Device can be an important tool in cases of head trauma and stroke
Research conducted at Unicamp's Faculty of Medical Sciences (FCM) by neurosurgeon Luiz Adriano Esteves sought to verify the safety, effectiveness and reproducibility of screening neurological patients carried out using smartphones.
This type of triage makes it possible to prioritize the treatment of patients based on the severity of their neurological condition, in addition to reducing unnecessary transport of patients for evaluation. In a country of continental dimensions like Brazil, this is extremely relevant.
Advances in the area of data transmission and the evolution of smartphones allowed telemedicine to gain prominence as a tool in several areas of medicine.
“The use of smartphone for neurological screening can be an important tool to improve the care of patients with stroke or head trauma, for example, as long as its safety and effectiveness is verified”, says Esteves.
The study was carried out in the Neurosurgery discipline of the Department of Neurology of the Faculty of Medical Sciences (FCM) based on the analysis of 232 patients from three reference centers in neurosurgery in the State of São Paulo: the Hospital de Força Aérea de São Paulo, the Franco da Rocha State Hospital “Dr. Albano da França Rocha Sobrinho” and the Galileo Hospital and Maternity, in Valinhos.
The results obtained were published in the doctoral thesis Assessment of the safety, effectiveness and reproducibility of using telemedicine for neurosurgical screening, recently defended within the Neurology concentration area of the FCM postgraduate Science program. The guidance was given by professor and neurosurgeon Andrei Fernandes Joaquim.
Data used in the research are from medical records of patients undergoing emergency neurological evaluation. Age, sex, initial diagnosis, severity, computed tomography of the head, initial management, time until care, period of hospitalization, transportation for evaluation and the final result were evaluated.
The initial diagnoses in the medical records were 119 cases of traumatic brain injury (TBI), 35 cases of cerebrovascular accident (CVA); 27 headache; 15 seizures; 4 from subarachnoid hemorrhages (SAH); 4 from tumors and 28 from other diagnoses. In 78 cases, the patient was transported from other municipalities to neurosurgery reference services. The time interval between the onset of the neurological event and the service ranged from one hour to 730 hours, with an average time of 18 hours. Of the total, 105 patients were discharged from hospital after evaluation, 101 remained hospitalized and 26 underwent immediate surgery.
The computed tomography images were obtained by the researcher using a device smartphone with 8 megapixel rear video camera, with 3264 X 2448 pixel resolution for photographs and Full HD, with 60 frames per second for videos. The images were obtained using two different techniques: photography of the printed exam and filming of the exam while it was displayed on the computer monitor.
The data was stored on a hard drive and also through the use of cloud storage technology. Esteves sent the images obtained for evaluation by five independent neurosurgeons, also through smartphones Neurosurgeons had to compare data, identify pathological changes on tomography, identify potentially serious patients and evaluate the safety of transferring patients to neurosurgery reference services.
According to the research, through the use of telemedicine resources and smartphones, the evaluators were 95,69% correct in identifying pathological changes on computed tomography and 95,26% correct in identifying a severe neurological condition. Regarding management, the evaluators showed 100% agreement in cases where the patient underwent surgical treatment.
“The use of smartphones proved to be extremely safe since, in the 26 cases of immediate surgery, the evaluators only did not opt for this approach in three cases, but proposed transferring the patient to a service with neurosurgery”, says Esteves.
At the same time that telemedicine has great potential as a tool that can change many paradigms in medicine, it brings with it a series of new situations that demand reflection, debate and regulation, especially with regard to ethical issues and the privacy and security of the patient.
In Brazil, there is no detailed legislation or government regulation on telemedicine. There are some resolutions from the Federal Council of Medicine (CFM) regarding the topic. Currently, a proposal to regulate telemedicine in Brazil is being prepared in the CFM technical chamber.
According to Esteves, there needs to be an extensive discussion on the topic, in order to standardize the use of telemedicine by health professionals and in the hospital environment, as a way of overcoming the barriers arising from the lack of regulation and restrictions that do not make sense given the technological advances of recent years.
“In Brazil, although telemedicine projects have already been developed, this is an area that is still underutilized, especially in the area of neurosurgery. WhatsApp can be considered as a global communication system between hospitals in the future, reducing the costs of telemedicine and expanding network connections around the world”, says the neurosurgeon.