Telemedicine deployed to treat concussions

The case of a concussed Arizona teenager illustrates how telemedicine can be utilized in rural areas, according to an article published online Oct. 26 by Telemedicine and e-Health.

“As the number of providers with specialized training in the subspecialty of concussion remains relatively small, rural communities are at a distinct disadvantage in obtaining appropriate concussion evaluation in a timely manner,” wrote lead author Bert B. Vargas, MD, a neurologist at Mayo Clinic in Phoenix. “As with many other telemedical applications, teleconcussion helps to bridge the gap in access to specialty care.”

Vargas and his colleagues shared the story of a 15-year-old patient who suffered a concussion while playing soccer. After striking his head against another player’s shin, the patient experienced a brief period of unconsciousness before leaving the playing field under his own power. He was transported to an 89-bed regional healthcare facility and admitted to the emergency department, where providers determined a Glasgow Coma Score of eight. While the patient’s mental status began to normalize within 30 minutes of being admitted and a complete return to baseline was evident within four hours, the patient was held for observation for 24 hours and a non-contrast head CT scan was determined to be normal.

The patient considered his symptoms significantly improved over the next two weeks and returned to physical activity. However, the patient was still experiencing headaches and the patient’s father recognized additional symptoms, including periods of sleep lasting longer than normal.

Using videoconferencing software, providers from the local healthcare facility connected the patient with remote specialists who determined that, based on postconcussive symptoms persisting 19 days after the initial incident, the patient should refrain from physical activity pending additional workup and an in-person meeting with a concussion specialist.

“In the case presented, teleconcussion was useful in identifying a concussed athlete who had begun to resume physical activity ahead of a commonly accepted return-to-play guidelines and was helpful in triaging the patient as being symptomatic and in need of a formal face-to-face evaluation and additional workup in order to construct a plan of care and eventual return to play,” Vargas et al concluded.