Impact of telemedicine on hospital transport, length of stay, and medical outcomes in infants with suspected heart disease: a multicenter study.

BACKGROUND: Previous single-center studies have shown that telemedicine improves care in newborns with suspected heart disease. The aim of this study was to test the hypothesis that telemedicine would shorten time to diagnosis, prevent unnecessary transports, reduce length of stay, and decrease exposure to invasive treatments. METHODS: Nine pediatric cardiology centers entered data prospectively on patients aged <6 weeks, matched by gestational age, weight, and diagnosis. Subjects born at hospitals with and without access to telemedicine constituted the study group and control groups, respectively. Data from patients with mild or no heart disease were analyzed. RESULTS: Data were obtained for 337 matched pairs with mild or no heart disease. Transport to a tertiary care center (4% [n = 15] vs 10% [n = 32], P = .01), mean time to diagnosis (100 vs 147 min, P < .001), mean length of stay (1.0 vs 26 days, P = .005) and length of intensive care unit stay (0.96 vs 2.5 days, P = .024) were significantly less in the telemedicine group. Telemedicine patients were significantly farther from tertiary care hospitals than control subjects. The use of inotropic support and indomethacin was significantly less in the telemedicine group. By multivariate analysis, telemedicine patients were less likely to be transported (odds ratio, 0.44; 95% confidence interval, 0.23-0.83) and less likely to be placed on inotropic support (odds ratio, 0.16; 95% confidence interval, 0.10-0.28). CONCLUSIONS: Telemedicine shortened the time to diagnosis and significantly decreased the need for transport of infants with mild or no heart disease. The length of hospitalization and intensive care stay and use of indomethacin and inotropic support were less in telemedicine patients.

Neuropsychologic impairment and MRI abnormalities associated with chronic solvent abuse.

OBJECTIVE: Individuals chronically abusing organic solvents have been reported in the medical literature for almost four decades to have a variety of neurological abnormalities. Most have been single case reports or studies in small numbers of individuals. The purpose of this study was to evaluate the neurologic and neuropsychologic effects of chronic solvent abuse in a larger group of individuals and compare the results to a control group of other drug abusers. Attempts to estimate a dose-response relationship between solvent abuse and either neuropsychological tests or magnetic resonance imaging (MRI) abnormalities were also undertaken. METHODS: A sample of 55 solvent abusers was compared to a sample of 61 users of other drugs, especially cocaine and alcohol, on a battery of cognitive and neuropsychological tests. Fifty of the solvent abusers and 51 members of the comparison sample also underwent MRI of the brain. Comparisons were made by means of multivariate analysis of variance and covariance. RESULTS: Compared to the general population, both groups performed poorly, scoring below the mean on most neuropsychological measures. Solvent abusers performed more poorly than the comparison sample on measures of working memory and executive cognitive functions. Both groups showed evidence of abnormal MRI findings, but a greater percentage of the solvent abuse group showed such abnormalities. No clear dose-response relationship was seen between solvent abuse and abnormalities on neuropsychological tests, but a strong dose-response relationship was seen in the presence of MRI abnormalities. CONCLUSION: The findings in this study document widespread cognitive impairment, which could not be attributed to the effects of solvents entirely. These findings expand upon previous data regarding neurological abnormalities in solvent abusers, by demonstrating a dose-response relationship with MRI abnormalities. An unexpected finding was the high prevalence of neuropsychological impairment and MRI abnormalities among the comparison group. The results of this study has implications regarding low-level solvent exposure, as in the occupational setting, suggesting that MRI may be a more useful tool to sort out the presence of neurological abnormalities rather than neuropsychological tests. Since no dose-response relationship was seen between solvent abuse and neuropsychological testing, reliance upon these tests in assessing neurological injury from solvents is a highly dubious practice.