After reviewing videos from this year's World Cup games, researchers
concluded that more than 63 percent of players who showed two or
more concussion symptoms did not get evaluated by a licensed
healthcare professional - which was slightly more than in the 2014
tournament - according to the results in JAMA Neurology.
"We examined adherence to updated and improved concussion protocols
which were established after the 2014 World Cup," said the study's
lead author, Dr. Ajay Premkumar, of the Hospital for Special Surgery
in New York City. "It appears that in spite of these changes,
concussion management on the field in regard to rates and length of
medical evaluation for potential concussion during this summer's
tournament were grossly unchanged from 2014."
That's a problem for several reasons, Premkumar said by email.
First, there's the danger to players if concussions are not caught
in a timely manner. "Playing with a concussion increases the
athlete's risk for more severe traumatic brain injury or 'Second
Impact Syndrome,' which can have devastating complications," he
said. "There is also significant literature which supports increased
symptom severity and a longer recovery time for those who continue
to play after a concussion compared to those removed from gameplay."
Second impact syndrome, which almost exclusively affects younger
athletes, occurs when a brain that has already been injured and
hasn't yet healed is concussed a second time. That second concussion
can result in disability or even death.
A second concern from Premkumar and colleagues is that younger
players watching World Cup soccer - known outside the U.S. as
football - may get the wrong message about concussions. "Concussion
assessment protocols and their implementation by large sporting
governing bodies may have widespread effects on officiating,
coaching and play of countless athletes at all levels and ages
around the world," Premkumar said.
To see whether rules added in 2014 by the medical committee of the
Federation Internationale de Football Association (FIFA) had
improved concussion identification and management, Premkumar and
colleagues reviewed video footage from all 64 games of the 2018
"A head collision event was defined as any event in which a player
stopped playing immediately after head contact," Premkumar
explained. "Observable signs and symptoms of potential concussion
were disorientation, clutching of head, motor incoordination/balance
disequilibrium, slow to get up (characterized by more than five
seconds in the recumbent position after contact), impact seizure,
blank or vacant look, visible facial injury, loss of consciousness
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Of the 90 players deemed to have two or more signs of concussion, 33
were evaluated by healthcare personnel for anywhere from 13 to 253
seconds, 39 were evaluated by the referee for less than a minute and
18 were evaluated by another player or not at all.
Among six players initially removed from a game after a head
collision, three were ultimately allowed to keep playing after
Overall, FIFA's concussion protocol was not followed in at least
63.3 percent of the head collisions that resulted in two or more
signs of concussion. That compares with 56.7 percent in the 2014
"Overall this study highlights the need to recognize and remove
players with suspected head injury from the field or pitch for
clinical evaluation and possible removal from the game," said Micky
Collins, clinical and executive director of the Sports Medicine
Concussion Program at the University of Pittsburgh Medical Center
and Anthony Kontos, research director of the UPMC program.
The new findings warrant changes in the way FIFA deals with head
injuries, said the Pittsburgh experts, who were not involved in the
"The implementation of a temporary head injury substitution - that
would not count against a team's normal allotted number of
substitutions per game and allow for an off-pitch evaluation - along
with head injury spotters and video review for potential head
injuries could improve current recognition and removal of
potentially injured players," the two noted.
"We know that it is important to identify and remove players with
suspected concussions, because if they continue to play following a
concussion they have an increased risk for another head injury or
orthopedic injury, experience reduced performance levels, and will
substantially lengthen their recovery time."
SOURCE: https://bit.ly/2QADqNr JAMA Neurology, online November 12,
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