Throughout the most recent soccer World Cup, held in 2014, many criticized the soccer competition for being lax in response to apparent concussions on the field. There were multiple incidents where players were left sprawled out on the field, either unconscious or significantly shaken up, but most of these athletes returned to the competition within minutes.
A new study confirms what these critics believed to be true, finding that more than four out of five athletes involved in head collisions during the World Cup did not receive the recommended concussion checks stipulated by FIFA.
This lack of recognition for head injuries goes against recommendations passed by the 2012 International Conference on Concussion in Sports. The consensus statement was affirmed and used as regulations by FIFA (Federation Internationale de Football Association), before the international competition.
Under these regulations, players showing any potential signs of a concussion after a head collision are required to be immediately pulled from play to be evaluated for brain injuries.
Despite the adoption of these regulations, Dr. Michael Cusimano says a review of footage from the games found evidence that sideline health professionals only assessed players in 12 instances throughout the World Cup. That accounts for only 15% of head collisions occurring during the 2014 competition. Cusimano is a neurosurgeon at St. Michael’s Hospital and the University of Toronto, where the study was conducted.
The report published in JAMA indicates that in more than half of head collisions (56%), players were assessed on the field by other players, referees, or team staff, however, they were not removed from the game. Over 25% of players involved in head collisions received no assessment at all.
The effectivity of these assessments is also called into question by Cusimano’s study as the average length of concussion evaluations was less than two minutes (107 seconds). Some assessments barely lasted a minute.
Notably, multiple players showing signs of concussions were either not assessed or allowed to continue competing. Of the 67 athletes exhibiting two or more symptoms of concussions, 11 (16%) received no concussion assessment. Additionally, 42 (63%) immediately returned to play after on-field evaluations. Just three players were removed from their match due to brain injuries. One of which was allowed to return to the tournament.
Among the 22 athletes showing three or more signs of concussions, 19 (86%) returned to the field during the same game.
“In the 2014 World Cup, we found that 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.
Dr. Cusimano also found a pattern of head collisions reported by team physicians to FIFA. Team staff reported only 19 injuries to the head during the World Cup, but Cusimano was able to identify over 81 incidents of collisions. He believes the cause is a mixture of teams only reporting the most severe and obvious injuries, combined with athletes underreporting injuries to avoid losing playing time.
The researchers conclude, “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.”