'Under no circumstances would he be put at personal risk'

Former Ireland team doctor Cliff Beirne has said that "under no circumstances would Johnny Sexton be put at personal risk" after it emerged he failed a head-injury assessment (HIA) during the province's victory over Exeter last Saturday. 

Leinster confirmed the out-half is undergoing return to play protocols today, two days after Ireland head coach Joe Schmidt aired his belief at the RTÉ Sport Awards that Sexton had passed the assessment.

Beirne is Dean of Faculty of Sports and Exercise Medicine at the Royal College of Surgeons in Ireland and Royal College of Physicians in Ireland.

He's previously been Honorary Maxillofacial surgeon to the IRFU.

Speaking to RTÉ Radio 1's Drivetime, he outlined the complexities of HIA assessments and stressed his belief that the 32 year old, who suffered four concussions in 2014 and was forced to take a 12-week break that ruled him out Ireland's opening game of the 2015 Six Nations, would have been red-flagged as a player requiring special attention.

"I think Johnny Sexton - and I’m not party or privy to what happened when he was given a three-month rest in France and he had prolonged symptoms and may have had more than one concussion - there are no hard and fast rules about how long you keep players off, how you check them regularly," said Beirne.

"It’s an evolving area... and knowing the people and the doctors involved I have no doubt that Johnny Sexton, he may not be molly-coddled, but he’d be watched very, very carefully as somebody who has a previous history of concussions.

"Under no circumstances would he be put at personal risk."

"Because a player fails a HIA, yes they don’t go back on to the pitch, but because they pass it, it doesn’t necessarily mean that they’re not concussed."  

Beirne expanded on the difficulties team doctors face when assessing head injuries, highlighting the sporadic nature of how symptoms reveal themselves with impact injuries.

"I think the whole area of concussion is quite confusing and there’s a mixed message.

"The HIA only takes place at the elite level in rugby. There are 11 criteria for permanent removal from the pitch where HIA is not necessary. These include loss of consciousness, convulsions, balance problems et cetera.

"It’s a process that takes place off the pitch. It’s performed by doctors who are trained to do this and it’s a 10-minute process now that consists of a sports concussion assessment test with symptom scores, memory tests, cognitive tests and a balance test.

"These are looked at against a baseline which the player has performed pre-season. If the score declines then they fail the HIA. The problem is, the concussion symptoms may not appear until later on or a player may get better quickly. Every concussion is different. I think that’s where problems may arise.

"Because a player fails a HIA, yes they don’t go back on to the pitch, but because they pass it, it doesn’t necessarily mean that they’re not concussed.  

"World Rugby do what they call a HIA 2 now at the elite level. Within three hours of the game afterwards they repeat the tests and some player who’ve initially passed the HIA 1 may fail the HIA 2.

"They then also have a HIA 3 which is carried out 48 to 72 hours after the initial assessment. I know myself with having been involved as a doctor for 35 years with sporting events, I’ve made mistakes.

"It’s a hugely difficult area."