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The Physician and Sportsmedicine Volume 48, 2020 - Issue 4
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Original Research

Concussions in the National Football League: the evolution of video review for assessing the frequency and reliability of visible signs

Scott L. Zuckermana Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA;b Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
,
R.J. Elbinc Department of Health Human Performance and Recreation/Office for Sport Concussion Research, University of Arkansas, Fayetteville, AK, USA
,
Allen K. Sillsa Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA;b Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA;d Player Health and Safety Department, National Football League, New York, NY, USA
,
Jeff R. Crandalle Biomechanics Consulting and Research, LLC, Charlottesville, VA, USA
,
David J. Lessleye Biomechanics Consulting and Research, LLC, Charlottesville, VA, USA
,
Caitlin M. Morand Player Health and Safety Department, National Football League, New York, NY, USA
,
Caroline D. Morand Player Health and Safety Department, National Football League, New York, NY, USA
&
Gary S. Solomona Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA;b Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA;d Player Health and Safety Department, National Football League, New York, NY, USA;f Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA;g Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USACorrespondence[email protected]
ORCID Iconhttps://orcid.org/0000-0002-0674-0718
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Pages 424-429 | Received 09 Oct 2019, Accepted 13 Feb 2020, Published online: 23 Feb 2020
 
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ABSTRACT

Background: The use of video review to document visible signs (VS) of sport-related concussion in the National Football League (NFL) is a novel method to recognize head injuries.

Hypothesis/Purpose: The current pilot studies used varying methodologies to (1) examine the frequency of VS in concussed NFL players using the Australian Football League’s (AFL) checklist, and (2) assess the reliability of VS between non-expert and expert raters.

Study design: Cohort study

Methods: In the first pilot study, two non-expert raters rated VS of SRC occurring in the 2015 NFL season (n = 96) using a single VS from the AFL checklist. Based on this pilot study, two expert raters then rated VS of SRC during the 2017 NFL season (n = 211) using all VS from the AFL checklist. The frequency, total percent agreement (TPA), and reliability (kappa coefficients) were calculated for all VS of concussion for the two seasons. Kappa agreement was classified as fair (.41–.60), moderate (.61–.80), or substantial (.81–1.00). Significance was set at p < .05.

Results: The most frequent VS of concussion identified by both non-expert and expert raters were no behavior observed, slow to get up, and motor incoordination. The least frequent VS were impact seizure, blank/vacant look, and facial injury. For non-expert raters, the average TPA for VS ranged from 84% to 100% and kappa coefficients ranged from .52 to .68. For expert raters, the average TPA ranged from 83% to 100%, and kappa coefficients ranged from .56 to .86.

Conclusion: In these preliminary analyses, use of multiple VS was a superior methodology, and the reliability of VS rating was stronger for experts. Due to the inherent differences in gameplay and protective equipment used in the NFL compared to other professional sports, it is our hope these data can generate new ways to improve existing practices and identify potentially novel VS of SRC.

Acknowledgments

The authors extend appreciation to Tim McMurry, Ph.D., for statistical expertise, and to the National Football League Players Association for their cooperation and assistance in the completion of this project.

Declaration of interest

No potential conflict of interest was reported by the authors.

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