Case 5

Patient basic data: Marc C., male, dob 01.01.1997, (23 y/o), smoker, no treated hypertension, or diabetes.

Symptom: Headache

Fictional diagnosis: Mild concussion (I°)

History: During an amateur soccer game (summer, sunny, 26 °C), the patient jumped after the ball and bumped his head against the knee of an opponent player, 1 h ago. No unconsciousness, no vomiting. He notices slight dizziness, which would become worse when standing up or while walking. Leading symptom is a strong dull headache, especially in the area of impact on the back of the head. This area is also painful to the touch. Tilting the head forward intensifies the headache. This is accompanied by moderate nausea. Otherwise, however, the young patient is awake, actively talking and moving, oriented and responsive. No other symptoms reported. He had retreated to a cool room within the sports facility and had drunk moderate amounts of water. Since he still had complaints and was generally dazed, other players advised him to consult the app.

Examination results: Patient awake, oriented and cooperative. Retrograde amnesia to the impact event itself; otherwise normal memory of the situation immediately before the trauma, the soccer game, and also the time after the trauma. Headache with painful pressure over the impact region at the back of the head, but no wounds or hematoma. While walking freely slight problems of balance were indicated, but no objective clear swaying, no nystagmus, no pain on pressure or other complaints in the facial region, no discharge from the ears. Visual acuity intact, no eye pain. Cervical and neck region freely movable without pain (also no complaints when moving against resistance).

Not anticipated while creating the vignette (and filled in while using the app in this trial): No lumps under the skin on the scalp, no jerking movements of the whole body, no recent decrease in alcohol intake

Answers suspected not to be answered by the fictional patient: N/A

Number of symptom-related questions: 33

General app estimation (“next steps”): People with symptoms similar to yours may require emergency care. If you think this is an emergency the safest thing to do is call an ambulance.

Suggested diagnoses: 1. Concussion (seek medical advice): 5 out of 10 people with these symptoms had this condition. 2. Acute subdural hematoma (seek emergency care): 1 out of 10 people with these symptoms had this condition. 3. Whiplash (seek medical advice): 3 out of 100 people with these symptoms had this condition. 4. Acute intracranial epidural hematoma (seek emergency care): 2 out of 100 people with these symptoms had this condition. 5. Skull fracture (seek emergency care): 1 out of 100 people with these symptoms had this condition.

Note: A worsening of the condition, e.g. a clouding with slowly progressive brain swelling, could not necessarily be detected with the single app use.