Feasibility and accuracy of teleconcussion for acute evaluation of suspected concussion.
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.
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. bert.vargas@UTSouthwestern.edu.
Bert B
BB
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.
Morgan
M
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.
Joseph G
JG
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.
Cherisse
C
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.
L George
LG
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.
Amaal J
AJ
Starling
D056352:Athletes; D001265:Athletic Injuries / Q000175:diagnosis*; D001924:Brain Concussion / Q000175:diagnosis*; D015331:Cohort Studies; D005240:Feasibility Studies; D005538:Football / Q000293:injuries*; D006801:Humans; D008297:Male; D019114:Remote Consultation / Q000295:instrumentation / Q000379:methods*; D012371:Robotics; D012720:Severity of Illness Index; D013997:Time Factors; D014495:Universities