Preliminary clinical algorithm to optimise remote delivery of paediatric concussion care in Canada’s North

Abstract

Concussion is a form of traumatic brain injury that affects thousands of children and adolescents across Canada annually. With timely access to comprehensive medical care, the majority of patients with acute concussion will recover within 1-4 weeks. Those who develop persistent postconcussion symptoms often benefit from early recognition and referral to multidisciplinary concussion clinics that have the personnel and resources to meet their complex needs. Youth who live in remote and isolated communities within Canada's North, a significant proportion of whom are Indigenous, face unique barriers and obstacles to accessing primary and specialised concussion care. Although telemedicine has recently emerged as a tool that can help address these gaps in care, there are presently no clinical guidelines or tools available to assist multidisciplinary concussion clinics in providing remote concussion care to these medically underserved patients. Here we incorporate literature from a scoping review and our early institutional experience to present an evidence-informed preliminary clinical algorithm and resources to help guide and optimise remote paediatric concussion care delivery in Canada's North. We also discuss how innovative technologies and partnerships can be leveraged to enhance the delivery of safe, equitable, cost-effective and culturally appropriate care to these communities.

Triage through telemedicine in paediatric emergency care—Results of a concordance study

“…The differences in the urgency assessment were also related to respiratory rate, heart rate or pain, oxygen saturation, the Glasgow coma scale and trauma injuries. This study confirms that trauma cases should be assessed very carefully when employing telemedicine [ 15 , 16 , 30 ]. Undertriage is a serious problem that requires specific attention in a follow-up study.…”

“…Nevertheless, in a real healthcare setting, overtriage could lead to unnecessary transfers to another hospital or unnecessary examinations. However, other studies have shown that telemedicine reduced the number of transfers and costs while still ensuring patients’ safety [ 10 – 12 , 14 , 15 , 18 ]. Cases in which the telemedicine doctor assigned a lower level of urgency than the on-site doctor (undertriage) should be evaluated more critically.…”

“…Multiple countries have established telemedicine centres to support paediatric acute healthcare, including: Australia [ 10 , 11 ], USA [ 12 – 14 ], Canada [ 15 – 17 ] and Israel [ 18 ]. These centres assist with the adequate allocation of patients, especially in rural or remote regions.…”

“…Other limitations include the bounded feasibility of urgency assessments and the assessment of the need for on-site treatment for brain injuries or concussions (e.g. for specialised neurological care or intervention) [ 15 , 16 , 30 ].…”

Current Use and Future Considerations for Concussion Telemedicine Healthcare in Canada

“…[17][18][19][20][21][22][23] More recently, a growing body of research has begun to demonstrate that telemedicine is a safe and cost-effective approach to delivering remote care to patients with concussion. [24][25][26][27] Similar to systems of care developed for acute stroke, 28,29 telemedicine-based networks centered around regional or provincial multi-disciplinary concussion clinics may be a novel approach to expand access to specialized care for patients living in remote, isolated, and medically underserviced communities throughout Canada. 30 Despite this innovative work, little is known about the use of telemedicine among Canadian concussion care providers and clinics, how use of this technology has changed during the COVID-19 pandemic, and what barriers must be overcome to promote greater adoption and sustainability of telemedicine to manage concussion.…”