concussion presentation for gpt dr. popoli’s presentation
DESCRIPTION
TRANSCRIPT
…To make kids better today and healthier tomorrow.
9.9.13
Program Development
Children’s Telemedicine
Program
Children’s Physician Group
at Children’s Specialty Services
Subspecialist at Egleston
Children’s Physician Group at North Druid
Hills
Marcus Autism
Additional Clinic Space
Subspecialist at Scottish
Rite
Stephanie Blank Center for Safe and
Healthy Children
• 501(c)3 – Not for Profit
• Network of Partners
• Minimal Partnership Fees: Field-Based Telehealth Liaisons Support for Credentialing Scheduling System Centralized PACS System 24/7 support for network
partners Access to Network
Our Program Our Network Partner
Clinical Services OfferedCurrent Specialties and Number of
Physicians:• Allergy and Immunology (1)• Autism (1) • Cardiology (1)• Child Protection (3)• Concussion/Neurosurgery (1)• Endocrinology (1)• Fetal ECHO (9)• Gastroenterology (1) • Nephrology (2)• Pulmonology (2) • Sports Medicine/Concussion (1)
Coming soon:• Autism (1)• Apnea (1)• Ear, Nose, Throat (1)• Transplant (1)• Neurology-Keto patients only (1)• Pulmonology (1)
Telemedicine: Working Together for Better Care
Patient Volume
2009 2010 2011 2012 20130
200
400
600
800
1000
1200
88
461
823971
767
Total/OverallNumber of Patients Seen
Through October 2013
CSHC
Specialist
Marcus
Total
0 200 400 600 800 1000 1200
92
355
524
971
91
231
445
767
2012 - 2013Through October 2013
Number of Patients Seen
20132012
Number of Patients Since Inception: 3,110
CONCUSSION:The Facts and Controversy
David M Popoli, MD
Pediatric and Adolescent Sports Medicine
Medical Director for Telemedicine
The Statistics
• 2008 (ED data)– 60 million youth 5-14 yr in organized sports– 3.8 million concussions from sport and
recreation– Underestimated due to under-reporting (1)
• 2009-2010 (H.S. Reporting Information Online)– 192 High Schools– 1056 Concussions
Objectives
• Define concussion• Explain concussion pathway• Discuss treatment and prevention• Georgia Return to Play Act 2014• Discuss controversies
Definition
• Consensus Guidelines 2012• Characteristics
1. Direct or impulsive force2. Rapid onset 3. Functional4. Clinical symptoms5. No abnormality on standard imaging
This is Not a “Bump on the Head”
The Big Picture
What’s Really Happening
Twist/Stretch
“Leaks” Electrical discharge Recharge
Mechanical Injury leads to Chemical Change
Assessment – What You’ll Be Told
• Symptoms • School performance• Activity tolerance• Sleep• Appetite• Mood
Assessment -- Symptoms• Loss of Consciousness• Amnesia, retrograde or anterograde• Disorientation • Appearing dazed• Acting confused• Forgetting game rules or play assignments• Inability to recall score or opponent• Inappropriate emotionality• Physical incoordination• Imbalance• Seizure• Slow verbal responses• Personality changes• Headache
• Headache• Nausea or vomiting• Difficulty balancing• Vision changes• Photophobia• Phonophobia• Feeling “out of it”• Difficulty concentrating • Tinnitus • Drowsiness• Sadness• Hallucinations
Assessment – What You’ll Be Told
Assessment – What You’ll See
• Mental status• Coordination/Balance/Walking• Strength• Sensation
Technology and Concussion Management
• Computerized neuropsychological testing• Telemedicine/telehealth
Computerized Neuropsychological Testing
Computerized Neuropsychological Testing
0102030405060708090
100
Baseline Post Injury1
Post Injury2
Post Injury3
Verbal Memory
Visual Memory
Processing Speed
Reaction Time
6 Days Post 16 Days Post 23 Days Post
Per
cent
ile
Telemedicine/Telehealth
• Improved clinical reach• Improved education/awareness• Convenience• Cost• Piece of mind
Current Sites
20
*Map and total does not include Child Advocacy Centers
• Participating with 43 presenting sites throughout Georgia*
• 11 specialties with 23 physicians- Future: 14 specialties 27 physicians
• Types of presenting sites- Hospitals- Primary care offices- Schools- Public Health Departments- DFCS offices
Our Community…
21
Research – Abstract accepted by Pediatric Academic Society “Resource Savings, Family and Societal Benefits of a Statewide Pediatric Telemedicine Program”.
• Patients served live in 63 of the Georgia’s 159 counties • 40% of all counties • All outside of the MSA
• 83% of our patients are covered by Medicaid /CMO’s• Overall cost of miles saved: $171,083 (0.55/mile)
2012 Statistics…Per visit: Median(Round Trip)
Range(Round Trip)
Miles Saved 333 72-524
Cost of miles saved $177 $39-$273
Hours Saved Traveling 5.8 2.0-9.0
School days*Children greater than 5 y/o
76% of our patients would have missed school to travel to Atlanta
Work Days Missed*One adult present
>75% of our parents would have missed a full day of work to travel to Atlanta
Management
• Physical and cognitive rest• Academic accommodations• RTP stages • Imaging* • Medication*
Academic Accommodations Algorithm
Georgia Return to Play Act• All public and private schools which provide youth athletic activities
are required: – Provide information to parents on the nature and risk of concussion and head
injuries– Establish a concussion management and return to play policy to include:
• An Information sheet prior to the beginning of each athletic season• Youth athlete must be removed from play if exhibiting symptoms• Youth athlete must be cleared by a healthcare provider before return to play
• Public recreational programs are also required to provide information to parents on the nature and risk of concussion and head injuries
• Georgia Department of Public Health shall endorse one or more concussion recognition education courses to inform Georgia citizens of the nature and risk of concussions in youth athletics
• Effective date: January 1, 2014
Return to Play
Stage Exercise Goal1 None Recovery2 Light Aerobic Increase HR3 Sport-Specific Add movement4 Non-Contact Drills Coordination5 Controlled-Contact
DrillsRestore
Confidence6 Full Contact Practice Game Ready7 Competition Play
Cumulative Effects
Prevention
• Mouthguards• Helmets• Rules/regulations• Style of play
More Information
• Children’s Healthcare of Atlanta• Centers for Disease Control and Prevention