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April 18, 2017; 88 (16) Article

Feasibility and accuracy of teleconcussion for acute evaluation of suspected concussion

Bert B. Vargas, Morgan Shepard, Joseph G. Hentz, Cherisse Kutyreff, L. George Hershey, Amaal J. Starling
First published March 24, 2017, DOI: https://doi.org/10.1212/WNL.0000000000003841
Bert B. Vargas
From the Department of Neurology and Neurotherapeutics (B.B.V.), University of Texas Southwestern Medical Center, Dallas; Departments of Neurology (M.S., A.J.S.) and Biostatistics (J.G.H.), Mayo Clinic in Arizona, Scottsdale; and Department of Sports Medicine (C.K., L.G.H.), Northern Arizona University, Flagstaff.
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Morgan Shepard
From the Department of Neurology and Neurotherapeutics (B.B.V.), University of Texas Southwestern Medical Center, Dallas; Departments of Neurology (M.S., A.J.S.) and Biostatistics (J.G.H.), Mayo Clinic in Arizona, Scottsdale; and Department of Sports Medicine (C.K., L.G.H.), Northern Arizona University, Flagstaff.
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Joseph G. Hentz
From the Department of Neurology and Neurotherapeutics (B.B.V.), University of Texas Southwestern Medical Center, Dallas; Departments of Neurology (M.S., A.J.S.) and Biostatistics (J.G.H.), Mayo Clinic in Arizona, Scottsdale; and Department of Sports Medicine (C.K., L.G.H.), Northern Arizona University, Flagstaff.
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Cherisse Kutyreff
From the Department of Neurology and Neurotherapeutics (B.B.V.), University of Texas Southwestern Medical Center, Dallas; Departments of Neurology (M.S., A.J.S.) and Biostatistics (J.G.H.), Mayo Clinic in Arizona, Scottsdale; and Department of Sports Medicine (C.K., L.G.H.), Northern Arizona University, Flagstaff.
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L. George Hershey
From the Department of Neurology and Neurotherapeutics (B.B.V.), University of Texas Southwestern Medical Center, Dallas; Departments of Neurology (M.S., A.J.S.) and Biostatistics (J.G.H.), Mayo Clinic in Arizona, Scottsdale; and Department of Sports Medicine (C.K., L.G.H.), Northern Arizona University, Flagstaff.
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Amaal J. Starling
From the Department of Neurology and Neurotherapeutics (B.B.V.), University of Texas Southwestern Medical Center, Dallas; Departments of Neurology (M.S., A.J.S.) and Biostatistics (J.G.H.), Mayo Clinic in Arizona, Scottsdale; and Department of Sports Medicine (C.K., L.G.H.), Northern Arizona University, Flagstaff.
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Citation
Feasibility and accuracy of teleconcussion for acute evaluation of suspected concussion
Bert B. Vargas, Morgan Shepard, Joseph G. Hentz, Cherisse Kutyreff, L. George Hershey, Amaal J. Starling
Neurology Apr 2017, 88 (16) 1580-1583; DOI: 10.1212/WNL.0000000000003841

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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.

GLOSSARY

CI=
confidence interval;
K-D=
King-Devick test;
mBESS=
modified Balance Error Scoring System;
RFP=
remove-from-play;
SAC=
Standardized Assessment of Concussion;
TBI=
traumatic brain injury

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received July 17, 2016.
  • Accepted in final form January 24, 2017.
  • © 2017 American Academy of Neurology
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