JMIR Publications

ABSTRACT

Background:

Approximately 2.0 million children in the United States sustain a concussion annually, resulting in an economic impact as high as $20 billion. Patients who receive treatment at concussion specialty clinics versus primary care experience faster recovery, thereby reducing patient burden and subsequent medical related costs. Accessibility to specialty clinics is typically limited by the availability of in-office visits. This is particularly relevant in light of the SARS-CoV2 pandemic and subsequent guidance to eliminate all non-medically necessary in-clinic visits. Telehealth has been used to effectively deliver in-clinic care across several disciplines including psychiatry, psychology, and neuropsychology. However, a model of telehealth delivered concussion assessment, treatment, and management has not been established.

Objective:

The purpose of this paper is two-fold: to describe the methods of telehealth delivered concussion services, and to provide preliminary descriptive data to guide future comparison studies of telehealth efficacy vs. in-office visits.

Methods:

The specialty concussion clinic described herein began providing telehealth services in 2019, and is part of the largest pediatric and fastest growing telehealth hospital network in the United States. The entire clinical care process will be described, including appointment scheduling, assessment during initial appointment, injury management including communication with relevant patient stakeholders (e.g., parent/guardians, athletic trainers, etc.), dissemination of rehabilitation exercises, and nature of follow-up visits. Descriptive data will include radius of care, access time between calling to schedule and initial visit, average number of follow-up visits, and days until medically cleared to return-to-learn and return-to-sport. The analytic sample included all telehealth concussion visits August 2019-April 2020.

Results:

During the period of observation, 18 patients, with a mean (standard deviation [sd]) age of 14.5 (2.5) years received tele-concussion care. Radius of care was a median (interquartile range [IQR]) 17 (11.0-31.0) miles from the clinic, with median (IQR) time between injury and the first visit 21 (6.0-41.5) days. Mean (sd) number of visits was 2.2 (0.8) with a median (IQR) days between visits of 5.4 (3.0-9.3) to manage and treat the concussion. Of the 18 patients, 55.6% (10/18) were medically cleared to return to learn/play in a median (IQR) 15.5 (11.0-29.0) days.

Conclusions:

This is the first paper to provide a clinically relevant framework for the assessment, management, and treatment of acute concussion via telehealth in an adolescent population. Limited access to health care is a well understood barrier for receiving quality care. Subsequently, there are increasing demands for flexibility in delivering concussion services remotely and in-clinic. These preliminary results are promising for providing future directions in the treatment and management of adolescent concussion remotely.