NFL Chief Medical Officer: 'We Often Struggle to Identify' Concussions Due to Testing

Amid the debate surrounding the Miami Dolphins' usage of Tua Tagovailoa, NFL chief medical officer Allen Sills explained the difficulty of diagnosing concussions, via Albert Breer of Sports Illustrated:

"As a practicing neurosurgeon, I would tell you that we often struggle to identify whether or not a concussion has occurred because we lack objective tests for a concussion. And what I mean by that is, our diagnosis of concussion is still very much dependent on self-reported symptoms. We obviously do have some objective neurologic findings, where we'll check, for example, cranial nerves, and we'll check memory and we'll check balance. Those items, when they're abnormal, make the diagnosis easy. There are difficult situations where all of the objective neurologic findings are normal, and we have to rely on symptoms. And those are difficult situations for all clinicians."

Tagovailoa was cleared to return in his team's Week 3 game against the Buffalo Bills despite seemingly displaying concussion symptoms on the field. He then suffered a concussion in Week 4 against the Cincinnati Bengals and was carted off the field.

The unaffiliated neurotrauma consultant was fired after making several mistakes in the initial concussion test, per Cameron Wolfe of NFL Network.

The NFL and NFLPA have agreed on changes to the concussion protocol, which would "rule out players who exhibit gross motor instability," according to Ian Rapoport and Tom Pelissero of NFL Network.

It's clear there is still work to do with concussions being difficult to diagnose.

Stills explained the league is relying on players to self-report in many cases, with 40 percent of tests featuring players acknowledging their own symptoms or asking for an evaluation. This is considered an improvement compared to a decade ago when players wouldn't come forward with information.

There were reportedly 187 diagnosed concussions during the 2021 season, a drop from over 200 in each year from 2015-19, per Peter King of NBC Sports.