ImportanceNearly 30 million predominantly rural US residents lack timely access to trauma care expertise available at level I or II trauma centers. Telehealth is an established approach to improve access to health care expertise using remote consultation; however, the prevalence of use of telehealth in trauma (teletrauma) across the US is not known.ObjectiveTo examine the prevalence of, trends in, and factors associated with teletrauma use and adoption among US emergency departments (EDs).Design, Setting, and ParticipantsThis survey study included data from the National Emergency Department Inventory (NEDI)–USA survey from January 1, 2016, to December 31, 2020. Each year, a 1-page survey was sent to the directors of nonfederal, nonspecialty EDs by mail and email up to 3 times; nonresponders were further contacted via telephone to complete the survey. Data were analyzed from January to March 2023.Main Outcomes and MeasuresThe primary outcome was self-reported ED use of teletrauma for each year studied. Additional measures included data regarding self-reported use of any other telehealth service and ED characteristics. Multivariable logistic regression analyses were performed to assess ED characteristics associated with teletrauma use in 2020 and teletrauma adoption between 2017 and 2020.ResultsOf 5586 EDs in the US in 2020, 4512 had available teletrauma survey data (80.8% response rate); 379 (8.4%) of these EDs reported teletrauma use. In contrast, 2726 (60.4%) reported use of any other telehealth service. Teletrauma use (among EDs with any telehealth use) ranged between 0% in Alabama; Connecticut; Washington, DC; Indiana; New Jersey; Nevada; Oklahoma; Oregon; Rhode Island; and South Carolina to more than 60% in Arkansas (39 of 64 [60.9%]), South Dakota (31 of 41 [75.6%]), and North Dakota (30 of 35 [85.7%]). Factors associated with teletrauma use included rural location (odds ratio [OR], 2.44; 95% CI, 1.77-3.36), critical access hospital (OR, 2.67; 95% CI, 1.83-3.88), and basic stroke hospital vs nonstroke hospital (OR, 1.74; 95% CI, 1.32-2.30) designations. Factors associated with adoption of teletrauma by 2020 included critical access hospital (OR, 1.98; 95% CI, 1.35-2.90) and basic stroke hospital vs nonstroke hospital (OR, 1.42; 95% CI, 1.04-1.94) designation.Conclusion and RelevanceThis survey study found that teletrauma use lagged significantly behind use of other telehealth services in US EDs in 2020. While most EDs using teletrauma were located in rural areas, there was significant state-level variation in teletrauma use. Future research is needed on how teletrauma is being used and to identify barriers to its wider implementation.

中文翻译：

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远程创伤在美国急诊科的使用


重要性近 3000 万主要是农村的美国居民无法及时获得 I 级或 II 级创伤中心提供的创伤护理专业知识。远程医疗是一种使用远程会诊改善获得医疗保健专业知识的既定方法;然而，美国在创伤 （Teletrauma） 中使用远程医疗的普遍性尚不清楚。目的检查美国急诊科 （ED） 远程创伤使用和采用的患病率、趋势和相关因素。设计、设置和参与者这项调查研究包括 2016 年 1 月 1 日至 2020 年 12 月 31 日的国家急诊科量表 （NEDI）-USA 调查的数据。每年，通过邮件和电子邮件向非联邦、非专业急诊科主任发送一份 1 页的调查，最多 3 次;通过电话进一步联系未回答者以完成调查。主要结局和措施主要结局是每年自我报告的 ED 使用远程创伤。其他措施包括有关自我报告使用任何其他远程医疗服务和 ED 特征的数据。进行多变量 logistic 回归分析以评估与 2020 年远程创伤使用和 2017 年至 2020 年远程创伤采用相关的 ED 特征.结果在 2020 年美国的 5586 例 ED 中，4512 例有可用的远程创伤调查数据（80.8% 的回复率）;这些急诊科中有 379 名 （8.4%） 报告了远程创伤的使用。相比之下，2726 人 （60.4%） 报告使用任何其他远程医疗服务。远程创伤使用（在具有任何远程医疗使用的 ED 中）在阿拉巴马州为 0% 之间;康涅狄格州;华盛顿;印第安纳州;新泽西州;内华达州;俄克拉何马州;俄勒冈州;罗得岛州;南卡罗来纳州的 60% 以上：阿肯色州（64 例中的 39 例 [60.9%]）、南达科他州（41 例中的 31 例 [75.6%]）和北达科他州（35 个中的 30 个 [85.7%]）。与远程创伤使用相关的因素包括农村地区 （比值比 [OR]，2.44;95% CI，1.77-3.36）、重症监护医院 （OR，2.67;95% CI，1.83-3.88） 和基础卒中医院与非卒中医院 （OR，1.74;95% CI，1.32-2.30） 指定。到 2020 年采用远程创伤的相关因素包括重症监护医院 （OR， 1.98;95% CI， 1.35-2.90） 和基础卒中医院与非卒中医院 （OR， 1.42;95% CI， 1.04-1.94） 指定。结论和相关性这项调查研究发现，2020 年美国急诊科远程创伤的使用明显落后于其他远程医疗服务的使用。虽然大多数使用远程创伤的 ED 位于农村地区，但远程创伤的使用在州一级存在显着差异。未来需要研究如何使用远程创伤并确定其更广泛实施的障碍。