Introduction.
This is a theoretical use case scenario for a digital method of using the SCAT 3 to recognise and monitor concussion in athletes. I think it could work quite well, but can't advise you of the legalities of it in your country. The data safety and privacy of medical information if very important and rightly heavily regulated, therefore please take advice local to your country before implementing any of these ideas. Of course what we know of the UK's Snooper's Charter, the NSA's access to everything and the ability of border agents in multiple countries to force you to hand over passwords make digital privacy a bit of a joke, but that's another matter......
So let's start at the beginning - the Sports Concussion Assessment Tool 3 (SCAT 3) is "a standardised tool for evaluating injured athletes for concussion" which is published by the British Journal of Sports Medicine as part of an expert group's concencus statement on concussion in sports, LINK.
It is widely used in sports as a tool to recognise and monitor concussion in athletes, but due to the nature of sports, with away games, tournament, different training venues etc. the paper based format of the test is not always practical. Whilst the SCAT 3 states that "preseason baseline testing with the SCAT3 can be helpful for interpreting post-injury test scores" how many of us actually carry these baseline tests with us to every game? Will it be the same Athletic Trainer/Doctor/Physio/Sports Therapist who sees the athlete every day during the recovery period? How will the tests be shared if you're not always based in the same location? Theses are problems that a digital system could theoretically solve.
System.
What I propose is a combination of Dropbox (website/Appstore) and Notability (website/Appstore) to fill, store and share the SCAT tests.
If we start with the example of an away rugby match, the medics on duty can easily fill a SCAT test using Notability on an iOS device. Using an iPad Pro (LINK) with an Apple Pencil (LINK) would make this a very natural 'pen and paper' experience. Whilst many of us have a tethering facility on our phones, using a cellular iPad means that the back-up and data retrieval necessary in this method is much simplified.
As well as the passcode or finger print lock on the iOS device Notability also allows for a password to be set on each folder, further increasing the security.
Notability's password protected folders.
Notability offers iCloud sync back to your computer in the clinic, but I would propose that by using Notability’s back-up feature to get the PDFs into Dropbox the ability to share information within a team is much improved. This is because Dropbox offers a shared folder facility to which all members of the medical staff can be invited.
In our away game example an initial SCAT 3 will have been filled by the medical staff at the match, then the following day a follow-up will be conducted. This follow-up may not always be conducted by the same person and so by having the tests available online it ensures previous test results are always available to the tester. Similarly baseline scores for each athlete can be held in his/her folder for easy comparison. In fact the iPad’s split screen abilities mean that whilst you are conducting a test you can have an athlete’s baseline scores on one side of the screen (in Dropbox) and the current test (in Notability) on the other side for easy comparison.
Dropbox (left) and Notability (right) running side-by-side on an iPad so that baseline and current test scores can be compared.
Dropbox doesn’t have the per-folder password of Notability but on iOS devices the app does offers a second passcode or fingerprint lock to further secure data whilst on the road.
Dropbox's iOS app can be secured behind a passcode and/or finger print.
World Rugby’s Head Injury Assessment system is very similar to the SCAT 3, but splits it up into different tests at different times for better monitoring and tracking of symptom changes. This makes it even more important that all of the medical team have access to all of the tests that have been conducted.
Back in the clinic/team medical room Dropbox is available for both Mac and Windows so the saved PDFs are easily accessible whatever system your team runs. Filling a new form could be again be done on an iPad for the most natural pen/paper experience, or if you have a Mac then again Notability can be used. If you have a Windows system in the office then there are many PDF annotation programs available, but sorry I can’t make any recommendations due to a lack of Windows knowledge.
Method.
Start in Notability and create a folder for each player. As stated before each folder can have a password set to it, to help maintain the privacy of the medical information contained in it, so please set that up and keep the password(s) secure (I recommend 1Password on iOS/Mac LINK).
In Dropbox set up a shared folder called something like ’Teamname SCAT’ but don’t go any further into creating a file structure. Now set-up your Notability so that it backs-up the necessary folders to your shared Dropbox folder. This will copy across all of the athletes’ folders that you have created and as you add tests they will be placed in the correct place within your structure.
The next step is to download the SCAT 3 form from the British Journal of Sports Medicine (LINK) and import it into Notability. Place it somewhere easily locatable (it’s own folder?) because it will be your template and will be needed even time you complete a test.
When you wish to conduct a test you have to duplicate your template (long press on iOS, right click on Mac) then fill in this duplicate. This way you always have a blank form available to you.
Complete the test, name it something appropriate (Name/Date?) then place it in the relevant folder (simply ‘drag and drop’ on both iOS and Mac).
Depending on your data connection it make take a little while to back-up to Dropbox, so you may have to leave the app open for a while after competing the test, but it doesn’t require any active steps from you.
And that’s it - the test has been completed and shared with all of the medical staff.
Conclusion.
I like this system, I think it makes a lot of sense, but as I said during the introduction, the digital storage of medical information is not an easy topic to talk about due to the legalities. Please take advice from somebody who know what they are talking about in your country before implementing any system and if you can offer me any information about the situation in Germany then please get it touch.