AFL doctors reject KO research
By Caroline Wilson
March 15, 2005
The 16 AFL clubs are resisting an international push to upgrade their matchday approach to concussion, rejecting computerised testing of players during games as impractical, expensive and unnecessary.
The Age believes that most AFL club doctors were unimpressed when the recommendations from the 2004 International Symposium on Concussion in Sport were delivered at the annual meeting of the AFL Medical Officers Association.
The symposium, sanctioned by the International Olympic Committee and world soccer's governing body, FIFA, has dictated that concussed players should not return to the field in professional sport unless they have successfully completed a computerised response test not unlike a series of simple card games.
Coming at an annual cost to each club of about $1000 a year, the test, produced by the Australian company CogState, would require internet access in players' rooms and take at least 11 minutes to complete.
Former Collingwood club doctor Paul McRory, a world expert on concussion, outlined the new requirements at the AFL medical officers' meeting earlier this month to a sceptical response from the 16 club doctors who either attended the meeting in person or over the telephone.
The reaction from Kangaroos' doctor Con Mitropoulos, whose 21-year-old midfielder Michael Firrito was badly concussed during a practice game last month, was typical of club doctors contacted by The Age.
"The really big decision is whether our clinical judgement should be overridden by something we are suddenly obliged to do because some research tells us we should," Mitropoulos said.
"The computer testing has a place during the week - we used it three or four times to test Michael Firrito the week after he was concussed - but the general consensus was it will be extremely difficult to use during a game.
"Michael's case was not a difficult one in that it was a classic concussion. He was thrown to the ground rugby-style and his head hit the knee of another player and he completely blacked out for about 90 seconds. When he came to, he was away with the fairies.
"He wouldn't stay on his stretcher. He was aggressive and irritable and frightened. After 15 minutes of testing, there was no improvement, so there was no question of him returning to play.
"The management was simple. He was sent by ambulance to hospital for a brain scan and we used the computer tests during the week to monitor his improvement.
"The test is very, very detailed into the brain function - but if you're in a game, in a final, and a player's been knocked out and there is 20 minutes to go before the final siren and you have an 11-minute test and something goes wrong with the internet response? I don't know," Mitropoulos said.
"The things we've been doing with footballers for years have been working for years and I'm not sure we've made too many wrong decisions over the years."
AFL medical officer Hugh Seward said: "The management of concussion at AFL level is already of a very high standard and the incidents of significant problems are already very rare.
"We have to decide how far to go to provide everyone with computerised testing.
"I think we should always aim to undertake best-practice methods but we also have to consider the practicalities, the time it takes to do the test and the fact that a phone line is required to log on to the internet and get a result during a game. The question . . . is how much better is this test than a clinical assessment we are already providing."
McRory is co-author of an article in next month's edition of the British Journal of Sports Medicine on the treatment of concussion on matchdays.
THE CONCUSSION TEST
* The player sits at a laptop in his club rooms and responds to a series of choices involving playing cards, pressing 'D' for yes or 'K' for no.
* The key to the test is speed and accuracy.
* The test should take between 10 and 15 minutes, with 11 as the norm.
* It is regarded as more accurate than the pen-and paper test currently used as it looks at the players attention devices, reaction times and memory.
* Once the player has finished the test it is sent down the phone for processing. A result is expected within seconds.
* The new system would cost each club about $1000 annually.