Apps can help professionals spot a concussion

Some smartphone and tablet apps contain accurate information to help parents, coaches and athletic trainers tell when an athlete has a concussion, according to a new review of the tools.

But concussion assessment apps vary widely, researchers found, so it's important for users to be able to pick the best one for their purposes.

"Although not essential to the recognition and management of a concussion, mobile apps provide a new dimension in concussion management for medically trained professionals," co-authors Hopin Lee of Neuroscience Research Australia in Sydney and Osman Ahmed of The FA Centre for Disability Football Research in Staffordshire, UK, told Reuters Health in a joint email.

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"However for the public, it is important that these apps are not seen as a 'do-it-yourself' solution and that the information is used to guide a player with a suspected concussion to seek urgent medical attention," they wrote.

Important markers of concussion

They collaborated on the review at the University of Otago in New Zealand. There are approximately 40 000 medical and healthcare apps available for smartphones or tablets, the authors write. For this review, they downloaded 18 English-language apps intended to help users recognise and assess concussions. Ten were available for Android and 16 for iOS, and 13 were free to download.

The researchers compared the information in each app to an international concussion diagnosis standard called the Sport Concussion Assessment Tool 2.They ranked each app designed to be used by people other than medical professionals in three areas that are important markers of concussion: symptoms, memory function and balance. In each area, a score of zero meant there was no information and a score of 2 meant the necessary information was totally complete.

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Some apps were designed specifically according to the SCAT2 standard, and therefore scored the highest. An app called simply "Concussion", version 1.2.0, also scored quite high, with full marks for symptoms and memory function assessment, according to findings published in the British Journal of Sports Medicine.

However, two of the apps scored zeros across the board."I think apps can be a valuable addition to the tools a sports medicine provider has to use," said Dr Kimberly G. Harmon, who specializes in sports medicine at the University of Washington in Seattle.

Apps useful to medical experts

Harmon was not involved in the review, but has used mobile apps to manage and track concussions. "We use a mobile app already at our institution and have found it to be quite helpful," she told Reuters Health by email. "It needs to be used as part of the bigger picture in conjunction with history and clinical judgment  "Harmon did not recommend any specific apps, but said she does agree with a consumer checklist the review authors created.

According to the checklist, people who don't work in medicine but may need one of these apps, like parents or coaches, should make sure the app they choose was intended for them, not for medical professionals. Users should also look for an endorsement from a recognised agency or organisation, like the Concussion in Sport Group, an international group of concussion experts.

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The checklist also recommends consumers choose apps that reference a best practice standard, have a clear way to contact the producer if support is needed and do not contain advertising or commercial messages. "The authors mention that they did not test the usability of these apps, and I think that is a point that requires additional emphasis in the discussion," Dr Amy K. Wagner told Reuters Health in an email.

Wagner studies brain injuries at the University of Pittsburgh in Pennsylvania and was not involved in the new review. It's important to know how easy the apps are to use, and if people use them correctly, as well as what information the apps contain, Wagner said.

Apps have limitations

"Another point is that it is hard to tell from this report if any of these apps had any language to inform consumers, particularly non-medical consumers, about what to do if a concussion is suspected," she said.

If it seems like an athlete has suffered a concussion, he or she should stop playing immediately and seek medical attention, but it's not clear if the apps remind people of that.

Though she uses apps and believes they can be useful for parents, coaches and schools, Harmon noted that apps have limitations. Apps "don't replace evaluation by a medical professional trained in the evaluation and management of concussion," she said.