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Concussion assessment guidelines not followed during Brazil World Cup

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Most footballers who were involved in a head collision during the 2014 World Cup in Brazil were not properly assessed, according to a new analysis.

Researchers led by Dr Michael Cusimano, a neurosurgeon at St. Michael’s Hospital in Toronto, reviewed footage of all 64 games played in the tournament. They found that head collisions happened 72 times (1.13 times per match), with 61 players having 81 head collisions.

In these 81 incidents, 14 of the players (17%) showed no sign or one sign of a concussion, 45 (56%) had two signs and 22 (27%) exhibited three or more signs.

The consensus statement from the 2012 and 2016 International Conference on Concussion in Sport — which was adopted by football’s governing body, FIFA — states that players showing any sign of sports-related concussion should be immediately withdrawn from play and assessed by healthcare personnel on the sidelines.

However, the review found that in the 2014 World Cup “players received no or very cursory assessment for a concussion after sustaining a collision and showing concerning physical signs for a concussion,” Dr Cusimano said.

Healthcare personnel assessed players in only 12 cases (15%) of head collision during the Brazil World Cup and these assessments averaged 107 seconds. Another 45 players (56%) were assessed by another player, referee or personnel on the field, and 21 players (26%) received no assessment.

In particular, Dr Cusimano highlighted the fact that of the 67 players who showed two or more signs of concussion, 11 players (16%) received no assessment and returned to play immediately. Another 42 (63%) immediately returned to play after an on-field assessment by another player (15), referee (12) or healthcare worker on the field (15). Eleven players (16%) were assessed on the sidelines by healthcare personnel and returned to play, and three (5%) were removed from the match or tournament.

Among the 22 players with three or more concussion signs, 19 (86%) returned to play during the same game after an average assessment of 84 seconds.

The findings have been published in a research letter in the journal JAMA.

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