Tele-Emergency Medicine in Remote Trauma Care within Resource-Limited Settings: A Systematic Review and Meta-Analysis.
Kanayo Kizito Uka, Chukwu Alphonsus Chekwube, Amujiogu Ikechukwu Peter, Philip Omede Alexander, Onu-Njoku Charles Enyinnaya and Onia Orinate Peters*
ABSTRACT
Background: Trauma accounts for 10% of global mortality, yet over five billion people lack access to timely surgical care, particularly in remote and resourcelimited settings. Tele-emergency medicine (TEM) offers a potential solution by connecting frontline providers with remote specialists.
Objective: To systematically evaluate the effect of TEM on clinical outcomes, timeliness of care, contextual modifiers, and cost effectiveness in remote trauma care within resource-limited settings.
Methods: A systematic review and meta-analysis was conducted following PRISMA guidelines. PubMed/MEDLINE (ID: 4205), Scopus, Web of Science, Cochrane Library, and other sources were searched. Studies reporting trauma patients in resource-limited settings receiving TEM compared to standard care were included. Random-effects meta-analysis was performed for mortality and time-to-definitive care.
Results: Of 4,205 records identified, 20 studies met inclusion criteria, with 14 contributing to meta-analysis. TEM was associated with a 28% reduction in mortality (pooled RR = 0.72; 95% CI: 0.58–0.89; p = 0.002; I² = 58%) and a 34.2-minute reduction in time-to definitive care (95% CI: 27.5–40.9; p < 0.001; I² = 72%). Complications reduced in 4 of 6 studies. Overtriage decreased by 12–28%. Cost savings included 3,200 per transfer avoided and 3,200 per transfer avoided and 15 per TEM consultation versus $120 in-person. Video consultation and LMIC settings showed larger effects.
Conclusion: TEM reduces mortality and time-to-definitive care in remote trauma settings, with evidence of cost-effectiveness. Infrastructure investment and video-enabled platforms are recommended for implementation.
