In-Game Concussion Diagnosis (DPJ vs. Maryland)
I haven't seen any news coverage on DPJ's relatively quick re-entry into the game after the targeting hit, so I did some quick internet research. It looks like at least some schools (and maybe the NCAA) use a commercial product called the "King-Devick" concussion test that takes as little as two minutes to administer (https://kingdevicktest.com/concussions/faq/). Here is a link to University of Miami's concussion protocol, which is posted on the NCAA site for some reason: https://www.ncaa.org/sites/default/files/2017-18CProto65_UofMiami_Protocol_20170803.pdf.
Page 4 lists several steps in the event a "suspected concussion occurs," including conducting the King-Devick test. The following step, number 4, seems to indicate that the athlete should be withheld from competition for the rest of the day. The term "suspected concussion" is obviously pretty broad and/or vague.
A few questions to anyone on the board who has experience with sideline concussion diagnosis / protocol:
- During an NCAA football game, who watches for a "suspected concussion"?
- How long does it take to rule-out a concussion? I realize there isn't a clear test for diagnosing a concussion, but perhaps there is a quick way to clear a player (such as the King-Devick test).
- How long was DPJ out of the game? I don't have the game on DVR anymore, but it looks like he was on the sideline for at least 5 minutes. More specifically, he sat out for 4 plays that took 3 minutes of game time (5:16 in 3rd until 2:15 in 3rd), plus a few minutes for the targeting review.
Thanks in advance for any insight / information.
October 9th, 2018 at 3:19 PM ^
After the Shane Morris incident, Michigan has led the way in on-field medical care and concussion protocol. After Brandon and Hoke absolutely destroyed the PR around that gaff, all of CFB has followed Michigan's lead. Also, Michigan led the fight for better medical facilities across the B1G because of last years fiasco with Will Speight at Purdue.
I'd be stunned, amazed, and greatly disappointed if Michigan doctors and AD staff allowed a concussed player back into a game after all of that the last few years...
October 9th, 2018 at 3:26 PM ^
Do you have a source for the concussion stuff? I'd be curious in reading more about it.
October 9th, 2018 at 3:34 PM ^
Great question, and I should have outlined this in my OP. I was pulling memory from Bacon's Endzone book, where he did an excellent job chronicling everything that happened around the Morris incident - including the resultant changes to in-game medical protocols (incl concussion) and medical clearances. I have no other link, or source of info, so I apologize for the misleading OP.
The medical facility thing was reported earlier this spring when the B1G opened up a commission to look at minimum standards for visiting team facilities and medical care in its stadiums.
October 9th, 2018 at 4:14 PM ^
I earned a Computer Science degree from University of Cincinnati a few years back. At that time a group of classmates created proof of concept software package for preliminary testing for concussions "in the field" as their senior project. The team had backing from the UC hospital as well as the UC athletic department and football program.
The test used a tablet for a short 5 to 10 minute test weekly to create a baseline fore each player. In the event of a suspected concussion in practice or a game, the player would stand and take the same test on a tablet, the answers and motor skills were measured against the baseline.
It could not determine if a concussion existed, but it gave a good idea of weather or not the player needed to go for further medical attention.
Last I heard the classmates were getting interest from the US Military for this project. There has been a lot of progress in head injury diagnosis over the last few years.
October 9th, 2018 at 4:35 PM ^
I heard about a similar program being developed to detect drivers impaired by marijuana. You have to test yourself 5-10 minutes a week sober to create a baseline, then test yourself before getting in a car to drive high. Not really feasible for law enforcement, but if you can prevent a few people responsible enough to test themselves from getting on the road when they shouldn't it can still be a large benefit.
October 9th, 2018 at 9:05 PM ^
Wait they started with concussions and now the tablet can tell the weather?
October 9th, 2018 at 10:18 PM ^
They use this in my sons U14 travel hockey.
October 9th, 2018 at 4:52 PM ^
Jeff Kutcher MD used to be (May still be) the team neurologist and helped create the current UM concussion protocols and is one of the leaders in the field of concussion research. If you search for him or his Sport Neurology clinic you can find a ton of stuff.
October 9th, 2018 at 3:26 PM ^
me too - but I have to say I was really surprised to see him back on the field. They were clearly doing some kind of noggin protocol with him in the tent etc. But they way his head bounced around (also looked like a purposefully dirty shot to me based on how the MD player pivoted to change directions and lead with the head but a different discussion) I thought he was done for the day. Protocol outcome > my ability to know anything from home - so I hope the protocol was followed/clean and of course that DPJ is ok.
October 9th, 2018 at 3:25 PM ^
Seems like one natural interpretation is that if the K-D test is performed and the player passes, then you have confirmed the lack of a concussion and the player can return to play (whereas if the player fails the K-D test, the suspicion of concussion remains and the player cannot return to play that day).
October 9th, 2018 at 3:32 PM ^
I don't care what the protocol is, that kid should not have gone back out on the field. I was disappointed to see him back so quickly after a hit like that.
October 9th, 2018 at 3:38 PM ^
So then basically he can never play again. By your standard, whether he passes the test 5 minutes later or 3 weeks later it's never good enough. Some of the most violent hits in sports don't result in any injury whatsoever. Then there are injuries that come during plays that are benign. You're like the ref that throws a flag because the hit looks scary.
October 9th, 2018 at 4:38 PM ^
The "ref that throws the flag because the hit looks scary" is a great analogy.
For instance, impact to the chin often causes a strong twisting force which triggers a protective reflex for the body to go limp (muscles, from top to bottom relax), colloquially called a "knockout".
However, it is not a 1-to-1 measurement of brain impact. Force to the head or neck area causes this reflex quite easily. This is akin to a boxer who gets stung on the chin, and their legs fold, dropping to their knees, even though they can get back up immediately--in less than 1 count.
However, one can receive a rather large blowto the head, either lateral, or frontal, never lose consciousness, and sustain a concussion.
Loss of consciouness is certainly an indicator (and DPJ definitely lost, as you can see on the replay as he falls), but, again, it isn't a direct predictor.
The total force of a collision is the overall strongest predictor, as in when each player lowers their helmet for a head on collision.
I'm not saying one way or the other whether he should have been out there--not my call/didn't admin the tests. But I'm going to guess that UM, per Harbaugh, adhere to the current guidelines.
October 9th, 2018 at 3:41 PM ^
I hear you; that was one of the dirtiest hits I have ever seen. I wanted to jump through the screen and take a baseball bat to that asshole.
October 9th, 2018 at 3:41 PM ^
What medical school did you graduate from?
October 9th, 2018 at 3:52 PM ^
Hollywood Upstairs Medical College
October 9th, 2018 at 4:22 PM ^
You've been out of it a while. They moved to the basement suite. Cheaper rent and a working bathroom or something along those lines.
October 9th, 2018 at 10:17 PM ^
Not to mention the savings in air conditioning costs for the year.
October 9th, 2018 at 3:59 PM ^
That kind of attitude is why strict protocols are needed and have to be followed.
"I don't care what the protocol is" leads just as easily to sending kids back in when they shouldn't.
October 9th, 2018 at 3:33 PM ^
I don't know about the K-D test, but generally when you're diagnosing a concussion you're testing a few things:
- can the patient walk in a straight line without being or feeling wobbly
- does the patient know where he is, know the date/day, what's going on around him ("who are we playing? What's your name?")
stuff like that. If you go through all that and you're fine, you've cleared the protocol. I assume that's what happened with DPJ.
October 9th, 2018 at 3:35 PM ^
Our youth hockey league has adopted the King Devick test. We use an iPad and set the baseline by pulling them out of practice and administering the initial test in the penalty box. Pretty simple. It's a cognitive test and if we suspect they've had a possible impact we can have a designated parent administer the test in the locker room and compare it to the baseline. The site/app will tell you based on the comparison what to do. Then you provide the results to the kid's parents and caregiver to proceed.
October 9th, 2018 at 3:46 PM ^
Well, your certified athletic trainer (ATC) is responsible for looking out for on field injuries including concussions obviously. Team Doc would be out there too for something egregiously serious. If it were me, I'd first establish if there were any gross signs of mental or physical impairment.
I'd be looking for:
Neck pain to clear the neck for cervical involvement
Signs & symptoms of major issues: headache, nausea, vomiting, dizziness (lasting more than a few minutes)
Loss of consciousness (LOC)
Changes in movement pattern (how he walks off the field)
Changes in speech
Personality, energy level changes
Memory/mental recall impairment/general awareness of time, place, situataion
Impairment in concentration tasks (serial 7s--basically doing simple math on the spot)
Balance/vestibular issues
Changes in gross upper body strength
Edit: Forgot to add eyeball issues: visual nystagmus (the follow my finger test) and pupil reactivity to light. Usually those are signs of more serious issues but are pretty easy to check real quick.
If he passes all those, then he's clear to return to play. If not, then you hold him out and give him a battery of mental and physical impairment tests to figure out how bad he is and as a baseline to gauge improvement. In that case he's out for the game and a minimum of a week usually.
Source: Me, 20+ years of ATC experience with collision sports (including many years on high school sidelines, UM, and a "pro" game with the Lions) although I've been out of athletic training for several years and I may have forgotten a few bits. I'm old; don't judge me.
October 9th, 2018 at 4:05 PM ^
Thank you very much - I appreciate the thorough information. How long does it take to run through those symptoms / tests? It sounds like a 5-minute test.
October 9th, 2018 at 6:35 PM ^
Yep, once you get to know your players, you can just eyeball them and you know as they walk off the field how they're doing. It would be a 5-10 min. run through if everything is negative.
October 9th, 2018 at 4:54 PM ^
Second all of this as a current PT pursuing advanced training in concussion assessment/treatment. Great summary.
October 9th, 2018 at 5:16 PM ^
I can't do serial 7s stone-cold sober and unconcussed...
October 9th, 2018 at 6:37 PM ^
Haha, in that case I've switched it up to serial 3s for those whom serial 7s are a bit challenging.
For those who don't know, Serial 7s is basically starting at 100 and counting down by increments of 7, so 93, 86, etc.
October 9th, 2018 at 3:49 PM ^
Having had a sports-related concussion and witnessed others, it's not usually that ambiguous.
If you are coherent and can focus on what's going on around you, you're probably not concussed.
October 9th, 2018 at 4:08 PM ^
I was a little confused because Collins had run back to the locker room only minutes earlier. According to the announcers he was going for a concussion test. Then DPJ was hit, and they administered the test on the sideline. I assume the announcers were wrong (shocking!) and he really didn't go back to the locker room for a concussion test, otherwise, why hold the same test in two different locations?
October 9th, 2018 at 4:41 PM ^
I doubt Nico was suspected of having a concussion. No way should they have let him run like that if they thought he might have a concussion.
October 9th, 2018 at 5:04 PM ^
I'm glad Michigan built a nearly-invisible medical exam awning into the wall instead of those giant popup tents.
October 9th, 2018 at 7:13 PM ^
He was out of the game but not fully out of the game.
October 9th, 2018 at 8:18 PM ^
Was playing a pick-up game of baseball a little over 60 years ago; left field. Pop fly between third base and left field. Ran in to make a diving catch. Dove into the knee of the third baseman running toward me looking back over his shoulder for the ball. Definitely got up wobbly. Player and spectators gathered around and someone asked me what time it was on the outfield clock. I saw two clocks and answered, "which one". At which point they told me I should probably not play any more, and I should go home. I walked home, about 7 blocks, including across a busy street, where my mother asked, Who won? "I don't know." What was the score? I don't know? What happened? I don't know. How did you get home? I don't know. She took me straight to the doctor. Diagnosis - Slight concussion with temporary amnesia.
That and some other experiences, like lying unconscious overnight in the hospital, led my parents and our doctor to conspire against me when I wanted to go out for high school football. Love the sport though.
We have known about the seriousness of concussions for a long time.
October 9th, 2018 at 9:55 PM ^
They administered the Voight-Kampf test, which only showed negative for being a replicant.
October 9th, 2018 at 10:08 PM ^
the sideline standard is to perform a SCAT5 exam, which is the 5th generation version Sport Concussion Assessment Tool. Problem is, it takes 30 minutes or more to administer. The king devick is an alternative, but requires baseline testing and is less conclusive. Also not an industry standard.
In a game, the training staff and team physician watch for possible concussion. It’s impossible to catch all possible head injuries, though.
Under 5 minutes seems fast for him to be back out, but it’s possible.
October 9th, 2018 at 11:41 PM ^
King-Devick is the Mayo Clinic baseline test. You take the test on a computer to set a baseline time and what not, and then in the event of a head injury, the test is administered again on a computer (iPad or laptop). If the time is slower or a bunch of mistakes are made, it's a concussion. Banner also has their own proprietary baseline test.
Also, if the pupils dilate, or just one pupil dilates, it's a concussion.
October 10th, 2018 at 10:26 AM ^
Can't tell if this is genuine curiosity or concern trolling, but I'll bite. As many others have said he did get checked by doctors and was cleared. The tough thing with concussions is it's quite common that symptoms don't show up until well after the injury takes place and swelling sets in. So aside from cases where there's a loss of consciousness, if the player passes the tests what are they supposed to do - hold him out for a week because he took a big hit even though there are no concussion symptoms?
I'll admit I was surprised he went back in - but only because of dumbass Todd McShay saying on the broadcast that DPJ looked completely out of it and obviously concussed. Which clearly was not accurate, and they kept showing DPJ close up and he did NOT look out of it at all. Thanks Todd. Take away that bit of shoddy reporting, and there's nothing to see here. There's nothing to gain when the sideline reporters speculate about concussions.
October 10th, 2018 at 10:40 AM ^
It's genuine curiosity. I didn't want to look like a troll - especially with a polarizing topic and my username! Lots of great info in the responses, though, and I really appreciate the responses.
Also, I agree that McShay's speculation was unhelpful and that DPJ did look coherent on the sideline. Thanks