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NFL announces new sideline concussion assessment protocol

NFL team medical personnel will use this season a new standardized sideline concussion assessment protocol, the NFL Head, Neck and Spine Committee announced Friday. The announcement was made in Indianapolis at the NFL Combine by Dr. Margot Putukian, member of NFL Head, Neck and Spine Committee and chair of the Return-to-Play Subcommittee.

Developed by the subcommittee in response to a team medical staff survey conducted last season, the new protocol combines a symptom checklist, a limited neurological examination including a cognitive evaluation, and a balance assessment. It uses as a foundation many components of the sideline tool developed by the Concussion in Sport group that most recently met in Zurich in 2008. It was developed by the NFL Head, Neck, and Spine Committee, with input from the NFLPA and its medical advisors, NFL team physicians, athletic trainers and their professional societies, and other medical experts.

"This tool provides a standardized format for evaluating head injury that medical staff can use on the sideline," said Dr. Putukian, who also is head team physician for Princeton University, a past president of the American Medical Society for Sports Medicine and the physician representative of NCAA and the American College of Sports Medicine. "It incorporates the most important aspects of a focused exam, so that injury is identified, and athletes with concussion and more serious head and spine injury can be removed from play."

The new medical protocol is the latest in a series of developments as part of the NFL's commitment to player health and safety. The NFL and its clubs have created numerous programs, initiatives and partnerships to protect the health of the members of the NFL family and to encourage safe play at all levels of football. In addition, standardized assessment techniques will support on-going research and development of return-to-play protocols that can be used to enhance player safety in both the NFL and other sports. For more information on the league's commitment to health and safety, visit

Dr. Putukian and the NFL Head, Neck and Spine Committee, co-chaired by Dr. Hunt Batjer of Northwestern University, and Dr. Richard Ellenbogen of University of Washington/UW Medicine, provided the below information on the sideline concussion assessment protocol.

Fact sheet on NFL sideline concussion assessment protocol:

What is the protocol and what does it accomplish?
Building on the foundation of the Sideline Concussion Assessment Tool II developed by the Concussion in Sport group in Zurich, 2008 (McCrory, BJSM '09), the new protocol includes modifications specific to professional football. It includes a focused screening neurological examination to exclude cervical spine and intracranial bleeding, and assessments of orientation, immediate and delayed recall, concentration, as well as a balance evaluation. The performance of these tests can be compared with a pre-season evaluation to see if any decline in function is present. It does not replace more sophisticated tests, and does not replace the individualized assessment by the clinician of the athlete, but does provide the medical staff with a standardized protocol to evaluate for head injury.

How it was created?
A survey was performed of team medical staff (head athletic trainers and team physicians) in November 2010 to evaluate what was currently being performed in terms of pre-season, injury, and post-injury evaluations for concussion. It was clear from this survey that most teams were using a combination of symptoms, cognitive evaluations, balance testing and additional testing to evaluate concussion, but a standardized protocol did not exist. Following the results of that survey, the NFL Head, Neck and Spine Committee, including the Return-to-Play Subcommittee, decided to create the sideline medical protocol to assist team medical staff in evaluating head injuries. A sub-committee of athletic trainers and team physicians was assembled to assist in development, along with the support from the Professional Football Athletic Trainers Society (Green Bay Packers Head Athletic Trainer Pepper Burruss, ATC) and the NFL Physicians Society (Tony Yates, MD). Both Burruss and Yates also serve on the Return-to-Play Subcommittee. The NFLPA and its medical advisors and other medical experts also provided insight throughout the development process. The protocol will be further refined this offseason.

Why it was created?
The protocol was created to support medical staff in providing care to players. Concussion is a complicated injury and one that is complex in its presentation. Unlike a fracture or ligament injury, the initial evaluation is not always abnormal, and there are often no obvious findings from a physical exam. Teams will benefit from a standardized approach to evaluating concussive injury on the sideline.

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