Specialist crystal clear on the dangers of taking concussion lightly

Brian O’Driscoll tweeting about hanging in against Australia but coming off in Ireland’s game against the All Blacks.

O’Driscoll: “Australia was different. Had a calf injury not a head injury.”

Brian Moore (ex-England hooker): “would you have tried to go back on if he advised but didn’t insist you stay off.”

O’Driscoll: “definitely would have tried to go back on but that’s why decision needs to be taken out of players hands.”

Moore: “Agreed. All you have to do is replicate that for the Six Nations – easy really.”

O’Driscoll: “True. No more one off-ers . . . ”

The PSCA (pitch side concussion assessment) tool is the IRB’s possible solution to assessing pitch side concussion, which has not been adopted by the Six Nations. It’s a five-minute medical review of the player’s health. Throw him back in or take him off.

Under the PSCA, Australia’s George Smith staggered from the pitch against the Lions in June and returned to play five minutes later. The PSCAs have since been adjusted.

In this year’s Six Nations Championship O’Driscoll was visibly dazed against France and continued to play. There have been many similar cases.

Yesterday Dr Micky Collins was in Dublin. Dr Collins sees 20,000 cases of concussion a year in his clinic in Pittsburgh and is recognised as a world authority. He is used to NFL but a knock on the head in Dallas is the same as a blow in Dublin.

His views on concussion come from a medical career dedicated to the injury. He doesn’t wish to talk specifically about rugby.

"Let's just talk about common sense," he says. "If you see anyone with balance issues, someone who is confused, someone who is repeating themselves, someone stunned, someone who is dizzy. That's an immediate no-go. You don't need five minutes. Once you see that sign or symptom that athlete is out of the game. Unequivocally. When in doubt take them out. You really need to live by that mantra. It's something that's very critical.

Different signs
"We just published a paper which shows that there are 22 different signs or symptoms of concussion. We did a pretty cool study asking which on field symptom best predicts someone will take a month or longer to recover, what is the most important predictor.

“So we followed these 300 kids and looked at their outcomes and we looked at what symptoms they had on the field. We looked at loss of consciousness, memory, confusion, dizziness, nausea, balance issues – all the symptoms. Guess what symptom was the best predictor? Dizziness.”

The Heineken Cup and Rabo PRO12 have sidestepped the PSCA protocols and the anecdotal reasons are because like Dr Barry O’Driscoll, they don’t believe in them. O’Driscoll, an uncle of Brian and a one-time IRB insider before resigning on principle, accused the governing body of putting players with brain damage back on the field.

“If I see someone who stumbles or lose consciousness it’s a no brainer, they’re out of play,” says Dr Collins. “In some of the on pitch assessments – if it’s a five minute assessment that gives me a lot of pause frankly because it’s a lot more complicated injury that that…If you are dizzy, we found that seven times more predictable of having the worst outcome from this injury. It’s not only not a trivial symptom, it’s a critical symptom. If you are dizzy you are out of play. It’s a brain injury.

“When you get an injury and you get hit again and again and again you are going down a very dangerous road. We know that. I don’t think there’s an expert in the world that would disagree if you have signs or symptoms you are out of play.”

The issue in rugby is that five minutes seems such a short time to make a call on a player’s health and doctors know that players will lie to get back on the pitch. The same mindset as athletes who take drugs although they know them to be deleterious to their health, rugby players often don’t think of consequences.

The point is what can you do in five minutes to determine if a player, who may have one of the 22 types of concussion, should go back on and subject themselves to another blow. And what are the consequences of making the wrong call in that short window.

“With obvious symptoms it is a very quick assessment . . .,” says Dr Collins. “I don’t want to put a time on it . . . there’s a lot of variability in it but you’d certainly need more than five minutes.”