What about return to competition?

If you’ve read Brad Keselowski’s comments about concussion testing, he raises the point of objectivity.

Quite a number of years ago, Sid pulled someone from a race weekend, and was lambasted in that driver’s national press for “manipulating the championship”. When I became Medical Delegate, I wanted to construct the best firewall possible between return to competition (RTC) decision-making and that kind of accusation.

Now of course, medicine is never perfectly objective. Neither for that matter is race engineering! But in an effort to provide the most reproducible, predictable and transparent return-to-competition criteria, I met with several authorities on concussion, and the medical directors of the top US open-wheel series. This resulted in an algorithm for RTC that reflected current best practice. The document was given to the Stewards, and they would be informed whenever a driver was to be reintegrated after an accident involving concussion. 

Here’s a copy of the RTC criteria I used. I have no idea whether Jean-Charles Piette (the current Medical Delegate and close mate of Jean Todt) uses these criteria. 

The decision to return a driver to competition after a head injury will be based on the following criteria:

Return to participation at the same event is possible if:

  • no loss of consciousness has occurred
  • amnesia has lasted < 15 minutes
  • neurological examination is normal with no overt post-concussive symptoms
  • CT and/or MRI scanning is negative
  • ImPACT testing reveals no significant decrement from baseline or from age-matched controls
  • if above criteria not met then

 

Return to participation in the NEXT event is possible if:

  • neurological examination performed before start of competition is normal with no overt post-concussive symptoms
  • ImPACT testing reveals no significant decrement from baseline or from age-matched controls
  • CT and/or MRI scanning is negative
  • if above criteria not met then

 

Return to participation requires:

  • neurological examination performed before start of competition is normal with no overt post-concussive symptoms
  • CT and/or MRI scanning is negative
  • normal electroencephalogram (EEG) off antiepileptic medications
  • ImPACT testing reveals no significant decrement from baseline or from age-matched controls
  • satisfactory performance on testing observed by a qualified observer
  • These drivers are considered to be under probation for the first practice session after return to competition.

 

A second episode of MTBI within 1 month of the first (as documented by a significant fall in ImPACT scores or clinical criteria):

  • one month out-of-competition
  • neurological examination performed before start of competition must be normal with no overt post-concussive symptoms
  • ImPACT testing reveals no significant decrement from baseline or from age-matched controls
  • CT and/or MRI scanning is negative

 

A third episode of MTBI during the same season eliminates the driver from further competition that season. The above criteria are then applied at the start of the next season.

 

Decline in baseline performance over several seasons in a driver suffering from multiple episodes of MTBI over time (even with strict adherence to the above) will result in discussion with the driver as to continuation of his career.

One thought on “What about return to competition?

  1. Sending prayers from USA Reining Horse friends from Texas all the way to Mississippi!
    Praying for family to hold on!

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