it is necessary to wait until a larger number of patients have been treated in order to attain a study with sufficient statistical power to obtain conclusions.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as: Salas Díaz AS, Saavedra Chacón MJ, Ramos Durán JM, Romero Gallego JD. Evaluación de un programa de telemedicina en trauma grave. Resultados preliminares. Cir Esp. 2017;95:412–413.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1170 "Ancho" => 1625 "Tamanyo" => 183721 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Algorithm of the consulted and referred patients.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Transfers<br><span class="elsevierStyleItalic">n</span>=4 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No transfers<br><span class="elsevierStyleItalic">n</span>=12 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vascular surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Injury to the humeral artery<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Seven injuries to the lower extremities (femoral and popliteal arteries<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Thoracic surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No transfer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Two diaphragmatic ruptures, one tracheal rupture \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiac surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">One knife wound to the myocardium,<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> one injury to the aortic arch and carotid artery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">One cardiac knife wound \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Maxillofacial surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">An underwater spearfishing harpoon with an entry orifice in the oral cavity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">One electric weapon malar/orbital impaction \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1576879.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Hemodynamically stable patient with no radial pulse. CT angiography showed evidence of arterial intimal flap. The patient was transferred for endovascular treatment and returned to our hospital the same day. Patient progress was satisfactory.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Three hemodynamically unstable patients could not be transferred and 4 cases with MESS score >7, which, after consultation with vascular surgery, required amputation.</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Hemodynamically stable patient with compatible CT angiogram, with injury to the aortic arch contained by hematoma; carotid artery with intimal flap and contusion, causing cerebrovascular accident. The patient was transferred after hemodynamic stabilization and previous consensus with cardiac and vascular surgery.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Results.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Live transference of surgical subspecialty skills using telerobotic proctoring to remote general surgeons" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.Q. Ereso" 1 => "P. García" 2 => "E. Tseng" 3 => "G. Gauger" 4 => "H. Kim" 5 => "M.M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 5 | 5 | 10 |
| 2024 September | 20 | 8 | 28 |
| 2024 August | 17 | 4 | 21 |
| 2024 July | 10 | 2 | 12 |
| 2024 June | 11 | 2 | 13 |
| 2024 May | 10 | 7 | 17 |
| 2024 April | 11 | 5 | 16 |
| 2024 March | 12 | 2 | 14 |
| 2024 February | 12 | 2 | 14 |
| 2024 January | 20 | 0 | 20 |
| 2023 December | 9 | 1 | 10 |
| 2023 November | 9 | 2 | 11 |
| 2023 October | 21 | 9 | 30 |
| 2023 September | 13 | 2 | 15 |
| 2023 August | 14 | 3 | 17 |
| 2023 July | 23 | 3 | 26 |
| 2023 June | 21 | 3 | 24 |
| 2023 May | 49 | 1 | 50 |
| 2023 April | 31 | 3 | 34 |
| 2023 March | 17 | 2 | 19 |
| 2023 February | 12 | 4 | 16 |
| 2023 January | 5 | 6 | 11 |
| 2022 December | 24 | 5 | 29 |
| 2022 November | 22 | 12 | 34 |
| 2022 October | 13 | 7 | 20 |
| 2022 September | 13 | 13 | 26 |
| 2022 August | 17 | 10 | 27 |
| 2022 July | 20 | 9 | 29 |
| 2022 June | 19 | 5 | 24 |
| 2022 May | 16 | 5 | 21 |
| 2022 April | 18 | 8 | 26 |
| 2022 March | 22 | 5 | 27 |
| 2022 February | 10 | 8 | 18 |
| 2022 January | 22 | 10 | 32 |
| 2021 December | 8 | 9 | 17 |
| 2021 November | 8 | 11 | 19 |
| 2021 October | 17 | 15 | 32 |
| 2021 September | 14 | 7 | 21 |
| 2021 August | 19 | 8 | 27 |
| 2021 July | 36 | 9 | 45 |
| 2021 June | 23 | 7 | 30 |
| 2021 May | 24 | 7 | 31 |
| 2021 April | 27 | 16 | 43 |
| 2021 March | 15 | 8 | 23 |
| 2021 February | 36 | 13 | 49 |
| 2021 January | 17 | 13 | 30 |
| 2020 December | 12 | 7 | 19 |
| 2020 November | 18 | 4 | 22 |
| 2020 October | 11 | 2 | 13 |
| 2020 September | 16 | 10 | 26 |
| 2020 August | 20 | 1 | 21 |
| 2020 July | 21 | 5 | 26 |
| 2020 June | 10 | 8 | 18 |
| 2020 May | 13 | 12 | 25 |
| 2020 April | 7 | 2 | 9 |
| 2020 March | 5 | 2 | 7 |
| 2020 February | 9 | 3 | 12 |
| 2020 January | 5 | 5 | 10 |
| 2019 December | 20 | 5 | 25 |
| 2019 November | 9 | 5 | 14 |
| 2019 October | 6 | 4 | 10 |
| 2019 September | 9 | 6 | 15 |
| 2019 August | 9 | 3 | 12 |
| 2019 July | 15 | 11 | 26 |
| 2019 June | 29 | 11 | 40 |
| 2019 May | 114 | 17 | 131 |
| 2019 April | 46 | 9 | 55 |
| 2019 March | 2 | 0 | 2 |
| 2019 February | 9 | 9 | 18 |
| 2019 January | 2 | 1 | 3 |
| 2018 December | 3 | 2 | 5 |
| 2018 November | 5 | 4 | 9 |
| 2018 October | 14 | 10 | 24 |
| 2018 September | 26 | 2 | 28 |
| 2018 August | 21 | 12 | 33 |
| 2018 July | 2 | 0 | 2 |
| 2018 June | 5 | 0 | 5 |
| 2018 May | 5 | 1 | 6 |
| 2018 April | 5 | 1 | 6 |
| 2018 March | 13 | 4 | 17 |
| 2018 February | 17 | 1 | 18 |
| 2018 January | 9 | 1 | 10 |
| 2017 December | 22 | 3 | 25 |
| 2017 November | 4 | 2 | 6 |
| 2017 October | 2 | 0 | 2 |
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