Moving to 7-Day Disabled List Improves Major League Baseball Concussion Reporting

Major League Baseball’s (MLB) change from a concussion-specific mandatory 15-day disabled list (DL) rule to a 7-day DL rule in 2011 seemingly has improved concussion reporting amongst the league’s athletes.

Study’s Statistics

This study, published in The Orthopaedic Journal of Sports Medicine, examined 112 players between 2005-2016. The average number of concussions increased from 3.7 concussions/year prior to 2011 when the mandatory 15-day DL was enforced to 13.0 concussions/year after the mandatory 7-day DL rule was implemented.

The Importance

There are numerous benefits of this increased reporting of concussion. Most generally, concussion is traditionally underreported and increasing reporting rates is an important improvement in the area of concussion management. More specifically, given the potential harms of inadequately diagnosed and managed concussions, increased reporting and subsequent concussion care benefits the injured player’s health. Specifically to baseball, since a professional baseball player’s career trajectory significantly changes for the worse if a concussion is left unreported, increased reporting and subsequent appropriate concussion care is beneficial for both player and team success.

While concussions are prominent topics in sport leagues such as the National Football League (NFL) and National Hockey League (NHL), baseball is often overlooked. Thus, this study provides valuable insight into concussion identification and management trends in professional baseball. In fact, this study examined which positions had the highest rates of concussion. The top three positions were outfielders (34%), catchers (33%), and infielders (20%) followed by pitchers (8%) and basemen (4%). Pitchers however, had the highest number of days on the DL as well as the highest concussion-associated costs, followed by fielders and catchers.

Financial Benefits

This study also examined the total cost of the player’s injury to the team. The cost per concussed player before 2011 was $1.1 million and that total decreased to $565,000 after the 7-day DL rule change. This decreased cost occurred despite an increase in reported incidents of concussion and an increase in player salaries. This decrease may be partially explained by the decreased average number of days that concussed athletes spend on the DL (from 38.8 days during the 15-day DL rule to 29.2 during the 7-day DL rule) although the study did not speculate as to why the total cost of an injured player to a team decreased by almost 50%.

Cause for Concern

Many studies and concussion protocols, including this one, cite the fact that most concussions typically resolve between 7-10 days [1][2]. The most recent protocols and guidelines however, state that concussions resolve anywhere from 10-14 days to 4 weeks (the latter time period being most relevant for youth) [3][4]. It is thus initially concerning that the MLB reduced the mandatory sit-out period from 15 days to 7 days which may mean players are returning to play too early.

There are two pieces of evidence that may suggest there is no need for worry. First, this study examined average performance metrics between injured players before and after the 2011 rule change – including earned run average, walks plus hits per inning pitched, batting average, and on-base percentage – and found that there were no significant differences. This means that players before and after the 2011 rule were returning to the game at a similar skill level. It would be important and more valuable however, to examine the performance metrics of the specific injured player before and after his concussion to truly assess whether the player is returning at an appropriate time or too early.

Second, the fact that the average number of days an athlete stayed on the DL after a concussion decreased from 38.1 to 29.2 after 2011 but remained around the 4 week mark suggests that players still are taking significant time off to appropriately recover. In short, simply because the rule mandates a 7-day sit-out period does not mean that immediately after 7 days the player is back on the field.

Conclusion

Ultimately, one cannot conclude that the 7-day DL rule increased the reporting rates of concussion amongst MLB athletes as the trend may be attributable to a general increase in awareness and understanding of concussive injuries which positively correlates with increased reporting [5]. However, it can be said that decreasing the mandatory days on the DL from 15-days to 7-days creates an environment where MLB athletes may be more likely to report concussions. This change is beneficial both physically and financially.

The full study can be read here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6383093/

References

1. Belanger HG, Vanderploeg RD. The neuropsychological impact of sports-related concussion: a meta-analysis. J Int Neuropsychol Soc. 2005;11(4):345-357.
2. Karr JE, Areshenkoff CN, Garcia-Barrera MA. The neuropsychological outcomes of concussion: a systematic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury. Neuropsychology. 2014;28(3):321-336.
3. “Guideline For Concussion/Mild Traumatic Brain Injury & Persistent Symptoms.” Ontario Neurotrauma Foundation, 6 July 2018, www.braininjuryguidelines.org/concussion.
4. McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport—the 5^thinternational conference on concussion in sport held in Berlin, October 2016. Br J Sports Med 2017;51:838-847.
5. Gessel LM, Fields SK, Collins CL, Dick RW, Comstock RD. Concussions among United States high school and collegiate athletes. J Athl Train. 2007;42(4):495-503.