clock menu more-arrow no yes

Filed under:

NFL’s chief medical officer defends Jacoby Brissett’s late concussion diagnosis

Dr. Allen Sills confirmed that the Colts followed the league’s concussion protocol with Brissett.

NFL: Pittsburgh Steelers at Indianapolis Colts Thomas J. Russo-USA TODAY Sports

Colts quarterback Jacoby Brissett was diagnosed with a concussion after the Colts’ loss to the Steelers on Sunday. On Tuesday, the league’s chief medical officer, Dr. Allen Sills, explained why Brissett wasn’t removed from the game.

Brissett was slow to get up after a hit in the fourth quarter. Colts medical staff attended to him on the field and walked him to the sideline so they could go through standard concussion testing with Brissett. He passed.

The protocol says that players must be evaluated for concussions by team medical staff and an independent neurotrauma consultant who is not affiliated with the team.

“What happened in this situation is [Brissett] went into the tent, and the team physician and the athletic trainers started the sideline evaluation,” Sills said Tuesday. “The unaffiliated neurotrauma consultant was not on the sideline at that moment because the unaffiliated neurotrauma consultant was in the locker room doing that locker room evaluation on another player.”

Even though Brissett passed the initial test, Colts medical staff waited and performed the test again once the unaffiliated neurotrauma consultant got back to the sideline.

“The player, again, passed that evaluation. Had no symptoms, had no findings,” Sills said. “There was nothing to suggest anything that was abnormal at that point. Based on that, and again, in conjunction with an injury video review, everyone in the equation felt that there was no diagnosis of a concussion. The player returned to the game.”

The Colts continued to monitor Brissett throughout the game.

“He was approached by team medical staff and had contact points throughout the game to make sure that no symptoms were appearing and that there was nothing that would change the previous diagnosis,” Sills said.

After the game was over, team medical staff and the neurotrauma consultant checked him once more in the locker room. Brissett still didn’t show any signs of a concussion. That changed after a little more time had passed.

“At some point, 20 to 30 minutes after the game, it felt like there might be the emergence of some very mild symptoms,” Sills said. “Because of that, he was again brought back to the medical staff. The medical staff — again, in conjunction with the independent and unaffiliated neurotrauma consultant — evaluated the player again.”

And Brissett still didn’t have any standard signs of a concussion. But because he did have some “very mild symptoms,” the team decided to err on the side of caution.

“He, again, was normal neurologically in all of the tests,” Sills said. “But because there were some very mild symptoms that appeared, and using what I would refer to as precaution, the team decided that at that point they would place him in the concussion protocol and treat him for that diagnosis.”

Sills, a neurosurgeon whose career focus has been treating athletes, emphasized that it’s not unusual for concussion symptoms to be delayed or to evolve over time.

“Concussion is a very heterogeneous injury,” Sills said. “There are some people that have certain symptoms, and others that have very divergent symptoms. Some people manifest a lot of symptoms right away. Some people have only one symptom and later will add three or four, and some people don’t have any symptoms early on and may develop symptoms on a delayed basis.”

That makes it difficult for medical professionals to accurately diagnose concussions. And that’s problematic, considering the link between head trauma NFL players experience and chronic traumatic encephalopathy, commonly known as CTE.

According to Sills, the Colts followed the concussion protocol correctly with Brissett. In an ideal world, he wouldn’t have been allowed to return to the field. But because his symptoms didn’t show up until after the game, there was no way for team medical staff to know he was concussed.

“It’s part of the frustration of us as medical practitioners trying to care for athletes with these injuries,” Sills said. “But we recognize that concussion is not one injury. It’s a spectrum of injuries. It’s going to have a lot of different presentations.

“Still, part of what we, as the medical profession, have to do is better understand this injury so we can better categorize it and continue our efforts to diagnose it.”

Sills said he believes this current version of the concussion protocol is the best version that the league has had to this point. But Brissett’s diagnosis after he returned to the field to finish the game drives home the fact that it is far from perfect.