Neurosurgical Teleconsultation Safety in the Management of Mild Traumatic Injuries

Introduction: Mild traumatic injuries (MTIs) involving brain injuries, stable spine fractures, and low-grade blunt cerebrovascular injuries (BCVI) frequently lead to requests for inpatient neurosurgical evaluation. The onset of the COVID-19 pandemic accelerated the use of telecommunication advances in regular medical practice to minimize exposure while maintaining quality of care in patients. In our institution, we briefly implemented neurosurgical virtual or over-the-phone consultation (teleconsultation) for inpatient evaluation of MTIs unlikely to lead to neurosurgical decline or necessitate neurosurgical intervention. In this study, we evaluated teleconsultation safety in the management of MTIs.

Methods: We performed a retrospective cohort of 258 patients with MTIs admitted to a Level 1 trauma center from 2020-2022 for which neurosurgical evaluation was requested. Our study included 216 in-person, pre-pandemic consultations and 48 teleconsultations conducted during the pandemic. We applied propensity score matching at a 4:1 ratio, without replacement, to identify patients with similar characteristics among the in-person, pre-pandemic consults. This yielded 165 matched in-person consultations paired with 48 teleconsultations for comparison analysis. The primary outcome assessed was neurosurgical re-evaluation. The secondary outcome was neurological decline defined as cranial nerve dysfunction, seizures, or death.

Results: Of the total 213 injuries, the average age was 55 for the in-person cohort and 59 for the teleconsultations (p = 0.3). The in-person consult group contained 45% males and 55% females, while the teleconsultation group held 46% males and 54% females. In both groups, 18% required re-evaluation by neurosurgery, while only 3.29% experienced neurological decline. No statistically significant differences were found in number of neurosurgical re-evaluations or neurological decline between the consultation groups. No patient experienced permanent neurological damage or death. Increased GCS scores indicated decreased likelihood of re-evaluation (Estimate: -0.162, p = 0.02) or neurological decline (Estimate: -0.305, p < 0.001).

Conclusion : Evaluation of MTIs can be safely accomplished via teleconsultation. With broader acceptance of telehealth in the daily practice of medicine, initial inpatient evaluation of MTIs through teleconsultation can be an acceptable modality for these patients in a post-pandemic era.