A researcher's struggle to get players and leagues to cooperate in a study of traumatic brain injury
The last time Dr. Paul Echlin attempted to research concussions occurring in young ice hockey players, one of the two participating teams dropped out halfway through the study.
Now, two years later, Echlin managed to get all of the data needed for a massive, 4-part analysis of traumatic brain injury among college varsity players -- but not without meeting enough opposition that he was inspired to write an accompanying editorial decrying the competitive culture that keeps concussions dangerously under studied and underreported. All were published in a special issue of Neurosurgical Focus.
In the course of this new study, 20 percent of the men and 25 percent of the women followed suffered a concussion. The numbers were only half of what Echlin's team reported in 2010, but were 3 and 5 times higher, respectively, than what had previously been reported for collegiate ice hockey.
But no one, Echlin wrote -- not the kids, not the coaches, not their parents -- wanted to acknowledge possible concussions if it meant interfering with their playing.
The way Echlin told it to me, the entire experience of following the teams had the air of a middle-school argument: One coach who had signed on with the study talked behind the researcher's back about how the whole thing was a waste of time and money. The comments made their way back to Echlin, who included them in his editorial along with some disturbing examples of what his team physicians observed:
At the game, the player took an elbow to the head. She got up immediately, and although she felt some mild symptoms at the bench (nausea), she noted that she had felt that before and did not have any prolonged symptoms or diagnosis of a concussion. She was not assessed by the study observers at that game, and she played next evening's game. She continued to feel sick over the next few days/weeks ... Her symptoms initially mostly consisted of a headache, but she also experienced nausea with minimal activity (walking to classes) and after a couple of weeks noted increased sensitivity to light. She was approached by the trainer who did objective concussion testing (SCAT2), but didn't notice any abnormalities except for some symptoms that they both attributed to having been sick ... the player specifically asked the trainer not to disclose to the doctor her current symptoms so that she could continue playing and the trainer obliged.
"It's about a culture that really wants to see this violence and doesn't want to evolve with our knowledge about brain injury," said Echlin.