Game Time Consults: Piloting Telemedicine for Sideline Care in Rural High School Athletics

OBJECTIVE: To assess the feasibility and clinical impact of sideline telemedicine for real-time injury assessment during high school athletic events in rural communities and to determine its potential effect on emergency department (ED) utilization. DESIGN: Prospective, observational cohort study. SETTING: Three rural high schools in southeast Minnesota without on-site athletic trainer or emergency medical services coverage. PARTICIPANTS: High school athletes and attendees injured during school-sponsored athletic events during the 2021 to 2022 school year. INTERVENTION: Sideline telemedicine consults were initiated by school officials using tablets to connect with on-call dual board-certified emergency and sports medicine physicians. Consults included video-based assessment, triage, return-to-play guidance, and follow-up recommendations. MAIN OUTCOME MEASURES: Disposition after consultation (return to play, outpatient follow-up, ED referral), satisfaction scores using the 10-item Telehealth Satisfaction Scale, and patient-reported intent to seek ED care if telemedicine were unavailable. RESULTS: Telemedicine was activated 15 times. Most (53%) injuries were musculoskeletal. Two (13%) patients were referred to the ED, where time-sensitive diagnoses (NSTEMI, testicular torsion) were confirmed. Thirteen patients were treated without ED referral; 6 (46%) reported they would have otherwise visited the ED. All diagnoses were confirmed by outpatient follow-up. Telehealth Satisfaction Scale scores were high: interpersonal communication (mean 4.00), respectfulness (3.96), and technical quality (3.99). CONCLUSIONS: Sideline telemedicine is a feasible and well-received model for acute injury evaluation at rural athletic events lacking on-site medical providers. It may reduce unnecessary ED use while preserving care quality and satisfaction, offering scalable support for resource-limited sports settings.