NFL reports remain inconsistent
Three years after Congress pressured the NFL to overhaul its concussion program, the league effort remains marked by inconsistencies in how it tracks, manages and even describes serious head injuries, making it difficult to assess the league's progress on the issue, an analysis by ESPN's "Outside the Lines" and PBS "Frontline" shows.
The analysis found that NFL officials this season have released conflicting data about head injuries, and medical personnel have sent some injured players back into games -- possibly in violation of new league guidelines.
The "Outside the Lines"-"Frontline" analysis was based on interviews with concussion experts inside and outside of the NFL and an examination of weekly injury reports over the past four years. Among the findings:
ESPN, 'FRONTLINE' TRACK CONCUSSIONS
ESPN's "Outside the Lines" and PBS "Frontline" sought to clarify the number of concussions in the NFL and established Concussion Watch, a database that uses the league's weekly regular-season injury reports to track every concussion and head injury this year.
The analysis shows that the number of players with concussions listed on injury reports is on pace to increase more than 9 percent from last year, to an average of nearly 9 per week. The NFL averaged 5.4 per week in 2009, 7.6 in 2010, and 8.4 last year.
According to Concussion Watch, teams had 128 players with concussions or head injuries on weekly regular-season injury reports through the first 14 weeks and are on pace to report 155 for the regular season. That's up from 92 who appeared on injury reports in 2009 and 129 in 2010. Last season, 142 players who sustained concussions or head injuries were reported.
The 155 players who are projected to show up on an injury report with a head injury or concussion during the regular season this year would represent a 68 percent increase over those listed on injury reports from 2009.
The Concussion Watch analysis, along with additional reporting, shows the NFL's data collection and dissemination of concussion information remains imperfect. But the analysis has limits because of the way the NFL provides injury data:
• Because the statistics are culled from weekly injury reports, the data represent primarily players who are reported to have sustained concussions or head injuries during the regular season only, except for those heading into Week 1, which includes some injury data from the preseason.
• It's unclear how many concussions never make the weekly injury reports when an injured player's team has a bye and the player recovers enough before the next game. In that case, the player would never appear on an injury report.
• A similar circumstance occurs at season's end. For example, injury reports from the final week of the regular season in 2009-11 were not tallied in the "Outside the Lines"-"Frontline" analysis unless their teams made the playoffs -- meaning players from 20 teams were unreported in the totals. The reason: No injury reports were made available for non-playoff teams.
• There are also discrepancies in how individual teams report and even describe head injuries. Some teams use the term "concussion" on the injury reports; others use the generic term "head."ESPN researcher Rachel Eldridge, Frontline reporter Sabrina Shankman, and Frontline researcher Jason Breslow contributed to this report.
ESPN reporters Mark Fainaru-Wada and Steve Fainaru are writing a book about football and brain injuries, scheduled to be published in 2013 by Crown Archetype, a division of Random House. PBS' "Frontline," in partnership with ESPN's "Outside the Lines," is producing a documentary based on the reporters' research. This article is a product of these partnerships.
"Outside the Lines'" cross-platform series, "Football at a Crossroads," examines health issues surrounding football at all levels of the sport, from youth football, high school and college football, through semipro and professional football.
"Out of respect for the injury, we took him to the locker room to perform a thorough evaluation to be sure," a Jets spokesman wrote ESPN in response to questions last month. "We were concerned enough to perform the testing, but all signs and tests suggest that he did not have a concussion."The Jets said Greene was allowed to return to play in the second half because he passed every test. Greene told reporters the next day that he was "fine" and didn't have a concussion. Last month in an interview with ESPN, Greene said: "I think what it was, when it first happened, I kind of got up too fast from the hit. I wasn't all the way there. It was kind of shaky." Two weeks later, Lions receiver Calvin Johnson took a helmet-to-helmet hit from Vikings linebacker Chad Greenway, who was later fined $21,000. Johnson was slow to get up and went to the sideline, where he was tested for a concussion. He returned about six minutes later. Johnson was not listed on the team's injury report when the Lions returned from a bye week after the Vikings game, yet, according to the Detroit Free Press, he told reporters at least three times that he had suffered a concussion. "Yeah, yeah, he knocked me good," Johnson said. "You could tell. It was obvious." The Lions disputed Johnson's claims about his injury. More than a month later, the team and the player issued a joint statement in which Johnson retracted his claim and said he had misused the term "concussion." Experts say the challenges in identifying concussions are compounded by players being reticent to self-report symptoms because they want to stay on the field and fear losing their jobs. That issue came into sharper focus recently with the case of Alex Smith. The 49ers quarterback admitted he was having double vision after taking a hit to the head in a Nov. 11 game against the Rams, was diagnosed with a concussion and then, despite recovering, he lost his starting spot to Colin Kaepernick. Dodick, of the Mayo Clinic, said he believes the NFL protocols are "reasonably sound, but they're not necessarily being followed."
The pressures on the sideline are too great, he said. Players want to play, and trainers and doctors, even those with the best intentions, wind up torn."The pressures must be enormous," Dodick said. "Doctors want to keep their patients happy; that's the bottom line." Dodick said he supports a proposal by the NFL Players Association to have an independent neurologist on the sideline. The league has rejected the idea, arguing that team medical personnel and doctors are most familiar with the players and thus best suited to treat them. Ellenbogen said he doesn't support the idea of independent doctors on the sideline, and he believes players might be even less inclined to self-report a concussion to someone they don't know. "Because there is no rapid test or X-ray for concussion, one depends on the sideline medical team to know their players and be able to recognize when they are different than the baseline," he said. "I think an independent doctor would miss the nuances of the exam and behavior that someone who knows the player would not." Without addressing specific cases, Ellenbogen acknowledged that teams are still learning and that concussions are missed. But he said it is unreasonable for people to make judgments watching on television. Margot Putukian, director of athletic medicine at Princeton University and chair of the NFL's Return to Play subcommittee, agreed. "It's a challenge; there's an elusiveness to the injury," she said. "Signs and symptoms can be delayed. The sideline assessment can be 'normal.' And the athlete can still have a concussion. It's easy to be the Monday morning quarterback." ESPN researcher Rachel Eldridge, ESPN reporter Rich Cimini, "Frontline" reporter Sabrina Shankman, and "Frontline" researcher Jason Breslow contributed to this report.