NFL standardizes concussion protocol

INDIANAPOLIS - In an effort to better deal with the incidence of concussions, the NFL will use a new standardized sideline concussion assessment protocol starting this season, according to Dr. Margot Putukian, a member of the NFL Head, Neck and Spine Committee and chair of the Return-to-Play Subcommittee.

Developed by the subcommittee in response to a team medical staff survey conducted last season, the new protocol combines a symptom checklist, a limited neurologic examination including a cognitive evaluation, and a balance assessment. It uses as a foundation many components of the sideline tool developed by the Concussion in Sport group that most recently met in Zurich in 2008. It was developed by the NFL Head, Neck, and Spine Committee, with input from the NFLPA and its medical advisors, NFL team physicians, athletic trainers and their professional societies, and other medical experts.

"This tool provides a standardized format for evaluating head injury that medical staff can use on the sideline," said Dr. Putukian, who also is head team physician for Princeton University, a past president of the American Medical Society for Sports Medicine and the physician representative of NCAA and the American College of Sports Medicine. "It incorporates the most important aspects of a focused exam, so that injury is identified, and athletes with concussion and more serious head and spine injury can be removed from play."

The new protocol includes modifications specific to professional football. It includes a focused screening neurological examination to exclude cervical spine and intracranial bleed, and assessments of orientation, immediate and delayed recall, concentration, as well as a balance evaluation. The performance of these tests can be compared with a pre-season evaluation to see if any decline in function is present. It does not replace more sophisticated tests, and does not replace the individualized assessment by the clinician of the athlete, but does provide the medical staff with a standardized protocol to evaluate for head injury.

A survey was performed of team medical staff (head athletic trainers and team physicians) in November 2010 to evaluate what was currently being performed in terms of pre-season, injury, and post-injury evaluations for concussion. It was clear from this survey that most teams were using a combination of symptoms, cognitive evaluations, balance testing and additional testing to evaluate concussion, but a standardized protocol did not exist. Following the results of that survey, the NFL Head, Neck and Spine Committee, including the Return-to-Play Subcommittee, decided to create the sideline medical protocol to assist team medical staff in evaluating head injuries.