Concussion presentation for gpt dr. popoli’s presentation

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  • 2009: 2 service lines with 2 physiciansCurrently: x service lines with x physiciansFuture: x service lines x physicians
  • Project ECHO – Extension for Community Healthcare Outcomes

Transcript

  • 1. …To make kids better today and healthier tomorrow. 9.9.13
  • 2. Program Development Children’s Telemedicine Program Children’s Physician Group at Children’s Specialty Services Subspecialis t at Egleston Children’s Physician Group at North Druid Hills Marcus Autism Additional Clinic Space Subspecialis t 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
  • 3. Clinical Services Offered Current 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
  • 4. Patient Volume 88 461 823 971 767 0 200 400 600 800 1000 1200 2009 2010 2011 2012 2013 Total/Overall Number of Patients Seen Through October 2013 92 355 524 971 91 231 445 767 0 200 400 600 800 1000 1200 CSHC Specialist Marcus Total 2012 - 2013 Through October 2013 Number of Patients Seen 2013 2012 Number of Patients Since Inception: 3,110
  • 5. CONCUSSION: The Facts and Controversy David M Popoli, MD Pediatric and Adolescent Sports Medicine Medical Director for Telemedicine
  • 6. 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
  • 7. Objectives • Define concussion • Explain concussion pathway • Discuss treatment and prevention • Georgia Return to Play Act 2014 • Discuss controversies
  • 8. Definition • Consensus Guidelines 2012 • Characteristics 1. Direct or impulsive force 2. Rapid onset 3. Functional 4. Clinical symptoms 5. No abnormality on standard imaging
  • 9. This is Not a “Bump on the Head”
  • 10. The Big Picture
  • 11. What’s Really Happening Twist/Stretch “Leaks” Electrical discharge Recharge Mechanical Injury leads to
  • 12. Assessment – What You’ll Be Told • Symptoms • School performance • Activity tolerance • Sleep • Appetite • Mood
  • 13. 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
  • 14. Assessment – What You’ll Be Told
  • 15. Assessment – What You’ll See • Mental status • Coordination/Balance/Walking • Strength • Sensation
  • 16. Technology and Concussion Management • Computerized neuropsychological testing • Telemedicine/telehealth
  • 17. Computerized Neuropsychological Testing
  • 18. Computerized Neuropsychological Testing 0 10 20 30 40 50 60 70 80 90 100 Baseline Post Injury 1 Post Injury 2 Post Injury 3 Verbal Memory Visual Memory Processing Speed Reaction Time 6 Days Post 16 Days Post 23 Days Post Percentile
  • 19. Telemedicine/Telehealth • Improved clinical reach • Improved education/awareness • Convenience • Cost • Piece of mind
  • 20. 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
  • 21. 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
  • 22. Management • Physical and cognitive rest • Academic accommodations • RTP stages • Imaging* • Medication*
  • 23. Academic Accommodations Algorithm
  • 24. 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
  • 25. Return to Play Stage Exercise Goal 1 None Recovery 2 Light Aerobic Increase HR 3 Sport-Specific Add movement 4 Non-Contact Drills Coordination 5 Controlled-Contact Drills Restore Confidence 6 Full Contact Practice Game Ready 7 Competition Play
  • 26. Cumulative Effects
  • 27. Prevention • Mouthguards • Helmets • Rules/regulations • Style of play
  • 28. More Information • Children’s Healthcare of Atlanta • Centers for Disease Control and Prevention