Teleneurosurgery : outcome of mild head injury patients managed in non-neurosurgical center in the state of Johor

Background: Technological advancement has influenced the way health care professions in managing cases. The implementation of teleneurosurgey been has proven to reduce the rate of unnecessary transfer of patient from primary hospital to hospitals with neurosurgical services. Head injury patients are among those who were managed in the primary hospital under the care of general surgical unit (GSU), with the help of teleneurosurgery. As more head injury patients are managed utilizing this model of management, there are growing concerns regarding the safety and outcome of the patients with no immediate neurosurgical services. This study is to evaluate the outcome of patients with mild head injury who were managed in non-neurosurgical centers with the help of teleneurosurgery. Methods: This study was conducted in the period of 16 months from the month of June 2015 through September 2016, by recruiting samples from five primary hospitals utilizing teleneurosurgery for neurosurgical consultations in managing mild head injury cases in Johor state. Low risk mild head injury patients that undergone CT brain were referred to neurosurgical (NSU) unit HSAJB and was managed remotely in the GSU. Two main outcomes were noted; favourable and unfavourable. Unfavourable outcome was considered when the patient needs a delay transfer to NSU, death, or discharge with a lower Glasgow Coma Scale (GCS) from admission. A follow up review of the Glasgow Outcome Scale (GOS) at 3 and 6 months was noted in the study. Results: A total number of three 359 samples were recruited in this study with a total of 36 exclusion. Mean age of the patients were of 45.39 years old, with 77.2% of them were male. Malay ethnicity constitutes a majority of 60.45% of all the subjects. A total of 11(3.06%) patients had an unfavourable outcome with 10(2.79%) needing a delay transfer to NSU. There was no significant difference in GOS at 3 and 6 months for patient in the unfavourable group (p=0.368) on McNemar test. Unvariate analysis reveals Malay ethnicity (p=0.021) and referral GCS (p=0.024) are two important factors in determining patient’s outcome. This finding was however not reproducible when using multivariate analysis. Conclusion: Despite absence of identified factor on multivariate analysis that determines patient’s outcome, Malay ethnicity and referral GCS are two possible important factors if larger sample was studied. The percentage of failure in utilizing this model of practice is relatively low, 3.06%. A prospective and multicentric model study with a bigger sample size is proposed in order to address the limitation encountered in this study