The use of telemedicine to provide pediatric critical care consultations to pediatric trauma patients admitted to a remote trauma intensive care unit

OBJECTIVE: Injured pediatric patients in remote communities are often cared for at trauma centers that may be underserved with respect to pediatric specialty services. The objective of this study is to describe a pilot telemedicine project that allows a remote trauma center's adult intensive care unit to obtain nontrauma, nonsurgical-related pediatric critical care consultations for acutely injured children. DESIGN: Nonconcurrent cohort design. SETTING: A remote, level II trauma center's shock-trauma intensive care unit and a tertiary care children's hospital pediatric intensive care unit. PATIENTS: Analyses were conducted on cohorts of pediatric trauma patients (<16 yrs) consecutively admitted to the remote adult intensive care unit, including historical control patients and patients who received and did not receive telemedicine consultations. INTERVENTIONS: Telemedicine consultations were obtained at the discretion of the remote intensive care unit provider for nontrauma, nonsurgical medical issues. MEASUREMENTS AND RESULTS: The Injury Severity Score and Trauma and Injury Severity Score were used to assess severity of injury and predicted mortality rates, respectively, for the patient cohorts. Parental and provider satisfaction with the telemedicine consultations was also described. Thirty-nine consultations were conducted on 17 patients from the 97 pediatric patients admitted during the 2-yr study. Patients who received consultations were younger (5.5 yrs vs. 13.3 yrs, p <.01) and were more severely injured (mean Injury Severity Score = 18.3 vs. 14.7, p =.07). Severity-adjusted mortality rates were consistent with Trauma and Injury Severity Score expectations. Satisfaction surveys suggested a high level of provider and parental satisfaction. CONCLUSIONS: Our report of a trauma intensive care unit based pediatric critical care telemedicine program demonstrates that telemedicine consultations to a remote intensive care unit are feasible and suggests a high level of satisfaction among providers and parents.