Report card on NCAA concussion policies

Colleges remain inconsistent in the way they handle athletes' concussions, according to a Harvard University study that comes more than four years after the NCAA began requiring schools to educate their players about the risks of head trauma and develop plans to keep injured athletes off the field.

In a survey that included responses from 907 of the NCAA's 1,066 members, researchers found that nearly one in five schools either don't have the required concussion management plan or have done such a poor job in educating their coaches, medical staff and compliance officers that they are not sure one exists.

"Collectively, the institutions without a concussion management plan are responsible for the well-being of thousands of college athletes each year," according to the study co-written by Harvard researcher Christine Baugh and published this week in the American Journal of Sports Medicine. "For stakeholders to follow an institution's concussion management plan -- or to have confidence that others are following the plan -- they must first know that it exists."

The findings in the study reinforce the images fans have seen in stadiums since the problem with concussions became more widely known: Wobbly players are sent back onto the field without proper medical clearance as coaches remain ignorant to their injury -- perhaps willfully. The authors recommend that the NCAA bolster its 2010 policy to require schools to make their plans public, to better educate coaches about concussion symptoms and to require that schools not only come up with plans but actually apply them.

"As written, the NCAA concussion policy only requires the presence of a plan and not that the plan is actually implemented," the study says. "Perhaps the most important next step is for the NCAA to revise the language of its concussion policy to reflect the necessity of plan implementation."

The most troubling implication of the study, though one its authors stopped short of concluding, may be found in the gap between the 90 percent of schools where athletes were told of their duty to report concussion symptoms and the 71 percent where athletes were educated about concussions themselves. The discrepancy creates a suspicion that schools are more interested in avoiding concussion lawsuits than sincerely educating their players.

"Athlete acknowledgement may function as a means through which member schools aim to limit their institutional liability or as a strategy to encourage positive athlete concussion reporting behaviors," the study said, adding that for the latter to succeed "acknowledgement should be paired with appropriate education."

The examination of the NCAA concussion policy involved a survey that was sent to more than 32,000 coaches, compliance officials and members of the sports medicine staff at all 1,066 member schools. The 2,880 responses revealed wide gaps in the way the policy has been implemented.

The authors received responses from five schools reporting that they do not have a concussion management plan, from 19 others schools where individuals were unsure and from 138 schools where the answers were inconsistent. The authors called for better education and communication, "at minimum."

The study also noted that the NCAA policy is unlikely to be effective if violations are discovered only when a school turns itself in. The authors also encourage the NCAA to require schools to make public their concussion management plan; it's now voluntary.

Another red flag: About 15 percent of those who responded to the survey said coaches or athletes had the final say in deciding when it was safe to return to play; either a physician or someone designated by a physician is supposed to have that authority. The researchers said they could not conclude that this was a problem, because it's possible that players and coaches could decide to stay out even after receiving medical clearance.

Although almost all -- 98.7 percent -- of those responding said the school's concussion plan protected athletes either well or very well, more than three-quarters of the total also said their school needed improvement in coach or athlete education or better staffing in the sports medicine department.

"Although providing athletes with any information about concussions is a positive step, it is concerning that even minimal levels of information" are not universally provided, the authors wrote. As a solution, they recommended that the education be standardized and include content on the possible short- and long-term effects of concussions.