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1030 CST: Session 7, final session: The Sharp End

First debate between Dr. Cantu (yes) and Dr. Herring (no): is no RTP same day the best management paradigm?  Is keeping a player out one week long enough and is the graduated RTP protocol sufficient…

THERE WILL BE NO RTP on same day in the new statement!!!

Change of direction on Session 7, questions with panel answers, pro-con (if available)

Do 3 concussions end your career?

• its comedy hour
• Aubrey – treat each athlete individually
• Dvorak – it has to be based on timing and complexity of each recovery – case-by-case basis
• Putukian – if we can’t agree on dx how can we agree on a number
• Overall theme is it is individualized, not all concussions are the same (Cantu)

Who is best qualified to make the sideline decision?

• Cantu – multiple members working under a physician can make the call
• Herring – concerning to him that some information is intrinsic to doctors so need to be careful
• better question is who best qualified – person with most experience
• Dvorak – looking at spectrum of games played, doctors are best qualified in most instances, but are they there in all matches?  We should aim all this to the “grass roots” as the professional level there is more than adequate coverage.
  • comedy about football versus american football
• Ellenbogen – those that know the athletes should be making the decision, maybe a parent in youth sports, or athletic trainers, understanding the patients baseline is important
• Putukian – balancing act, in a perfect world its a team approach (Athletic Trainer mention), and she says in the US the athletic trainer should be making the decisions on the sidelines…
• Aubrey – Hockey Canada has a safety person (volunteer) in lieu of an athletic trainer
• Cantu – brings up possibly training school teachers in concussion
• Herring – if you are team physician do you need someone else to make the decision if you are on the sideline?  Panel – no

Is there a role for grading concussions?

• Cantu – not perfect, but informing patient is important about severity and duration of recovery, after the fact
• McCrory – we have moved from grading, look at the recovery – perhaps look at the SCAT/serial testing
• Putukian – looking at history is more important than arbitrary “grade”
• Herring – may help with continual care from one place to another, but again important to understand history

Should we be returning on the same day of concussion?

• Aubrey – what about the NHL player in the playoffs (rhetorical question)
• Cantu – no once recognized
• McCrory – what about the players that clear the SCAT, so no concussion, but you know something is amiss?
• Putukian – example of hockey player with delayed symptoms
• McCrory – concussion is often an evolving injury
• Ellenbogen – it is a traumatic brain injury, is the game worth it?  No.
• Panel – consensus is NO RTP same day
• McCrory to Aubrey about playoff example – what about a regular season, and Aubrey is being very honest, and he feels the player push back is greater
• Ken Dryden from the audience – why are we treating professional athletes different from the youth or non-elite athlete
  • We are starting to move away from that, all athletes should be treated the same

Should there be helmets in woman’s lacrosse and field hockey?

• Cantu – yes, because of stick and ball causation of concussion
• Putukian – no, change nature of the game, no reports of intercranial bleeds in women’s lacrosse, weary of unintended consequences (BTW, probably has the most experience with this)
• Cantu and Putukian discussing this topic
• Change gears – what about football?
  • Dvorak not in FIFA’s plans to recommend, many reasons including the false security of wearing head gear
• Audience Q: should we discourage the use of the head bands/head gear
  • Dvorak – your own prerogative but data does not support the use of them as recommendation (Czech goalie wears one)
  • McIntosh – Rules are more important at this time

Should there be age restriction on tackling in American football, heading in soccer and checking in ice hockey?

• Cantu – his words speak for themselves, youth sports needs to look at how the game is played because of the differences between older
• McCrory – in Australia you cannot get to the gladiatorial aspect of Aussie Rules until they are “of age” (13 if I heard correctly)
• Ellenbogen – risk of activity, most concussions via CDC information is from wheeled sports and recreation, does not make sense at this time to him, advise accordingly
• Cantu – youth sports don’t have the good data, personally he does not believe learning a sport at age 5 will make you elite, it is a genetic disposition in his opinion
• Putukian – it makes sense to decrease exposure, US Lacrosse has put age 13 on checking, her take on soccer is that there is no data to support this when using proper sized ball and equipment
• Dvorak – young soccer players learn sport first, and fundamentals of “football” its not “headball”, studies done on heading ball and with study there was no increase in biomarkers they were looking at it.  They don’t force kids to head ball until skills are sufficient.
• Herring – false warranty?  Arbitrary age is concerning, take head out of the game rather then taking the game away from youth athletes.  The limit to exposure is accurate, but complete removal of the sport may not be necessary.
• Cantu – sport needs to be safer for younger athletes
• Aubrey – ice hockey has set limits on age for body checking, research is very important, it will help make decisions

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Dr. Jamie Kissick speaking on “From Consensus to Action”

• Knowledge is power
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