599 - Mobile health to facilitate specialist access for pediatric concussion patients seen in the emergency department

Publication Number: 1576.599

Olivia Fedio, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Kruthika Kunam, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Melissa Godfrey, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Kristy Arbogast, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Christina Master, Children's Hospital of Philadelphia/University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States; Daniel Corwin, Childrens Hospital of Philadelphia, Philadelphia, PA, United States

Background: Concussions are prevalent pediatric injuries, with the worst outcomes borne disproportionately by those first seen in emergency departments (EDs). While individualized, active therapies are the mainstay of consensus guidelines, these are nearly exclusively prescribed from specialty settings, which the majority of pediatric ED patients do not access. Novel mobile health tools, via remote patient management (RPM), have the potential to improve care continuity.

Objective: Assess the feasibility of an RPM-guided care navigation tool to facilitate specialty engagement for pediatric ED concussion patients

Design/Methods: We enrolled participants aged 13-18 with concussion seen in the ED of our urban, tertiary care children's hospital in the northeastern US < 72 hours after injury from 3/12/2024-9/19/2025. Following enrollment, participants engaged daily in a secure, HTML-based chat platform assessing symptom burden, activity, sleep, and medication usage (Figure 1); responses directly integrated into our institution's electronic health record (EHR). A series of built-in alerts (e.g. plateauing/escalating symptoms, poor exercise tolerance) triggered an EHR notification to our specialty team, who subsequently contacted the participant to engage in care. Participants received chats for up to 28 days, with recovery assessed at 28 and 90 days. Feasibility metrics included overall engagement with the platform and with specialty care following an alert. The primary recovery metric was persisting symptoms after concussion (PSaC; symptoms above baseline at 28 days).

Results: We enrolled 74 participants, median age 15 years, 60% female, 8% Hispanic, 56% non-Hispanic Black, 26% non-Hispanic White, 66% public insurance, 66% non-sport injuries. Of 66 evaluable participants, 54 (82%) engaged with >=1 chat; of those, 23 (43%) triggered >=1 alert, with a specialty engagement rate of 68% (15/22; 1 participant sought specialty care independently). Differences in engagement by demographic variables are listed in Table 1. The overall incidence of PSaC was 41% (61% triggering an alert vs. 26% with no alert triggered, p=0.010). Of those triggering an alert, PSaC incidence was 63% for those engaging in specialty care vs. 57% not engaging (p=0.809).

Conclusion(s): Mobile health using RPM is a feasible tool to facilitate engagement of pediatric ED concussion patients with specialty care, with pre-programmed alerts accurately identifying patients at highest risk for persisting symptoms. Additional studies are needed to further elucidate disparities in engagement, and assess the effect of RPM on PSaC incidence in this at-risk population.

Figure 1. Example of web-based remote patient management platform
Example of participant-facing chats, including: A. Introduction and symptom description; B. Participant rating individual symptoms; and C. Direct feedback to participants with tips for individual symptom management

Table 1. Feasibility metrics by participant demographics
1. Chat engagement defined as participant completing at least one chat session
2. P-value Wilcoxon rank sum test for continuous variable (age), Fisher's exact test/chi-squared test where appropriate for categorical variables
3. Specialty engagement defined as those patients triggering alerts who interacted with the specialty team at least once
IQR = interquartile range