TABLE 2.

List of Studies Comparing Neurosurgical Telemedicine Consults to Other Means of Consultation

	Study	Population	Study type	Patients included	Results	Interpretation
1	Klein13	Head trauma transfer triage	Retrospective cohort comparative study	Group 1: 98 patients evaluated for transfer via telemedicine	Group 1: 58% patients not transferred; 0% neurological sequela	Neurosurgical telemedicine reduces unnecessary head trauma transfers without neurological sequela	100% telemedicine encounters successful
				Group 2: 73 patients evaluated for transfer by non-neurosurgeons via guidelines	Group 2: 26% patients not transferred. 0% Neurological sequela
2	Meyer22	Thrombolytic administration for stroke	Randomized blinded prospective study	Group 1: 111 patients via telemedicine	Correct treatment decision made in 98% of group 1 vs 82% in group 2 (P = .0009)	Telemedicine is superior to telephone consultation for decision to administer thrombolytic	One telemedicine consult aborted for technical issues
				Group 2: 111 patients via telephone consultation
3	Wong39	Transfer triage (all subspecialties)	Randomized prospective study	Group 1: 235 patients via telephone consultation	Trend toward more favorable outcome (61%; P = .12) and reduced mortality (25%; P = .025) in group 2 compared with group 3 (54 and 33%, respectively)	Telemedicine had worse outcomes than teleradiology. However, interpretation complicated by high telemedicine technology failure rate	30.1% telemedicine consultation failure rate (technical issues)
				Group 2: 239 patients via Teleradiology consultation
				Group 3: 236 patients via video consultation
4	Poon44	Transfer triage (all subspecialties)	Randomized prospective study	Group 1: telephone consultation	Trend towards more favorable outcome in the group 3 (44%), vs group 2 (31%) and group 1 (38%)	Telemedicine had better outcomes than teleradiology and telephone consultations	53.4% video consultation failure rate (technical issues)
				Group 2: Teleradiology consultation	No P-values provided
				Group 3: Video consultation
				327 patients total, subgroup numbers not provided
5	Thakar49	Postoperative outpatient follow-up	Retrospective comparison study (patients chose face-to-face vs telemedicine visits	Group 1: 166 face-to-face visits	Group 1: mean cost of visit 6848 rupees	3% telemedicine patients referred for face-to-face visit (0.9% for neurosurgical problem, 2.0% for non-neurosurgical medical problem).	Reasons for referral to face-to-face visits not described
				Group 2: 1034 telemedicine visits	Group 2: mean cost of visit 2635 rupees
6	Reider-Deimer50	Postoperative outpatient follow-up	Retrospective cohort comparison	Group 1: 42 face-to-face visits	In first 90 d postop, group 1: 2.4% ER visit rate and 2.4% readmission rate vs group 2: 0% ER visit rate and 4.2% readmission rate	No significant difference between telemedicine and face-to-face visits for postoperative care	100% telemedicine encounters successful
				Group 2: 57 telemedicine visits
7	Mendez18	Remote programming of neuromodulation devices	Randomized prospective study	Group 1: 10 patients for face-to-face programming	No difference between groups for accuracy	No difference between groups for accuracy	100% telemedicine encounters successful
				Group 2: 10 patients for remote guidance of nurses for programming
8	Ionita1	Thrombolytic administration for stroke	Retrospective study	Group 1: 128 patients treated face-to-face at hub site	No significant difference between groups 1 and 2 for mortality (10.9% vs 11.1%; P = .34), ICH (20.3% vs 33.3% P < .35), good outcome of mRS 4 to 6 (52.3% vs 51.9% P = .16), or length of stay (8.8 vs 10.7 d, P < .23)	No difference between groups for outcomes	100% telemedicine encounters successful
				Group 2: 27 patients treated via telemedicine at spoke sites
9	Shoira24	Stroke trial enrollment	Retrospective review	Group 1: 117 patients enrolled face-to-face at hub site	Annual increase in trial enrollment higher in group 2 than group 1 (11.55 ± 11.30 vs 0.68 ± 1.03, P < .0005) and had increased correlation with total enrollment increase (0.98 vs 0.94, P < .0001)	Significantly more stroke patients successfully recruited to stroke trials in telemedicine group	100% telemedicine encounters successful
				Group 2: 182 patients enrolled via telemedicine at spoke sites
10	Jackson35	Pediatric transfer triage	Retrospective review	All patients ≤ 18 y/o	Group 1 had trend towards decreased rates of repeat preoperative neuroimaging (P = .62), short time between trauma bay arrival and surgery (P = .22), diagnosis to surgery (P = .45), and higher home discharge rates (P = .28).	Telemedicine consult during interhospital transport of pediatric patients with operative intracranial hemorrhage appears to expedite emergent care and decrease decreased postoperative length of hospitalization	100% telemedicine encounters successful
				Group 1: 8 via telemedicine	Also trend towards shorter ICU stay (P = .338) and hospitalization (P = .409)
				Group 2: 7 nontelemedicine
11	Angileri19	Acute transfer triage	Retrospective review	Group 1: 2819 patients evaluated via telemedicine	Trend toward faster neurosurgical consult for group 1 (38 min vs 160 min) (P-value not specified)	Telemedicine consult faster for determining need to transfer than nontelemedicine consult	100% telemedicine encounters successful infeasible
				Group 2: patients evaluated before telemedicine implemented, number not specified
12	Demaerschalk (2010)20	Thrombolytic administration for stroke	Prospective blinded study	Group 1: 138 patients evaluated via telemedicine	Correct treatment decision: 85% group 1 and 89% group 2 (P > .999),	Telemedicine is equivalent to telephone consultation for decision to administer thrombolytic	100% telemedicine encounters successful
				Group 2: 138 patients evaluated via telephone consultation	No difference between groups for good 90-d functional outcome, mRS, or mortality
13	Demaerschalk (2012)21	Thrombolytic administration for stroke	Prospective blinded study	Group 1: 27 patients evaluated via telemedicine	Correct decision regarding thrombolytic administration 96% for group 1 and 83% for group 2 odds ratio (OR) 4.2; 95% CI	Telemedicine is superior to telephone consultation for decision to administer thrombolytic	100% telemedicine encounters successful
				Group 2: 27 patients evaluated via telephone consultation	CI 1.69-10.46; P = .002).
14	Schwab30	Thrombolytic administration for stroke	Prospective study	Group 1: 170 patients evaluated via telemedicine	For group 1 and group 2, mortality rates were 11.2% vs 11.5% at 3 mo (P = .55), good functional outcome was 39.5% vs 30.9% (P = .10)	Telemedicine is equivalent to telephone consultation for decision to administer thrombolytic	100% telemedicine encounters successful
				Group 2: 132 patients evaluated face-to-face
15	Handschu31	Stroke care	Prospective study	Group 1: 77 patients evaluated via telemedicine	Group 2 compared to group 1 had higher stroke center transfers (9.1% vs 14.9%, P < .05), higher 10 d mortality (6.8% vs 1.3%, P < .05), diagnosis had to be corrected more frequently (17.6% vs 7.1%, P < .05)	Telemedicine had fewer transfers, lower 10 d mortality, and more frequent correct diagnosis compared to telephone consultation	100% telemedicine encounters successful
				Group 2: 74 patients evaluated via telephone
16	Goh48	Acute transfer triage	Prospective study	Group 1: 66 patients had telemedicine consult	Group 1 compared to group 2 had 21% fewer unnecessary transfers, fewer complications during transfers (8% vs 32%, P = .002), and transfer time shortened (72 min vs 80 min, P = .38)	Telemedicine resulted in fewer unnecessary transfers, fewer complications during transfers, and shorter time to transfer	100% telemedicine encounters successful
				Group 2: 50 patients before telemedicine available

ER: emergency room; mRS: modified Rankin Score.