Concussion protocols often not followed during FIFA World Cup

The consensus statement from the 2012 and 2016 International Conference on Concussion in Sport, adopted by Federation Internationale de Football Association (FIFA), indicates that players showing any feature of concussion should be immediately withdrawn from play and assessed by sideline health care personnel. Such recommendations and their enforcement may influence officiating, coaching, and play of millions of young players.

To evaluate compliance with the consensus statement, Michael D. Cusimano, M.D., Ph.D., of St. Michael's Hospital, Toronto, and colleagues examined the incidence, characteristics, and assessment of head collision events during the 2014 FIFA World Cup. Trained reviewers identified head collisions through observation of video footage of all 64 matches of the tournament. Any event involving head contact in which a player did not continue playing immediately afterward was defined as a head collision event. Observable effects of the collision on the player (slow to get up, disoriented, obvious disequilibrium, unconsciousness, seizure-like movements, head clutching) were documented as potential signs of concussion.

During 64 games, 61 players had 81 head collisions in 72 separate events. Health care personnel assessed the player in 12 cases (15 percent); 45 players (56 percent) received assessment from another player, referee, or personnel on the field; and 21 players (26 percent) received no assessment. Of the 67 occasions in which players manifested two or more signs of concussion, 16 percent received no assessment and returned to play immediately. Among players with three or more concussion signs, 86 percent returned to play during the same game after an average assessment duration of 84 seconds.

The researchers note that the estimates from this study could be underestimated because video footage follows the play and some injuries could have been missed.

"Soccer players presenting signs of concussion following a head collision event deserve assessment from independent health care personnel to avoid delay of care or further injury. Assessment and management of soccer players suspected of concussion should be improved," the authors write.