Neurosurgical Teleconsultation Safety for Mild Traumatic Brain Injuries and Low-Grade Blunt Cerebrovascular Injuries.

Abstract

Mild traumatic brain injuries, stable spine fractures, and low-grade blunt cerebrovascular injuries are frequent at level I trauma centers and often prompt neurosurgery consultation, regardless of clinical status. We evaluated the safety and utility of virtual consultations (teleconsultations [TECs]) in the management of these injuries. We performed a retrospective review of 260 patients admitted to a level I trauma center from 2020 to 2022. Groups were divided by consultation type, with 210 in-person consultations and 48 TECs. Propensity score matching, accounting for covariates, was performed to maintain unbiased comparability based on observed characteristics. With a 4:1 matching ratio, 165 in-person consultations were compared with 48 TECs. Outcome differences between groups were assessed by χ 2 test based on neurological and/or neurosurgical re-evaluation. Univariate and multivariate regression models were used to determine predictive value of patient characteristics and outcomes. Of the total matched 213 injuries, the average age was 55 years for the in-person cohort and 59 for the TECs ( P = .3). Gender distribution was similar in both groups. Rates of neurosurgical re-evaluation (18%) and neurological decline (3.29%) were similar, and no patients experienced permanent neurological injury or death. Higher Glasgow Coma scale scores were associated with decreased likelihood of re-evaluation ( P = .02) or neurological decline ( P < .001). No predictive factors were identified in the TEC group. Neurosurgical TEC may be effective in management and treatment of nonoperative mild traumatic brain injury and low-grade blunt cerebrovascular injuries. Future multicenter studies should evaluate TEC safety and generalizability across diverse clinical settings.