Is the NFL Concussion Protocol and SCAT Being Used Properly?
In 2011, the National Football League implemented a neuropsychological assessment scale called the Standardized Concussion Assessment Tool (SCAT). The motivation came from a concussion crisis that faced the NFL (and still faces the NFL) and was portrayed in the recent Hollywood film “Concussion”.
As an avid fan, I watch hundreds of NFL football games every year. Even to this day, it is not rare to see a player down on the field for a significant amount of time, wobbling when they stand up, or even unconscious. The even more troubling fact is that you will often see that same player return to the game a week later, or even the same afternoon. It is hard to ignore the troubling signs of how concussions are handled… and it all starts with testing.
Just this past NFL season, 5 years since the concussion protocol was put into use, the league announce that the number of concussions “rose significantly” (Kevin Seifert, ESPN). In case you were curious, the officially number was 271 concussions… in one season!! To put that in perspective, each team plays 16 games in the regular season. With 32 teams in the league, this means a concussion occurred in more than half the games played throughout the season. Mindboggling. You would think the concussion protocol would put these players at a lesser risk for multiple concussions, but that is clearly not the case based on the numbers.
Here’s the problem, though: the players are playing a role in this problem as well. In 2011, 23 of 44 NFL players interviewed by the Associated Press admitted that if they could, they would hide their concussions in order to keep playing rather than come out of the game (Associated Press, 2011). You can look at this as an unavoidable problem, or you can admit that the SCAT isn’t valid enough to see through the faking of these players. Another problem with the test is that they have found there to be high error in the concentration portion of the test (Jinguji et al., 2012).
This is how the concussion protocol is supposed to work: players are being watched by the team’s medical staff, the officiating crew, a special observer up in a booth and cameras that show a multitude of angles on every play. When a concussion is spotted, the player meets immediately with an independent neurologist who assesses the player with the SCAT. This is how it is SUPPOSED to work. The problem is that this isn’t how it is executed. Dr. Jene Bramel did a lot of research on the how the concussion protocol is actually performed. What she found is that it often does not work the way it is described (Carroll, Bleacher Report, 2013).
What we have seen here is a mix of potential issues with the validity and reliability (error in concentration portion of the test), as well as systematic problems with the proper administration of the SCAT and the NFL concussion protocol as a whole.
The NFL is playing with people’s future in the most dangerous sport in the world. They have made a habit of making promises they cannot keep, as well as hiding behind problems that could spell the end of the league as we know it. If the NFL wants to survive this ugly storm brewing, they need to be better psychometricians, or at least hire people who can.
Sources:
Pellman EJ, Lovell MR, Viano DC, Casson IR. Concussion in professional football: recovery of NFL and high school athletes assessed by computerized neuropsychological testing — Part 12. Neurosurgery. 2006 Feb.
Jinguji TM, Bompadre V, Harmon KG, Satchell EK, Gilbert K, Wild J, Eary JF. Sport Concussion Assessment Tool-2: Baseline values for high school athletes. British Journal of Sports Medicine. 2012;46(5):365–370
http://bleacherreport.com/articles/1800166-why-the-nfls-concussion-policy-just-isnt-working
http://espn.go.com/nfl/story/_/id/7388074/nfl-players-say-hiding-concussions-option
http://espn.go.com/nfl/story/_/id/14672860/nfl-says-diagnosed-concussions-way-season
