Editorial
Telemedicine in the Management of Head Trauma
Ganapathy K*
Department of Neurosurgery, Apollo Main Hospital, Chennai, India
*Corresponding author: Ganapathy K, Department of Neurosurgery, Apollo Main Hospital, Chennai, India
Published: 22 Nov, 2017
Cite this article as: Ganapathy K. Telemedicine in the
Management of Head Trauma. Clin
Surg. 2017; 2: 1755.
Editorial
The term "Telemedicine" encompasses the entire spectrum of technology, armamentarium
and processes that are required to enable history taking, conduct a clinical examination, perform
investigations and manage a patient, with the consultant and the patient physically at different
locations. It presupposes the availability of a Personal Computer (PC)/laptop/tablet/smart phone,
a good video conferencing system/digital camera, adequate connectivity, and software to capture,
store, transfer, visualize data, and enable the teleconsultant at the remote end to view reports and
digitally manipulate images. Peripheral medical devices, for example, a blood pressure apparatus or
an ophthalmoscope need to be connected to the internet to enable remote monitoring. The role of
telemedicine lies in rendering the concept of "distance" and "terrain" meaningless. Once the "virtual"
presence of a specialist is acknowledged, a patient can access resources existing in a tertiary referral
centre without the constraints imposed by distance. It is easier to set up a telecommunication
infrastructure in suburban and rural areas than to make specialists available there. In developing
countries, most citizens do not have immediate access to an appropriate specialist. In a publication
in March 2015 [1] the author conclusively demonstrated that 935 million Indians lived in areas
where there was not a single neurosurgeon (or neurologist). Neurological expertise is not available
in several areas of the world. A 20% of the US population does not have access to immediate
neurological services. Establishing telemedicine would in part resolve the "man power" shortage
problem. Deploying telemedicine would partly resolve the acute shortage of surgical specialists.
Patients often travel far, at a considerable expense, when local treatment would have sufficed with
tele-consultation. Head injuries are universally a public health hazard. In India a fatality occurs
every four minutes, making head injury the sixth commonest cause of death. Only about 1800
neurosurgeons are available for a population of 1300 million. Only 200 new neurosurgeons qualify
every year from 60 teaching programmers. There are less than 15 state of the art neuro trauma
critical care units and 700 million living in rural India have no direct access to neurological care.
Telemedicine is particularly useful in neurotrauma by helping institute therapeutic
measures before transfer and reducing unnecessary transfers. The author, in the last 17 years, remotely
evaluated 335 patients with head trauma. Several serious head injuries were successfully managed.
Patients were seen at peripheral telemedicine centers and also at their homes. Commercially available
video conferencing systems were used. Laboratory reports and DICOM compatible images were
uploaded at the remote end enabling digital manipulation by the tele-consultant. Tele-discussions
of treatment options were conducted when transfer was recommended. Tele-consultation was used
for subsequent follow-up. A general surgeon, tele-mentored by the author remotely, operated upon
three cases of compound depressed skull fractures. Interestingly, there was a subsequent drop in
neurosurgical tele-referrals from telemedicine-enabled centers. The doctor at this remote center had
acquired the confidence to manage most cases of simple head trauma without the need for further
tele-consulting. A study in France, revealed that tele-radiology had a positive impact on emergency
neurosurgical care, reducing time to diagnosis, avoiding unnecessary transfers and initiating earlier
pre-hospital management. The acceptance of tele-consultation by the rural patient, the suburban
doctor and the suburban community was much better than expected. None of them were averse
to a tele-consultation. The tele-consultants have also accepted virtual interaction with a patient.
In a general, community hospital setting, less than 10% of head injuries require referral to highly
specialized neuro intensive care units or surgery. Earlier, the family physician did not have the skills
to manage head injuries or simple poly trauma cases. With immediate virtual access to specialists in
tertiary care centers through telemedicine, this is no longer true.