Feasibility and accuracy of teleconcussion for acute evaluation of suspected concussion

Abstract

Objective: To assess the feasibility and accuracy of telemedical concussion evaluations (teleconcussion) for real-time athletic sideline assessment of concussion, as such assessment may address the gap in access some populations of athletes have to providers with expertise in concussion evaluation.Methods: A cohort of 11 consecutive male collegiate football players with suspected concussion was assessed using Standardized Assessment of Concussion (SAC), King-Devick test (K-D), and modified Balance Error Scoring System (mBESS). A remote neurologist assessed each athlete using a telemedicine robot with real-time, 2-way audiovisual capabilities, while a sideline provider performed a simultaneous face-to-face assessment. After the assessment, a remove-from-play (RFP) determination was made. The remote and the face-to-face providers were blinded to each other's examination findings and RFP decision until the end of the assessment. Results:The teleconcussion and face-to-face SAC were in agreement 100% of the time (6/6; 95% confidence interval [CI] 54%-100%). The mean (SD) difference between remote and sideline K-D times was 0.7 (1.4) seconds. Remote and sideline K-D times were within a 3-second difference 100% of the time (11/11; 95% CI 72%-100%). Remote and sideline mBESS scores were within 3 points 100% of the time (6/6; 95% CI 54%-100%). RFP decisions were in agreement 100% of the time (11/11; 95% CI 72%-100%). Conclusions:The aim of this study was to investigate the feasibility of teleconcussion for sideline concussion assessments. These data suggest a high level of agreement between remote and face-to-face providers with regard to examination findings and RFP determinations. An estimated 1.6-3.8 million traumatic brain injuries (TBIs) occur annually in the United States among 38 million children and adolescents and 170 million adults engaged in organized physical and sports-related activities.1 To help improve concussion and TBI identification and postinjury care, some sports organizations have employed unaffiliated neurotrauma consultants to provide sideline evaluation for suspected injuries. This same level of care is not available for most youth and collegiate-level athletes. Of more than 4,000 US colleges and universities, 3 most have qualified medical staff providing care for elite-level sports teams; however, most have no access to neurotrauma experts on the sideline. Moreover, among the 37,000 US public and private secondary schools, 4 58% do not have access to any sideline medical personnel (including athletic trainers).5 This problem may be compounded by geographic disparities as rural colleges, universities, and high schools may have even less access to specialty care than schools in major metropolitan areas.Telemedicine has been shown to be a safe and effective means to evaluate and treat numerous acute neurologic conditions, including stroke, 6 in populations with limited access to subspecialty care.

Evaluation of a pilot paediatric concussion telemedicine programme for northern communities in Manitoba

“…The diagnosis of acute concussion requires a physician to reliably exclude more serious forms of TBI, as well as structural injury to the cervical spine, which can only be accomplished through a careful history, focused physical examination and the evidence-based use of diagnostic imaging [43]. Although some authors have demonstrated the feasibility and reliability of using abbreviated concussion screening tools, such as the Sport Concussion Assessment Tool (SCAT) and King-Devick Test via telemedicine videoconferencing [35,36], several essential aspects of the neurological examination including testing of motor and sensory functioning, tone, reflexes and fundoscopy can not be performed unless another trained clinician is available to conduct these tests and present the findings to the remote consulting physician [44,45]. Subtle signs appreciated during objective assessment of oculomotor, vestibular and cervical spine function can be helpful in guiding clinical decisions regarding the need for diagnostic imaging and targeted rehabilitation but are also challenging or impossible to elicit during telemedicine consultations [46][47][48].…”

“…Previous work has demonstrated the feasibility of using telemedicine to assist with the clinical care of patients with a wide spectrum of neurological conditions including stroke [16,21,22], headache [23][24][25], multiple sclerosis [26], mental health disorders [27,28], epilepsy [29,30] and neurodegenerative diseases [31][32][33][34]. Although preliminary studies have suggested that telemedicine may be helpful in providing sideline and inoffice care to patients with concussion [35,36], there have been no studies that have examined the use of this technology to provide clinical care of paediatric concussion patients living in remote and medically underserviced communities in northern Canada.…”

Mental health management of elite athletes during COVID-19: a narrative review and recommendations

“…67 Telehealth for mental healthcare has not been systematically studied in athletes, but this method of care delivery is feasible for athletes with other medical needs. [68][69][70] For athletes in some countries, remote provision of mental healthcare has necessitated changes in licensure rules. 17 For example, in the USA, during non-pandemic times, a physician must be licensed in the state where the patient is physically located, 17 and most physicians are only licensed in a single state.…”

“You can’t touch this”: Delivery of inpatient neuropsychological assessment in the era of COVID-19 and beyond

“…There is limited research on the feasibility of assessing individuals with traumatic brain injury (TBI) using telephone or virtual methods. Preliminary work has been conducted in the area of sports medicine evaluating the potential for "teleconcussion" assessment and care (Vargas et al, 2012(Vargas et al, , 2017. However, this method requires a remote assessment centre and trained staff to complete cognitive, balance, and brief neurological examinations before consulting via videoconference with a neurologist.…”