Abstract
Concussion is a form of mild traumatic brain injury that affects thousands of Canadian children and adolescents annually. Despite national efforts to harmonize the recognition and management of pediatric concussion in Canada, timely access to primary and specialized care following this injury remains a challenge for many patients especially those who live in rural and remote communities. To address similar challenges facing patients with stroke and other neurological disorders, physicians have begun to leverage advances in telemedicine to improve the delivery of specialized neurological care to those living in medically underserved regions. Preliminary studies suggest that telemedicine may be a safe and cost-effective approach to assist in the medical care of select patients with acute concussion and persistent post-concussion symptoms. Here we provide an overview of telemedicine, teleneurology, the principles of concussion assessment and management, as well as the current state of concussion care in Canada. Utilizing preliminary evidence from studies of telemedicine in concussion and experience from comprehensive systems of care for stroke, we outline steps that must be taken to evaluate the potential of telemedicine-based concussion networks to improve the care of pediatric concussion patients living in underserved rural and remote communities in Canada.
Highlights
Concussion has emerged as an important public health issue among children and adolescents living in Canada
Most pediatric concussion patients can be successfully managed by their primary care provider, certain patients including those with pre-existing conditions, those who develop persistent postconcussion symptoms, and athletes returning to high risk sports often benefit from referral to medically-supervised multidisciplinary pediatric concussion clinics that have the personnel, expertise, and diagnostic resources to meet their complex needs [5, 6]
Drawing from preliminary studies examining the use of telemedicine in concussion and well-established systems of care for stroke, we present a vision for telemedicine-based concussion networks to serve as an innovative approach to help optimize care of pediatric concussion patients living in rural and remote communities in Canada
Summary
Concussion has emerged as an important public health issue among children and adolescents living in Canada. Initial assessments using real-time videoconferencing consisted of a clinical history, administration of the Post-Concussion Symptom Scale which was faxed between sites, review of previous diagnostic imaging studies via a secure PACS system and an abbreviated physical examination performed without a remote examiner that included testing of gross extraocular movements, facial symmetry, tongue movement, pronator drift, cervical spine range of motion, symptom provocation during saccade and gaze stabilization testing, balance testing and immediate and delayed 5-word recall Among this cohort, 17 patients were diagnosed with acute concussions, one patient was diagnosed persistent postconcussion symptoms and post-traumatic migraine headaches and two infants were diagnosed with head injuries.
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