{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T18:01:13Z","timestamp":1788026473657,"version":"build-2784847793"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Complicated mild traumatic brain injury (cmTBI) is a common emergency consultation in trauma care at community and tertiary hospitals. While neurosurgical evaluation is typically required, actual neurosurgical intervention is rare. The aim of this study was to evaluate the adoption, safety, and effectiveness of a telemedicine-based neurosurgery consultation program (tele-TBI) in reducing unnecessary interhospital transfers of patients with cmTBI.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n A multidisciplinary team implemented the tele-TBI program at 4 community hospitals. Patients with cmTBI who were eligible to receive telehealth consultations over the first 2 years of the program were retrospectively analyzed. The program\u2019s impact on reducing interhospital transfers, disposition outcomes, and safety were assessed.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Of 179 eligible patients (94 female, mean age 75 years) reviewed, 117 underwent tele-TBI consultation and 62 did not. Among the patients with tele-TBI consultations, 15 (13%) were transferred to tertiary centers, with 2 (1.7%) admitted to the ICU, 10 (8.5%) admitted to the floor, and 3 (2.6%) managed in the emergency department. Most patients (87%) who underwent tele-TBI consultation were effectively managed at community hospitals; 90 (77%) were observed in the emergency department then discharged and 12 (10%) were admitted. In contrast, all 62 patients without tele-TBI consultation were transferred to tertiary hospitals, of whom 10 (16%) were admitted and 52 (84%) were observed in the emergency department and then discharged. Multivariate analysis revealed that subdural hematoma (OR 2.90, 95% CI 1.53\u20135.51) and age < 80 years (OR 0.25, 95% CI 0.11\u20130.56) significantly influenced the likelihood of transfer.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The tele-TBI program reduced unnecessary interhospital transfers. Notably, most patients with tele-TBI consultation were successfully managed in their community hospital. Moreover, nearly 4 of 5 patients without tele-TBI consultation were transferred, only to be discharged directly from the tertiary referral center\u2019s emergency department.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.7.jns25409","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T17:26:37Z","timestamp":1765214797000},"page":"539-546","source":"Crossref","is-referenced-by-count":2,"title":["Telemedicine-based triage protocol for complicated mild traumatic brain injury: a strategy to reduce unnecessary interhospital transfers"],"prefix":"10.3171","volume":"144","author":[{"given":"Forough","family":"Yazdanian","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Beth Israel Deaconess Medical Center;"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Enriquez-Marulanda","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Beth Israel Deaconess Medical Center;"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan S.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Beth Israel Deaconess Medical Center;"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan A.","family":"Stenson","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Beth Israel Deaconess Medical Center;"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle W.","family":"Trecartin","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Beth Israel Deaconess Medical Center;"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terrance","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Beth Israel Deaconess Medical Center;"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason C.","family":"Imperato","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Beth Israel Deaconess Medical Center;"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger B.","family":"Davis","sequence":"additional","affiliation":[{"name":"General Medicine, Beth Israel Deaconess Medical Center; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo L.","family":"Rosen","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Beth Israel Deaconess Medical Center;"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron L.","family":"Alterman","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Beth Israel Deaconess Medical Center;"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Stippler","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Beth Israel Deaconess Medical Center;"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Low rate of delayed deterioration requiring surgical treatment in patients transferred to a tertiary care center for mild traumatic brain injury","volume":"29","author":"Carlson AP","year":"2010","unstructured":"Carlson AP, Ramirez P, Kennedy G, McLean AR, Murray-Krezan C, Stippler M. Low rate of delayed deterioration requiring surgical treatment in patients transferred to a tertiary care center for mild traumatic brain injury. Neurosurg Focus. 2010;29(5):E3."},{"issue":"4","key":"b2","series-title":"Neurosurgery","first-page":"773","article-title":"Pathway-based reduction of repeat head computed tomography for patients with complicated mild traumatic brain injury: implementation and outcomes","volume":"88","author":"Stippler M","year":"2021","unstructured":"Stippler M, Keith S, Nelton EB, Pathway-based reduction of repeat head computed tomography for patients with complicated mild traumatic brain injury: implementation and outcomes. Neurosurgery. 2021;88(4):773\u2013778."},{"issue":"5","key":"b3","series-title":"IHS Primary Care Provider","first-page":"99","article-title":"Management of acute head trauma in rural locations: University of New Mexico teleradiology initiative for mild traumatic brain injury. 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Telemed J E Health. 2010;16(9):945\u2013949."},{"key":"b5","series-title":"Am J Emerg Med","first-page":"340","article-title":"Outcomes of a novel ED observation pathway for mild traumatic brain injury and associated intracranial hemorrhage","volume":"45","author":"Singleton JM","year":"2021","unstructured":"Singleton JM, Bilello LA, Greige T, Outcomes of a novel ED observation pathway for mild traumatic brain injury and associated intracranial hemorrhage. Am J Emerg Med. 2021;45:340\u2013344."},{"issue":"2","key":"b6","series-title":"West J Emerg Med","first-page":"307","article-title":"Rapid discharge after interfacility transfer for mild traumatic intracranial hemorrhage: frequency and associated factors","volume":"20","author":"Borczuk P","year":"2019","unstructured":"Borczuk P, Van Ornam J, Yun BJ, Penn J, Pruitt P. Rapid discharge after interfacility transfer for mild traumatic intracranial hemorrhage: frequency and associated factors. 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Am J Emerg Med. 2017;35(9):1281\u20131284."},{"issue":"3","key":"b15","series-title":"Neurosurgery","first-page":"450","article-title":"Interhospital transfer of neurosurgical patients: implications of timing on hospital course and clinical outcomes","volume":"81","author":"Holland CM","year":"2017","unstructured":"Holland CM, Lovasik BP, Howard BM, McClure EW, Samuels OB, Barrow DL. Interhospital transfer of neurosurgical patients: implications of timing on hospital course and clinical outcomes. Neurosurgery. 2017;81(3):450\u2013457."},{"issue":"4","key":"b16","series-title":"J Stroke Cerebrovasc Dis","first-page":"105616","article-title":"A triage model for interhospital transfers of low risk intracerebral hemorrhage patients","volume":"30","author":"Kaleem S","year":"2021","unstructured":"Kaleem S, Lutz MW, Hernandez CE, A triage model for interhospital transfers of low risk intracerebral hemorrhage patients. 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BMC Health Serv Res. 2025;25(1):234."},{"issue":"5","key":"b1","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Low rate of delayed deterioration requiring surgical treatment in patients transferred to a tertiary care center for mild traumatic brain injury","volume":"29","author":"Carlson AP","year":"2010","unstructured":"Carlson AP, Ramirez P, Kennedy G, McLean AR, Murray-Krezan C, Stippler M. Low rate of delayed deterioration requiring surgical treatment in patients transferred to a tertiary care center for mild traumatic brain injury. 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Management of acute head trauma in rural locations: University of New Mexico teleradiology initiative for mild traumatic brain injury. Native Health Database. IHS Primary Care Provider. 2011;36(5):99\u2013104.Accessed August 5, 2025.https:\/\/nativehealthdatabase.net\/digital-heritage\/management-acute-head-trauma-rural-locations-university-new-mexico-teleradiology"},{"issue":"9","key":"b4","series-title":"Telemed J E Health","first-page":"945","article-title":"The impact of a telehealth web-based solution on neurosurgery triage and consultation","volume":"16","author":"Moya M","year":"2010","unstructured":"Moya M, Valdez J, Yonas H, Alverson DC. The impact of a telehealth web-based solution on neurosurgery triage and consultation. Telemed J E Health. 2010;16(9):945\u2013949."},{"key":"b5","series-title":"Am J Emerg Med","first-page":"340","article-title":"Outcomes of a novel ED observation pathway for mild traumatic brain injury and associated intracranial hemorrhage","volume":"45","author":"Singleton JM","year":"2021","unstructured":"Singleton JM, Bilello LA, Greige T, Outcomes of a novel ED observation pathway for mild traumatic brain injury and associated intracranial hemorrhage. Am J Emerg Med. 2021;45:340\u2013344."},{"issue":"2","key":"b6","series-title":"West J Emerg Med","first-page":"307","article-title":"Rapid discharge after interfacility transfer for mild traumatic intracranial hemorrhage: frequency and associated factors","volume":"20","author":"Borczuk P","year":"2019","unstructured":"Borczuk P, Van Ornam J, Yun BJ, Penn J, Pruitt P. Rapid discharge after interfacility transfer for mild traumatic intracranial hemorrhage: frequency and associated factors. West J Emerg Med. 2019;20(2):307\u2013315."},{"issue":"4","key":"b7","series-title":"J Trauma Acute Care Surg","first-page":"965","article-title":"The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons","volume":"76","author":"Joseph B","year":"2014","unstructured":"Joseph B, Friese RS, Sadoun M, The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons. J Trauma Acute Care Surg. 2014;76(4):965\u2013969."},{"issue":"9","key":"b8","series-title":"JAMA Surg","first-page":"866","article-title":"Improving hospital quality and costs in nonoperative traumatic brain injury: the role of acute care surgeons","volume":"150","author":"Joseph B","year":"2015","unstructured":"Joseph B, Pandit V, Haider AA, Improving hospital quality and costs in nonoperative traumatic brain injury: the role of acute care surgeons. JAMA Surg. 2015;150(9):866\u2013872."},{"issue":"3","key":"b9","series-title":"J Trauma Acute Care Surg","first-page":"483","article-title":"Safety and efficacy of brain injury guidelines at a Level III trauma center","volume":"84","author":"Martin GE","year":"2018","unstructured":"Martin GE, Carroll CP, Plummer ZJ, Safety and efficacy of brain injury guidelines at a Level III trauma center. J Trauma Acute Care Surg. 2018;84(3):483\u2013489."},{"key":"b10","series-title":"World Neurosurg","first-page":"e340","article-title":"Telemedicine for neurotrauma prevents unnecessary transfers: an update from a nationwide program in Albania and analysis of 590 patients","volume":"128","author":"Olldashi F","year":"2019","unstructured":"Olldashi F, Latifi R, Parsikia A, Telemedicine for neurotrauma prevents unnecessary transfers: an update from a nationwide program in Albania and analysis of 590 patients. World Neurosurg. 2019;128:e340\u2013e346."},{"key":"b11","series-title":"World Neurosurg","first-page":"100","article-title":"Mild traumatic brain injury in patients on long-term anticoagulation therapy: do they really need repeated head CT scan?","volume":"93","author":"Uccella L","year":"2016","unstructured":"Uccella L, Zoia C, Perlasca F, Bongetta D, Codec\u00e0 R, Gaetani P. Mild traumatic brain injury in patients on long-term anticoagulation therapy: do they really need repeated head CT scan? World Neurosurg. 2016;93:100\u2013103."},{"key":"b12","series-title":"World Neurosurg","first-page":"702","article-title":"Maximizing interhospital transfer resources for neurosurgical patients","volume":"104","author":"Schnurman Z","year":"2017","unstructured":"Schnurman Z, Chin R, Fishkin ER, Huang PP. Maximizing interhospital transfer resources for neurosurgical patients. World Neurosurg. 2017;104:702\u2013708."},{"issue":"4","key":"b13","series-title":"Ann Emerg Med","first-page":"351","article-title":"Cost-effectiveness of helicopter versus ground emergency medical services for trauma scene transport in the United States","volume":"62","author":"Delgado MK","year":"2013","unstructured":"Delgado MK, Staudenmayer KL, Wang NE, Cost-effectiveness of helicopter versus ground emergency medical services for trauma scene transport in the United States. Ann Emerg Med. 2013;62(4):351\u2013364.e19."},{"issue":"9","key":"b14","series-title":"Am J Emerg Med","first-page":"1281","article-title":"Opportunity to reduce transfer of patients with mild traumatic brain injury and intracranial hemorrhage to a Level 1 trauma center","volume":"35","author":"Yun BJ","year":"2017","unstructured":"Yun BJ, White BA, Benjamin Harvey H, Opportunity to reduce transfer of patients with mild traumatic brain injury and intracranial hemorrhage to a Level 1 trauma center. 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J Stroke Cerebrovasc Dis. 2021;30(4):105616."},{"issue":"6","key":"b17","series-title":"Am J Emerg Med","first-page":"1097","article-title":"Redefining mild traumatic brain injury (mTBI) delineates cost effective triage","volume":"38","author":"Arnold MR","year":"2020","unstructured":"Arnold MR, Cunningham KW, Atkins TG, Redefining mild traumatic brain injury (mTBI) delineates cost effective triage. Am J Emerg Med. 2020;38(6):1097\u20131101."},{"issue":"4","key":"b18","series-title":"Am J Surg","first-page":"665","article-title":"Trauma center transfer of elderly patients with mild traumatic brain injury improves outcomes","volume":"219","author":"Velez AM","year":"2020","unstructured":"Velez AM, Frangos SG, DiMaggio CJ, Berry CD, Avraham JB, Bukur M. Trauma center transfer of elderly patients with mild traumatic brain injury improves outcomes. 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Scand J Trauma Resusc Emerg Med. 2023;31(1):34."},{"issue":"1","key":"b20","series-title":"BMC Health Serv Res","first-page":"234","article-title":"Decision-making in interhospital transfer of traumatic brain injury patients: exploring the perspectives of surgeons at general hospitals and neurosurgeons at neurotrauma centres","volume":"25","author":"Cuevas-\u00d8strem M","year":"2025","unstructured":"Cuevas-\u00d8strem M, Wisborg T, R\u00f8ise O, Helseth E, Jeppesen E. Decision-making in interhospital transfer of traumatic brain injury patients: exploring the perspectives of surgeons at general hospitals and neurosurgeons at neurotrauma centres. 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