Tua Tagovailoa concussion discussion (update: Tua to IR 9/17/2024)(Merged)

I understand there are those of you who don’t like what I have to say…and if you are apart of that group…simply disregard. But for those that do, here is my take.

Let me start by saying that the focus of concussion prevention by the lay public is misplaced. Sure…there are concerns about post-concussive symptoms and CTE. But that isn’t the biggest concern. The biggest concern is something referred to second impact syndrome, which means a second head injury before the first one heals, which can result in SIGNIFICANT BRAIN INJURY OR DEATH. That’s why Tua’s case is so concerning.

Concussion testing was never intended to be the definitive determinant on whether or not a player has a concussion. It was created as a tool to assist on cases that you are not certain about.

Example 1. Player takes a hard hit and temporarily sees stars or loses their breath but on brief exam the player is acting themself without any neurological concerns. This is a great case to use sideline concussion screenings. Concussion screening puts the player through a timed neurological assessment compared to baseline testing. For these borderline cases…it is great for RULING IN concussion. But you really shouldn’t be doing the test to RULE OUT concussion.

Example 2 (Tua part 1). Player takes a hard hit, holds his head, his legs buckle and teammates have to support him while he walks off the field with clear neurological impairment. Clinically what is happening? Can a back injury cause someone to hold their head, be wobbly, and be almost catatonic. The simple answer is no. The differential diagnosis would be concussion versus transient quadriparesis. And in either case, the player is not returning to the field. The value in a neuro exam/concussion screening would be to differentiate a concussion or cervical spinal cord injury, but even that gets tricky because both conditions can occur simultaneously. But the concussion testing shouldn’t be utilized to determine return to play for that game. ENORMOUS second impact syndrome risk, or risk of significant spinal cord injury (your exam will only help you so much).

So what went wrong? Before I cast blame on the medical staff, l think it’s important to understand what happens with sports coverage. You aren’t just hanging out, drinking a beer, and watching the game on the sidelines. You are tending to injured players. There is a chance that the injury, and therefore the mechanism, was missed. I know that seems impossible…but it is possible. But honestly, that’s the only conceivable thing that makes sense to me. Otherwise, anyone who saw the injury should have known better. Another possibility is that the medical staff didn’t understand how to use the concussion screenings. I suspect that they did the concussion screening and Tua passed…but that doesn’t override clinical judgement. The test should have never been done to rule out concussion in my opinion. And this is something that needs to be widely reviewed throughout the NFL.

Example 3 (Tua part 2). Player takes a hard hit and loses consciousness, and then goes into a fencing posture. This would NOT be the appropriate time for sideline testing. Because there is nothing you can see on that sideline test that should dissuade you from thinking that it’s a concussion. You run the risk of having a false negative, which would be catastrophic.

I hope that the NFL forces the Dolphins into treating this as Tuas second concussion in a week. The reason is because the return to play guidelines change. If they treat this as Tuas first concussion there is a chance that Tua will have an opportunity to get his third concussion in three weeks. Insanity.