RESUMO
We carried out a retrospective analysis of all emergency referrals to the neurosurgery department of the Wentworth Hospital from 1996 to 1999. The hospital provided a service to seven peripheral hospitals with computerized tomography (CT) scanners and 46 hospitals without, in the province of KwaZulu Natal. By the end of the study, six of the hospitals with CT scanners had facilities for teleradiology and the mean patient return rate had fallen to 17%. In comparison, almost half the patients seen from the hospitals with no CT scanners were returned to hospital after assessment at the Wentworth Hospital. We also carried out a prospective analysis of 100 consecutive teleradiology-assisted consultations from January to March 2000. Of the 57 patients (79%) who remained at their referral hospitals, 45 had a good outcome, while the other 12 (21%) patients had a poor outcome. The implementation of teleradiology-assisted consultation decreased the number of inappropriate inter-hospital transfers while maintaining appropriate patient care and improving outcome.
Assuntos
Neurocirurgia/normas , Consulta Remota/normas , Telerradiologia/normas , Adulto , Pré-Escolar , Emergências , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Neurocirurgia/métodos , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Consulta Remota/métodos , Estudos Retrospectivos , África do Sul , Telerradiologia/métodos , Tomografia Computadorizada por Raios X/métodosAssuntos
Endoscopia/métodos , Hidrocefalia/terapia , Ventriculostomia/métodos , Criança , Pré-Escolar , Custos e Análise de Custo , Endoscopia/efeitos adversos , Endoscopia/economia , Feminino , Humanos , Hidrocefalia/etiologia , Lactente , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento , Ventriculostomia/efeitos adversos , Ventriculostomia/economiaRESUMO
Some children with craniosynostosis demonstrate raised intracranial pressure (ICP), requiring surgical decompression. Conventional methods of measuring ICP in such children are invasive, expensive, and require expertise. Transcranial Doppler ultrasonography (TCD) is an alternative, useful means of assessing ICP qualitatively, and is noninvasive, inexpensive, and safe. We evaluated the use of TCD prospectively in 16 children with craniosynostosis and correlated TCD findings with intraoperative ICP measurements by lumbar puncture (LP) and with computed tomographic (CT) findings. TCD evaluations were performed before and after surgery to determine the pulsatility index (PI), which is known to show close correlation with ICP. The three modalities--TCD, ICP, and CT--showed poor correlation with each other. However, the fall in the PI value after surgery, as determined by TCD, was shown to be clinically useful, with a rise in the PI value after surgery being an ominous sign.
