Buzz: Just as concerning to me as CTE (and I think we should do age-matched athletes in other sports) is the possibility of ALS. It is not nearly as frequent but it is disturbing that several prominent players including Steve Gleason and Dwight Clark developed ALS at relatively young ages.
Buzz, I am so grateful for your column. The medical media is really pretty bad, they don't investigate, they don't know how to read studies, they draw wrong conclusions, and worst, they swallow whole what they are told. It's so important that we rescue American medicine from the excesses of the AMA, A Ped A (endorsing multilation of kids for ideology), etc etc. Thank you for being a sane & rational voice!
Steve Devick provided clarification on SCAT testing: I have the articles he mentions in attachment form. If you'd like to review them, let me know the most convenient way to do so.
“Scat3 is not used by the nfl. It’s a much maligned neuro cognitive test that I can tell you all about. There are articles comparing KD and Scat3 and KD is always more sensitive and specific. It is a subjective test whereas KD is an objective test.
I've attached a list of KDT peer reviewed article abstracts sorted by disease/condition. More than 130 of the abstracts validate King-Devick Test in association with Mayo Clinic as the most sensitive and specific sideline test. Separately I’ve attached an article published in the British Journal of Medicine which concludes that King-Devick is the best of all tests for sideline concussion detection. Finally I’ve attached an article published last month which demonstrates that King-Devick Test-along with a test of balance and cognition is the best combination of sideline tests.
We should talk about why the NFL does not utilize KDT for sideline testing. The players are as much to blame as the owners-the players simply don’t want to be removed from play via an accurate objective concussion test on the sidelines-they fear that they will use their job.
Let’s discuss this-Dr. Hollander mentions Tua the Miami quarterback. This article describes his injury and states that the NFL should use KDT, Scat5, and a balance test (KD has a FDA approved balance app) https://www.medpagetoday.com/popmedicine/popmedicine/101173;”
Objective, peer reviewed technology is available for immediate sideline assessment of concussions. The technology was developed in conjunction with the Mayo Clinic and has been mandated in several states at the high school level. The NFL is aware but fails to implement it. Perhaps they prefer a subjective analysis to get players back on the field or fear litigation due to a test that readily identifies concussions. https://kingdevicktest.com/research/concussions/
I'm assume from the link you reference the King-Devick test? I'll say this, from what I can tell: it is faster and relies wholly on recognizing numbers, vs the much more varied testing that the NFL uses (SCAT3). Is it possible it's better? Sure -- but I have my concerns given its simplicity. It's hard to evaluate something without a "gold standard" - there is no lab test or MRI that can diagnose a concussion so we can know reliably what %age a given test captures. I think we can agree that something just flat went wrong with evaluating Tua after his first concussion; I don't care if he could count 6-2-9-7-1 backwards, the game tape told everyone all they needed to know - the man needed to be on the bench the rest of the game!
That’s the beauty-it simplicity, reproducibility, and inability for concussed patients to fudge. The test also predicts recovery time from injury to the time when one can return to competition. 60% of cerebral function involves the brain’s optic centers, making analysis of saccadic eye movements a sensitive signal for global neurological injury.
Tia’s injury was obvious on both occasions, but imagine the numbers of sub clinical injuries week to week occurring in practice and games. If the players union did its job, it would compel an objective neurological evaluation weekly at a minimum. This level of scrutiny would be a big step in protecting them from CTE and owners whose primary motivation is a winning team, not the long term health of their employees.
If you and your readers are interested in learning more about the technology, I can put you in touch with Steve Devick, KDT’s inventor.
I looked into the research on the test, and while it seems like a fast and elegant approach to screening for brain injuries, esp for lay people, I don't see anything as to how it out-performs a more comprehensive test like SCAT-3. Maybe I missed something. But the NFL is blessed with actual trained MDs at every game, and I don't see the need for a faster tool unless it is somehow more accurate (which I find no evidence for).
Buzz: Just as concerning to me as CTE (and I think we should do age-matched athletes in other sports) is the possibility of ALS. It is not nearly as frequent but it is disturbing that several prominent players including Steve Gleason and Dwight Clark developed ALS at relatively young ages.
It's certainly interesting, and probably real (though a pretty hot controversy: https://www.scientificamerican.com/article/can-intense-exercise-lead-to-als/#:~:text=There%20is%20a%20long%20list,the%20U.S.%20National%20Football%20League.), but in context the study on NFL and ALS found a 0.2% rate (https://alsnewstoday.com/news/als-increased-risk-nfl-players-football/#:~:text=The%20average%20age%20at%20ALS,was%20almost%20four%20times%20higher.); granted, 3.5X higher than the general population, but probably not something weighing heavily on people's minds on draft day.
Buzz, I am so grateful for your column. The medical media is really pretty bad, they don't investigate, they don't know how to read studies, they draw wrong conclusions, and worst, they swallow whole what they are told. It's so important that we rescue American medicine from the excesses of the AMA, A Ped A (endorsing multilation of kids for ideology), etc etc. Thank you for being a sane & rational voice!
Steve Devick provided clarification on SCAT testing: I have the articles he mentions in attachment form. If you'd like to review them, let me know the most convenient way to do so.
“Scat3 is not used by the nfl. It’s a much maligned neuro cognitive test that I can tell you all about. There are articles comparing KD and Scat3 and KD is always more sensitive and specific. It is a subjective test whereas KD is an objective test.
I've attached a list of KDT peer reviewed article abstracts sorted by disease/condition. More than 130 of the abstracts validate King-Devick Test in association with Mayo Clinic as the most sensitive and specific sideline test. Separately I’ve attached an article published in the British Journal of Medicine which concludes that King-Devick is the best of all tests for sideline concussion detection. Finally I’ve attached an article published last month which demonstrates that King-Devick Test-along with a test of balance and cognition is the best combination of sideline tests.
We should talk about why the NFL does not utilize KDT for sideline testing. The players are as much to blame as the owners-the players simply don’t want to be removed from play via an accurate objective concussion test on the sidelines-they fear that they will use their job.
Let’s discuss this-Dr. Hollander mentions Tua the Miami quarterback. This article describes his injury and states that the NFL should use KDT, Scat5, and a balance test (KD has a FDA approved balance app) https://www.medpagetoday.com/popmedicine/popmedicine/101173;”
Objective, peer reviewed technology is available for immediate sideline assessment of concussions. The technology was developed in conjunction with the Mayo Clinic and has been mandated in several states at the high school level. The NFL is aware but fails to implement it. Perhaps they prefer a subjective analysis to get players back on the field or fear litigation due to a test that readily identifies concussions. https://kingdevicktest.com/research/concussions/
I'm assume from the link you reference the King-Devick test? I'll say this, from what I can tell: it is faster and relies wholly on recognizing numbers, vs the much more varied testing that the NFL uses (SCAT3). Is it possible it's better? Sure -- but I have my concerns given its simplicity. It's hard to evaluate something without a "gold standard" - there is no lab test or MRI that can diagnose a concussion so we can know reliably what %age a given test captures. I think we can agree that something just flat went wrong with evaluating Tua after his first concussion; I don't care if he could count 6-2-9-7-1 backwards, the game tape told everyone all they needed to know - the man needed to be on the bench the rest of the game!
That’s the beauty-it simplicity, reproducibility, and inability for concussed patients to fudge. The test also predicts recovery time from injury to the time when one can return to competition. 60% of cerebral function involves the brain’s optic centers, making analysis of saccadic eye movements a sensitive signal for global neurological injury.
Tia’s injury was obvious on both occasions, but imagine the numbers of sub clinical injuries week to week occurring in practice and games. If the players union did its job, it would compel an objective neurological evaluation weekly at a minimum. This level of scrutiny would be a big step in protecting them from CTE and owners whose primary motivation is a winning team, not the long term health of their employees.
If you and your readers are interested in learning more about the technology, I can put you in touch with Steve Devick, KDT’s inventor.
Scott Sturman MD
I looked into the research on the test, and while it seems like a fast and elegant approach to screening for brain injuries, esp for lay people, I don't see anything as to how it out-performs a more comprehensive test like SCAT-3. Maybe I missed something. But the NFL is blessed with actual trained MDs at every game, and I don't see the need for a faster tool unless it is somehow more accurate (which I find no evidence for).