Sideline Guidelines

A key role of the sports doctor, physiotherapist and athletic trainer is to detect, diagnose and treat sports injuries and medical emergencies on the sideline to ensure the health and safety of athletes.1 Sideline Guidelines, developed by Cleveland Clinic Innovations, is an app that is informed by a respected (US) national faculty, with the aim of assisting healthcare practitioners to manage sports injuries for high school, college and professional athletes from the sideline. The developers claim Sideline Guidelines to be the 'first of its kind'.2 The overall purpose of this app is to provide sports medicine practitioners with easily accessible information for a comprehensive list of sports injuries to assist diagnosis, postinjury evaluation and return-to-play decision-making. Sideline Guidelines contains three sections—'Emergency', 'Search' and 'Tools' (figure 1). The 'Emergency' section enables rapid reference to medical emergencies, including sudden cardiac arrest, heat illness, environmental, pulmonary and orthopaedic emergencies. The 'Search' section provides a list of common sports injuries (eg, anterior cruciate ligament strains) listed in alphabetical order. Although the guidelines in the 'Emergency' and 'Search' sections (figure 2) are succinct, the use of medical jargon (eg, 'apneic') and acronyms (eg, 'PPE') may prove challenging for clinicians without extensive sports medicine training. The 'Tools' section includes three subsections: preseason evaluation (eg, baseline testing); on-field evaluation (related to level of consciousness); and sideline concussion evaluation (eg, Sports Concussion Assessment Tool 3). However, the intended purpose of each test is not described, and the functional capacity of smartphones is not fully utilised (eg, data input, telecommunication). The disclaimer statement states that the app is not intended to replace the medical advice of a healthcare professional. Use in clinical practice Sideline Guidelines is intended for clinical practice but has several shortcomings. In standard clinical practice, the sideline clinician identifies and assesses the signs and symptoms of the injured athlete which then might inform diagnosis and management.3 Unfortunately, the 'Search' function in Sideline Guidelines operates counter-intuitively, where the user is expected to search for a diagnosis, rather than to use the signs and symptoms to inform a differential diagnosis. At most, this function allows the user to look up a suspected diagnosis to confirm its common signs and symptoms. Although the 'Tools' section houses a range of tests, it does not allow the user to administer the tests and thereby limits its clinical utility. Despite these caveats, the management and return-to-play subsections serve a useful purpose as a first port-of-call for guiding early management. In summary, Sideline Guidelines is a simple electronic pocket-guide, but its functional limitations and lack of evidence-based content warrant caution. This is a recurring theme—mobile apps often provide advice that is not anchored in evidence.4 Pros Information is well organised in the search function Easily accessible key points for injury management and return to play guidelines Rapid reference to sideline medical emergencies Cons Content is based on expert knowledge that lacks current evidence-based information Counter-intuitive process for differential diagnosis Limited target population to high school, college and professional athletes No data entry features and lack of functionality to administer sideline tests No function to directly contact hospitals and clinics to share information