International Rugby
IRB set to continue with controversial concussion test
ESPN Staff
August 7, 2013
Wallabies flanker George Smith is helped from the field, Australia v British & Irish Lions, ANZ Stadium, Sydney, July 6, 2013
Australia flanker George Smith appeared to be concussed during his side's recent clash with the British & Irish Lions but was cleared to play on © Getty Images

Pitchside Suspected Concussion Assessment (PSCA)

  • A PSCA can be requested by the player's team doctor and the match referee if they suspect that a player may have suspected concussion.
  • Match referee will signal, via comms device and hand signal of three taps to the head, that a PSCA has been called. PSCA carried out at pre-agreed place, medical room or alternative if not easily accessible, with a temporary replacement taking the field.
  • The substitution will become permanent should a player fail the test, while temporary replacements are not allowed to take kicks at goal.
  • PSCA must be completed inside five minutes - commencing with the player leaving the field at the half-way line and ending with presentation to the reserve official after being cleared to play.
  • PSCA incorporates the Maddocks Questions (cognition), a balance assessment and a 'symptoms and signs' assessment.
  • Maddocks Questions: At what venue are we today? Which half is it now? Who scored last in this match? What team did you play last game? Did your team win the last game?
  • One failed Maddocks question, four balance errors and the presence of one or more signs will see the player removed from the game. A 15-minute period is allowed for players suffering suspected concussion and a blood injury.

The International Rugby Board is set to stick with its controversial concussion assessment protocol trial despite widespread concerns about its accuracy and allegations that players are cheating the test.

The sport's governing body introduced the Pitchside Suspected Concussion Assessment (PSCA) last year as part of its bid to improve player welfare but has since been accused of endangering those that play the game.

The test sees players who have suffered a suspected concussion leave the field for five minutes while the doctors determine whether they are fit enough to return to the pitch by asking the player a series of questions. If the player is suspected of having concussion he is not allowed to return to the game. Previously medics were forced to assess suspected concussion on the field with only players with blood injuries allowed to leave the field of play.

The implementation of the PSCA prompted the resignation of former IRB medical advisor Dr Barry O'Driscoll who has since gone public with his criticism of the process, accusing his former employers of 'trivialising concussion' while insisting, "There is no scientific, medical or rugby basis for the safety of this process."

The sight of Australia flanker George Smith staggering from the field following a head knock during his side's recent clash with the British & Irish Lions in Sydney, only to return to the fray a few minutes later sparked yet further criticism. Ex-Scotland international Rory Lamont labelled the PSCA as "flawed" while also revealing that players know how to cheat the tests and ensure they are cleared to play on.

Adding to alarm, Dr Willie Stewart, a consultant neuropathologist at Glasgow's Southern General Hospital, has revealed what he believes to be clear evidence related to dementia in the brain of a male in his 50s who had played rugby.

The current IRB chief medical officer Dr Martin Raftery has acknowledged the widespread criticism and vowed to add their concerns to the feedback from team doctors and their own video analysis. Changes to the PSCA are expected as a result but the trial will continue as planned.

"I read what Rory had to say and I applaud him," Rafferty told The Scotsman. "His decision to come out and speak about what is going on in the game is helpful and his message to players to stop cheating tests and ignoring head knocks is vital.

"I hope that we can use him as an ambassador because we need people in our sport to be honest if we are to make players, coaches, medics and parents aware of the seriousness of concussion and the importance of stopping players from playing with head knocks."

He added: "Having been a team doctor in those situations I have sympathy with the difficulties in diagnosing concussion in five minutes, even off the field. That is a key message to get across - concussion has been recognised as being the most complex sports injury to diagnose and there is no perfect diagnostic test or marker for clinicians to rely on. The science is lagging quite a bit behind the demands of doctors in the modern game.

"The PSCA test is not perfect, but nothing is, so, what do we do? Sit on our hands? Before PSCA medics had to make the call in a minute or so during the mayhem on the field and research showed around 25 percent of players confirmed as having concussion, through missing training or a game afterwards, had not been taken off in the game they suffered the head knock. In the past year, with the PSCA, research shows it now to be around 11 percent. It's still not good enough, but it has to be a step in the right direction."

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