490 Tele-TBI: A Telemedicine Triage Protocol Reduces Unnecessary Inter-Hospital Transfers for Mild Traumatic Brain Injuries

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INTRODUCTION: Complicated mild traumatic brain injury (cmTBI) is a common emergency consultation at community and tertiary hospitals. While neurosurgical evaluation is typically required to rule out immediate surgery, actual surgery is rare. To address this, our community hospitals implemented a telehealth-based neurosurgery consultation program (tele-TBI) for cmTBI patients. METHODS: A multidisciplinary team implemented tele-TBI at 4 community hospitals in March 2021. We retrospectively analyzed patients over the first 2 years (2021–2023) who either received a Teleconsultation (Tele-TBI group) or met eligibility criteria but did not receive Tele-TBI (Non-Tele-TBI group). Eligibility was based on defined clinical and radiographic criteria. Primary outcomes included inter-hospital transfers (necessary vs. unnecessary), admission (floor vs. ICU), ED observation, and home discharge. Secondary outcomes included 3-month safety data: mortality, ED returns, and neurosurgical interventions. Logistic regression identified transfer predictors. RESULTS: Among 179 cm TBI patients, 117 were in Tele-TBI group and 62 were in Non-Tele-TBI. Only 13% of Tele-TBI patients required transfer; 87% were managed locally. All non-Tele-TBI patients were transferred, with 84% to be discharged home to the tertiary center. All non-Tele-TBI transfers were unnecessary, while 6.7% of Tele-TBI transfers were unwarranted (p < 0.01). Tele-TBI transfers led to more floor admissions (67% vs. 16%, p < 0.01). Three-month mortality was not significantly different (1.6% vs. 0%, p = 0.77), and no ED returns were due to TBI progression. Logistic regression identified subdural hematoma (SDH) (OR 2.90, 95% CI 1.53–5.51) and age <80 (OR 4.00, 95% CI 1.78–8.89) as significant transfer predictors. CONCLUSIONS: Tele-TBI reduced unnecessary transfers, with over 4 out of 5 patients managed at community hospitals, reducing tertiary centers burden. Tele-TBI transfers were more often led to floor admission, reflecting better triage. Mortality was low and without significant difference among groups, highlighting approach’s safety.

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