Disagreements Occur Over Postconcussion Guidelines in College

Last Saturday, Stanford quarterback Tavita Pritchard was struck in the head by an opponent so violently that his helmet was ripped off, his bare head snapped back and forth and his skull slammed to the ground with a thud.

Hawaii quarterback Colt Brennan, a Heisman Trophy contender, was knocked unconscious by a crushing hit three weeks ago. The Oklahoma freshman quarterback Sam Bradford sustained a concussion while being trampled in a game two weeks ago.

Each impact triggered the delicate and controversial process of determining when the athlete is fit to return to the field, both that day and in subsequent weeks. College players operate in a murky zone: their bodies are between youth and manhood, they play in quasi-professional environments on national television — unpaid but with the riches of professional careers dangling before them — and no rules govern how concussions are treated in college football.

Amid much debate about the dangers of concussions, the National Football League has adopted new rules and guidelines for handling the injury. Experts are trying to raise awareness at the high school level, where players appear particularly susceptible to postconcussion syndrome and more serious injuries. At the college level, each team can devise its own procedure for diagnosing and treating concussions.

Hawaii’s Brennan and Oklahoma’s Bradford, both cleared by their team’s medical personnel, will start in crucial games Saturday: Brennan against Washington and Bradford against top-ranked Missouri in the Big 12 Conference championship game. Hawaii and Oklahoma stand to receive millions of dollars if they qualify for an elite bowl game.

Pritchard also has been cleared as Stanford prepares to play Saturday against the University of California at Berkeley, its archrival. But Coach Jim Harbaugh said in a telephone interview yesterday that he had not decided whether Pritchard would start or if T. C. Ostrander, who has started four games this season, will take Pritchard’s place.

Back at the Pritchard home in Lakewood, Wash., Kelli Pritchard, Tavita’s mother, has found herself resisting the urge to get as involved with her son’s care as her instincts tell her. She said that while she trusts Stanford’s medical staff, a part of her knows that a few years ago she would be driving Tavita to his pediatrician and having tremendous influence over his safety.

“I have to be careful that I’m not being condescending and asking questions that are totally inappropriate,” Kelli Pritchard said. “And yet I can’t ever separate myself from being the mama bear.”

Harbaugh said he expected both Pritchard and Ostrander to play Saturday because both are capable and of similar talent. He said he would decide how much each plays, and who starts, solely on how they perform in practice.

“We’ll make that evaluation on who gives us the best chance to win,” Harbaugh said. He added that unless Pritchard displayed the effects of the concussion in practice, which he had not through Tuesday, the injury would not be a consideration. “If there was some kind of postconcussion effect, like being not as accurate with his passes, that would without question impact how much he plays,” Harbaugh said.

Pritchard’s case has been scrutinized heavily both inside and outside Stanford, in part because of a strange series of events in which Pritchard was removed from the Notre Dame game last Saturday but returned for several downs after Ostrander was injured, only to be removed again.

Pritchard’s concussion took place late in the third quarter when he was struck in the helmet after a long scramble. He lay motionless for about 30 seconds before standing up and woozily walking off the field.

Harbaugh said trainers on the sideline gave Pritchard the Standardized Assessment of Concussion test, a 10-minute series of questions that evaluates short-term memory, cognitive awareness and other neurological issues.

“He received a perfect score,” Harbaugh said. Doctors also determined that Pritchard was displaying no physical symptoms of a concussion.

When Ostrander injured his hand midway through the fourth quarter, Harbaugh said he was told by medical personnel that Pritchard had been cleared to play. Pritchard appeared for one series, and took one hard tackle in which his head struck the ground again, before Ostrander returned for the rest of the game.

“The doctors determined that he was cleared to go back in after 10 minutes,” Harbaugh said. “I believe that there definitely should be scrutiny on this. But the other thing that I’m saying is that we have a concussion protocol. Tavita passed that. We have a battery of doctors that were with him from the time he got hit until the time he went back into the game. And that decision is clearly in the hands of the doctors, 100 percent. Coaches don’t make those decisions, and neither do the players.”

Pritchard said in a telephone interview: “I think it looked worse than it was. It kind of looked like T. C. went down, is Tavita O.K., he’s O.K., and I run in. People need to know that there was a lot more that was done beforehand.”

The question of whether a player who sustains a concussion should ever return to the same game can be divisive. It is strongly discouraged at the high school level because studies have shown that teenagers’ brain tissue is less developed and they are more susceptible to subsequent concussions, which in rare cases can lead to coma or death. (At least 50 high school or younger football players in more than 20 states since 1997 have been killed or have sustained catastrophic head injuries on the field, according to research by The New York Times.)

N.F.L. players, meanwhile, are generally believed to be fit to return if their symptoms have cleared.

Dr. Henry Feuer, who works the sidelines for every home football game for Indiana University and the Indianapolis Colts, and also counsels many of his state’s high schools, agreed with several other experts that college athletes are generally more comparable to professionals than high school players. He also said that most — if not all — Division I programs have formal postconcussion guidelines and testing.

“I feel strongly that teenagers are different, and high schools often don’t have a physician on the sideline,” Feuer said. “In college they almost always do and they have sports-medicine athletic trainers, too.”

Oklahoma’s Bradford sustained a concussion in a Nov. 17 game against Texas Tech, and was removed after telling team personnel that he was forgetting the plays. Scott Anderson, the Sooners’ head athletic trainer, said that Oklahoma used the Automated Neuropsychological Assessment Metrics test, another set of questions that evaluate neurological symptoms, in determining that Bradford should not return to the game.

Bradford was cleared to play the next week. Anderson said he was pleased that Bradford alerted team personnel to his injury because, as opposed to a sprained knee, concussions can be (and often are) hidden by a player who wants to stay in the game.

“One of our huge battles with concussion is we’re extremely dependent on self-reporting,” Anderson said.

The injury to Hawaii’s Brennan was obvious — while he was scrambling in the fourth quarter, a Fresno State player hit him at full speed virtually helmet-to-helmet. Brennan was briefly knocked unconscious and did not return. The Hawaii team doctor, Andrew Nichols, declined to be interviewed about how Brennan was cleared to play the following week, on Nov. 16. Last Friday, in a victory against Boise State, Brennan passed for 495 yards and 5 touchdowns.

Brennan had the extra consideration of his professional future. Sustaining another concussion could cost him several spots and millions of dollars in next spring’s N.F.L. draft. Without discussing Brennan specifically, Feuer said that he asks every prospect at the N.F.L. combine about his concussion history.

“You check for easy concussability, and whether it takes them a long time to get back,” Feuer said. “That gets put into their negative column, or whatever, come draft time.”

The last thing Kelli Pritchard said she has considered this week was how Tavita’s sitting out Saturday would affect his N.F.L. future. She speaks with Tavita several times a day on the phone to monitor how he is feeling, but knows that all she can do is hope that her feelings are considered.

“I know a lot is going to go into this decision,” Kelli Pritchard said. “It’s a really hard decision to make for everybody, because everybody’s going to get criticized one way or another.”