IndyCar doctors respond to Brad Keselowski’s pointed concussion criticism

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When Will Power was held out of the St. Petersburg Grand Prix with an apparent concussion Sunday, his cross-series teammate at Team Penske offered an opinion 2,000 miles away.

Brad Keselowski, who was racing at Phoenix International Raceway later the same day, cast his doubts on the ability of doctors to diagnose concussions and the wisdom of sports leagues putting their faith in the decisions.

The IndyCar Series announced Wednesday that Power had been misdiagnosed and didn’t have a concussion at St. Pete. During a news media conference call with Power and two doctors, Bob Pockrass of ESPN.com asked whether Keselowski might have a point.

“That’s really a very good question,” said Dr. Stephen Olvey, a former doctor with the circuit and the retired former director of the Neurocritical Care Unit at Jackson Memorial Hospital in Miami. “The problem (is), as you all know, 12, 15 years ago, we used to say if a driver had a particularly bad crash and maybe he was unconscious for a minute or two and then felt fine or it was getting better, we’d say, ‘Oh, good, he just had a concussion.’ Well, as you all know now, we understand the concussion is very serious. Too many concussions can be really bad, and too many too soon can lead to CTE and all of that stuff that everyone has read about in papers.

“The problem is the medical profession has lagged behind this. I went to a neurology conference two years ago, and there were a couple of neurologists that were rather well-known who were kind of scoffing at the idea of chronic traumatic encephalopathy (CTE, which has been found in NFL players) and having too many concussions.

“The situation is still present — especially at lower levels, lower than IndyCar, NASCAR, Formula 1 and all — where you have, maybe, physicians at the racetrack, but they’re not really tuned in on diagnosing the concussion. There’s still people that think you have to be knocked out. There’s still people that think you had to have hit your head. None of that’s true. You can have a very significant concussion and not hit your head at all.

“Imagine what it’s like in Pee Wee football leagues and things like that where you may have no physician there at all or no medical person at all — and the coach says, ‘Oh, you know, you’re all right, kid, you’re awake, you’re talking, and put them back in the game,’ and they get into trouble.”

Olvey said the goal is raising awareness and said that diagnosing a concussion is harder now because doctors have become more attuned to a broader spectrum of symptoms that might indicate it.

“We’re trying to spread the word to different organizations in motorsports as well as to sports medicine, and the American College of Sports Medicine has a task force on this,” he said. “We’ve got special education in South Florida with all the high schools and grade schools, and it’s recognizing concussions.

“It has to be a conscious thing and a conscious awareness around team members. I mean, even in motorsports, if a crew member or the car owner or the chief principal thinks the driver is not acting quite right after an incident or is just a little bit strange, you need to err on the side of being conservative, and they need to be brought in and given an exam. And if it leads to what happened with Will, even though the symptoms were due to something other than a concussion, you still have to go through that process because concussion is very serious.”

Power was held out of Sunday’s race after failing a sports concussion assessment test (SCAT). In a Wednesday release, IndyCar said Power might have been suffering symptoms related to an inner-ear infection that caused nausea.

Dr. Terry Trammell, a safety consultant with IndyCar, said standardized instruments such as the SCAT test were a key to evaluating drivers.

“Because that doesn’t have much room for the bias of an individual examiner,” Trammell said. “And that’s been the drift, to try and get doctors to buy into these various sideline tests or acute concussion inventories that you can do on the spot.

“And that is, first of all, something that we’ve mandated with IndyCar, and since we have the same physicians available at the racetrack all the time, they’re able to do that consistently and do away with any personal bias that might come into it if you’re just doing a ‘Well, you look OK,’ kind of exam.”

Trammell said erring on the side of caution in diagnosing a concussion was important.

“First and foremost, it’s for the driver’s own benefit so that he doesn’t end up with a chronic condition or a worsened injury, having a second concussion before the first one is resolved,” Trammell said. “And then, of course, when you’re in the middle of 22-plus other drivers, you certainly don’t want to not be performing at your peak where you endanger all of them.

“Our goal is to protect all of our drivers, both from themselves and others.”

Team Penske president Tim Cindric said Power likely wouldn’t have driven Sunday morning even without the concussion diagnosis because he was feeling so ill despite winning the pole position Saturday. Oriol Servia drove the No. 12 Chevrolet in a morning warmup and then the race.

“There was never a point where there was any disagreement about racing or not racing,” Cindric said. “I think the only discussion on Sunday morning was whether or not he should do one or two laps just to see how he feels in the car vs. having a real run.

“I think it’s fair to say that with or without the diagnosis or whatever or any of the doctors’ orders on Sunday, he wasn’t going to drive.”

Power said he was feeling better Wednesday and would be testing at Barber Motorsports Park next week.

Keselowski has been outspoken about concussions in NASCAR, criticizing the sanctioning body when a new policy was announced in October 2013 that mandated ImPACT testing to create a baseline for drivers.

Power’s misdiagnosis was discovered after he underwent ImPACT testing Wednesday at the University of Miami, determining he hadn’t suffered a concussion in his Friday crash on the streets of St. Pete.