HeadCheck: A concussion app

Increasing numbers of sports-related concussions have been reported in a number of countries.1, 2 Of several international guidelines to guide care after concussions,3-5 the Concussion in Sport Group consensus statement 20123 is the basis of many management recommendations and field side assessment tools propagated by sporting organisations in Australia and overseas. Some of the tools available to assist with recognising the symptoms of concussion have significant shortcomings: they are designed specifically for adults and elite sports professionals; they are paper based and do not necessarily provide a clear means of interpreting the information and guiding management; and are not always user friendly on the sidelines. Recent studies from Australia indicate that trainers and coaches have limited knowledge about concussion.6 Young athletes presenting to the emergency department did not follow head injury guidelines (e.g. were not taken off the field after a concussion, returned to play the same day), and parents and players were unaware of head injury guidelines from their sporting organisations.7 Based on reviews of the topic,8, 9 there was a need for an accessible, affordable, user-friendly, reliable and valid tool for use by those entrusted with the care of adult and child athletes at risk of concussive injuries. In a collaboration of child concussion experts at the Murdoch Childrens Research Institute (MCRI), the Royal Children's Hospital and the University of Melbourne, along with Curve Tomorrow, a software development and design company with expertise in the child health sector, a smartphone app, HeadCheck, was developed to help adults recognise the signs and symptoms of concussion in children. Although the primary focus of the app was for use in school-aged children and adolescents, the app is sufficiently robust for use in adult players as well. HeadCheck dynamically guides users through a series of concise questions to quickly assist in recognising symptoms of concussion ( Figure 1). The HeadCheck algorithm prioritises the information the user needs to understand, ensuring logical steps are followed in a potentially stressful situation. Depending on the severity of the individual's symptoms, the app may automatically re-direct the user to call the Australian emergency services phone number, ‘000’. Screen shot of HeadCheck concussion recognition app. The individual items examined in HeadCheck are consistent with the outcomes from deliberations at the 4th International Conference on Concussion in Sport,3 including the widely used and endorsed Sports Concussion Assessment Tool (SCAT-3), the ChildSCAT3 and the Pocket Concussion Recognition Tool (Pocket CRT). HeadCheck avoids medical jargon and uses plain and simple language. The smartphone format is more accessible and concise than the paper Pocket CRT currently used by coaches/parents to recognise concussive symptoms in children. HeadCheck is available as a free download from the Apple AppStore and is compatible with the iPhone (http://itunes.apple.com/au/app/headcheck/id887756402?mt=8). HeadCheck can easily be updated to incorporate future advances from concussion research and users can download updates to the app. User trials have been conducted for HeadCheck and researchers at MCRI (not involved in the project) also trialled the app while being observed by the software development and design team; their feedback was used to improve the functionality and usability of HeadCheck. HeadCheck has received endorsement from the Australian Football League; other national football codes have also shown interest in endorsing HeadCheck. An android version is being developed. Sideline validated, easy-to-use, interactive tools may improve concussion recognition and care. Ongoing collaboration between clinicians with expertise in concussion management and experts in technology, as well as feedback from the public, are instrumental in ensuring that such tools are of high quality and up to date.