Comparison of Emergency Neurosurgical Referrals Using Instant Messaging Application versus Smart Glasses to Optimize Telehealth Solutions for the Developing World

OBJECTIVE: Prompt and precise decision-making and management are important in neurosurgery for best outcomes. Emergency neurosurgical referral at the forefront of patients' journey is the most important checkpoint, although usually a junior doctor stands guard here lacking knowledge, skills, and confidence. Information is subsequently relayed to the specialist in delayed fashion subject to inadequacies and discrepancies. Our study objective was to determine if telehealth via smart glasses was feasible and effective to overcome the barriers and challenges associated with emergency neurosurgical referrals. METHODS: A pair of junior doctor and specialist used either WhatsApp (Meta, Inc) or smart glasses during emergency neurosurgical referrals. In WhatsApp referrals, the junior doctor reviews the patient and sends a summary message with relevant radiologic imaging to the specialist, who then responds with a management plan. In smart glasses referrals, they actively have a 2-way interaction until a decision is reached. The next morning, a physical session identified missing or inaccurate information and the plan is amended if necessary. Both referral methods were compared and analyzed to identify differences and statistical significance. RESULTS: A total of 100 emergency neurosurgical referrals were performed in each arm. Referrals using smart glasses resulted in significantly shorter response times, where on average it was 18.7 minutes faster to receive a plan from the specialist. Smart glasses referrals also had significantly fewer inadequacies compared with WhatsApp referrals. This was consistent for all types of information. CONCLUSIONS: Emergency neurosurgical referrals using telehealth via smart glasses were feasible and effective, thus offer an alternative solution for adoption by developing countries.