Neurologists examining college football players via a telemedicine robot made the same decisions as onsite physicians on removal from play and reached similar diagnoses in a pilot study, researchers said.
The findings suggest a potential solution to the shortage of immediate neurological care for potentially injured young athletes.
Sports neurologist Bert Vargas, MD, of the University of Texas Southwestern Medical Center, and colleagues studied the Northern Arizona University football team over two seasons, stationing a VGo robot on the sideline during games monitored by remote neurologists, in addition to the team's official caregivers. The motorized robot was equipped with a high-resolution camera, microphones, speakers, and wireless internet connectivity. The researchers followed 50 players, with 11 suffering suspected concussions.
The remote neurologists made the same decision on whether to remove injured players as the onsite provider in all 11 cases (while blinded). They administered the diagnostic King-Devick (KD) test on average within 0.7 seconds of the onsite providers and KD times were within 3 seconds in all 11 cases (95% CI, 72%-100%).
Among the six players not already removed from play based on personal history and K-D scores, Standardized Assessment of Concussion scores matched for all six. And, modified Balance Error Scoring System scores were within 3 points for all six.
"This feasibility study suggests that teleconcussion evaluations are safe and effective for providing accurate and rapid assessments of athletes and RFP determinations at the time of suspected injury," the authors wrote in an article published online in Neurology.
Results suggest a telemedicine approach could help a high school sports population that lacks the resources to universally address suspected brain injury immediately. More than half of U.S. high schools did not have sideline medical personnel including athletic trainers when the authors launched this study (and reports indicate that statistic has not improved much). The problem is especially acute in rural areas, where the closest accessible medical professional may be miles away during a Friday night football game.
Younger pediatric athletes face a similar deficit -- leading the National Athletic Trainers Association, Korey Stringer Institute and Safe Kids Worldwide to call for more medical help to address brain injury among other suggested guidelines released at a youth sports safety summit in March.
"I see the possibility of being able to manage the entire spectrum of (sports) concussion care tele-medically," Vargas said, noting promising evidence corresponding to each step is emerging.
The Arizona study is merely a pilot and featured college athletes, so authors cautioned against drawing any conclusions.
In addition: "This study did not address whether using a robotic unit versus less-expensive, more portable technology influences the ease and accuracy of assessments," they wrote, addressing financial concerns. "The cost-effectiveness of these assessments, and the need for a face-to-face provider to assist with the examination should also be appraised critically."
"We realize many school districts and individual schools wouldn't have money to buy a telemedicine robot," Vargas said. But smartphones could be a viable long-term option, he added, for such schools and youth club teams that can find people to monitor the phone onsite.
Vargas' team is planning to launch a larger study of providers' return-to-play decisions regarding college and high school players, he said. He noted that the current study didn't address return-to-play decisions for athletes benched because of head injuries.
Vargas also cautioned that the results in college players may not apply to younger athletes. The researchers studied college players because sideline providers presented a "gold standard" for comparisons with remote evaluators.
Vargas reporting receiving honoraria for serving on scientific and clinical research advisory boards for Pernix Therapeutics and Alder Biopharmaceuticals. He has also received honoraria from Eli Lilly and Company, and Avanir Pharmaceuticals for clinical research consulting and participating on clinical research advisory boards. He serves on the speakers' bureau for Avanir Pharmaceuticals.