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Telemedicine Shows Promise for Evaluation of Comatose ICU Patients

PHOENIX, AZ — Comatose patients must be regularly assessed in ICUs so clinical status changes can be quickly recognized and appropriate interventions undertaken.

A new study published in the journal Telemedicine and e-Health raises the question of whether physicians need to be physically present to conduct the evaluations.

Instead, suggests the study conducted at the Mayo Clinic’s Arizona facility, robotic telemedicine can be used successfully to complete the assessment.

"To assess a patient in an intensive care unit who has an altered level of consciousness or coma, doctors must track the patient's progress through bedside clinical examinations," explained senior author Bart Demaerschalk, MD. "This assessment is commonly completed through the use of either the Glasgow Coma Scale or the Full Outline of UnResponsiveness Score scale. These scales are scoring systems that allow providers to measure a patient's level of consciousness."

Over a 15-month period, 16 physicians performed assessments on 100 patients. Two providers were randomly assigned to each patient, who had a mean age of 70.8 — one provider conducting the assessment at the patient's bedside, and the other provider conducting the assessment using a real-time audio and visual robotic telemedicine system.

At the end of the five-minute evaluation, each physician independently scored the patients using both the Glasgow Coma Scale (GCS) and the Full Outline of UnResponsiveness (FOUR) Score scale.

Results indicate that mean GCS total score at bedside was 7.5 vs. remotely conducted examination score of 7.23. The mean FOUR total score, meanwhile, was 9.63 at bedside vs. a remote examination score of 9.21.

“Differences between total bedside and remote GCS and FOUR scores were small,” according to study authors. “Telemedicine could be adopted to help evaluate critically ill patients in neurologically underserved areas.”

"This is good news in many ways," suggested first author Amelia Adcock, MD. "We use telemedicine frequently when evaluating acute stroke patients. This study suggests yet another way telemedicine can enhance patient care. There is a shortage of intensive care unit providers and facilities with round-the-clock patient coverage. Telemedicine can provide a way to ameliorate this shortage and improve early evaluation of critically ill patients."