JMIR Publications

ABSTRACT

To systematically review whether the clinical outcomes achieved favours telemedicine decision support for medical interventions during prehospital care. Design: systematic review of peer-reviewed journal articles. Data sources: Searches of seven databases and in relevant reviews. Eligibility criteria: Studies were included that covered telemedicine based on data/information sharing and communication with the objective of support for medical decisions (e.g. diagnosis, treatment, receiving hospital decision) in a prehospital emergency setting. Simulation studies and paediatric populations were excluded.

Methods:

The procedures in this review followed the PRISMA statement. ROBINS-I was used for the assessment of risk of bias. The results were synthesised based on predefined aspects of medical decisions that are made in a prehospital setting which include diagnostic decision support, receiving facility decisions, and medical directions for treatment. All data extractions were done by at least two reviewers independently.

Results:

Out of 42 full-text reviews, seven were found eligible. Diagnostic support and medical direction/decision for treatments were often reported. A majority of the articles described the clinical value of having access to remote experts without robust quantitative data. Most telemedicine solutions were evaluated as a feasibility or short-term preliminary study. In general, the results were positive for telemedicine use, however biases, due to confounding factors pre-intervention, and a lack of documentation on quality assurance and protocol for telemedicine activation, makes it difficult to determine the direct effect on patient outcomes.

Conclusions:

The information-sharing capacity of telemedicine enables access to remote experts to support medical decisions being made at scene or in prolonged field care. The influence of human and technology factors on patient care is poorly understood and documented.