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Telemedicine Gets a Passing Grade in School Concussion Study

A long-awaited study by the Mayo Clinic and UT Southwestern Medical Center proves that a telemedicine platform is just as good as an on-site trainer in diagnosing concussions in athletes.

Source: ThinkStock

By Eric Wicklund

- A telemedicine platform works just as well as a physical trainer in diagnosing concussions during a sporting event, according to a long-awaited study.

In a two-year project conducted on the sidelines of Northern Arizona University football games, a VGo robot with videoconferencing capabilities equaled the performance of an on-site physician in analyzing 11 athletes suspected on having suffered a concussion.

“Worst-case scenario, you have nobody at the games who can identify or address potential concussion cases,” Bert Vargas, MD, director of the sports neuroscience and concussion program at the O’Donnell Brain Institute at Dallas-based UT Southwestern Medical Center and an associate professor of neurology and neurotherapeutics, said in a press release. “You’re putting the athlete in a position to have a more severe injury with prolonged symptoms and longer recovery time.”

Vargas was lead author of the study, conducted in a partnership with the Mayo Clinic. Using the VGo robot, trainers at the football game were able to consult with neurologists hundreds of miles away at the hospital on athletes taken out of the game following a hit to the head.

According to the study, athletes were assessed using the Standardized Assessment of Concussion (SAC), the King-Devick test (K-D) and the modified Balance Error Scoring System (mBESS). A remote neurologist assessed each athlete using the VGo robot with real-time, two-way audio-visual capabilities, while the on-site physician performed a simultaneous face-to-face assessment. After the assessment, a remove-from-play (RFP) determination was made.

READ MORE: Using mHealth to Tackle the Concussion Conundrum

“These data suggest a high level of agreement between remote and face-to-face providers with regard to examination findings and RFP (removal from play) determinations,” Vargas concluded in the study, which was recently published in Neurology.

“Removal from play decisions are of utmost importance in the setting of an acute concussion,” added Amaal J. Starling, a neurologist and concussion expert at the Mayo Clinic who collaborated in the study, in the press release. “This teleconcussion study demonstrates that a remote concussion neurologist accessible through telemedicine technology can guide sideline personnel to make those decisions in a meaningful and timely manner.”

Vargas, who studied brain injury at Mayo before moving to UT Southwestern Medical Center, sees telemedicine technology as vital in assessing concussions at sporting events where certified neurologists are few and far between.

According to statistics provided by the hospital, some 3.8 million recreational and athletic concussions occur each year in the United States, with children under the ages of 15 accounting for the most ER visits for traumatic brain injury. Meanwhile, 65 percent of public high schools don’t have a full-time athletic trainer who could diagnose a concussion on-site.

“I see teleconcussion being applicable anywhere in the world,” Vargas said. “Right now there’s a significant disparity in access to concussion expertise.”

READ MORE: The Benefits and Challenges of Telehealth for Specialists

Vargas’ study has been eagerly awaited since it was first announced that UT Southwestern and the Mayo Clinic were deploying a telemedicine platform at college football games. But they aren’t the only game in town. Many healthcare providers, citing the prohibitive cost of deploying a robot at sporting events, have been experimenting with pre-programmed laptops and tablets.

In Houston, 19 rural schools districts have been using Microsoft Surface tablets embedded with the imPACT (Immediate Post-Concussion Assessment and Cognitive Testing) Applications app to analyze student athletes taken out of games for suspected concussions. Trainers then coordinate a concussion diagnosis via video-consult with Houston Methodist Hospital’s Concussion Center.

“Replacing an office visit with a telemedicine visit can allow the student-athlete (to) begin the correct treatment plan sooner and safely return to school and sports faster,” Greg Grissom, vice president of corporate development for the Houston Texans, which is funding and supporting the program with GE Healthcare, said in a press release. “Many student-athletes in southeast Texas are two to three hours from a concussion specialist, so this telemedicine program gives Houston Methodist a chance to provide the same level of concussion care as our players receive.”

The app, developed by Pittsburgh-based impact, is also in use in more than 20 California high schools. And the company is working with, among others, University Hospitals Case Medical Center, the University of St. Augustine for Health Sciences, Mercy Sports Medicine, Harvard Medical School, Spaulding Rehabilitation Hospital, Seattle Children’s Hospital, UPMC, Texas Health’s Ben Hogan Sports Medicine and Nebraska Orthopedic Hospital.

Vargas said projects like his prove that telemedicine platforms can be used to bring needed healthcare services to rural communities where those services don’t exist, or to help large, cash-strapped school districts that don’t have the resources to cover every athletic event.

READ MORE: Factors Behind the Adoption of School-based Telehealth

“This is a way of bringing physicians into these outlying areas,” he said. “One person could cover numerous schools. If you’re on-call virtually, you could be anywhere and available as soon as a consult is needed.”

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