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Professional assessment of potential concussions in elite football tournaments
  1. Christopher Tarzi1,2,
  2. Jason Aubrey1,2,
  3. Mario Rotundo1,2,
  4. Nicholas Armstrong1,2,
  5. Ashirbani Saha2,
  6. Michael D Cusimano1,2,3
  1. 1 Neurosurgery, St. Michael’s Hospital, Toronto, Ontario, Canada
  2. 2 Injury Prevention Research Office, St. Michael’s Hospital, Toronto, Ontario, Canada
  3. 3 Department of Surgery, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Michael D Cusimano, Department of Surgery, St. Michael’s Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada; injuryprevention{at}


Background Potential concussive events (PCEs) are a major health concern in football. Though there are protocols set in place for assessments of PCEs, there has been no evidence of adherence in major football tournaments.

Methods Our research goal is to determine if PCEs in elite football are professionally assessed according to the International Conference on Concussion in Sport (ICCS) consensus statement recommendations. Identification and analysis of PCEs in the 2018 World Cup (WC) were accomplished through standardised observation of video footage by trained observers. Results were contrasted with data from the 2014 WC and 2016 Euro Cup. Our primary outcomes include frequency and professional assessment of PCEs, signs of concussions and time stopped for assessments.

Findings In the 64 games of the 2018 WC, 87 PCEs (1.36 per game) were identified. Thirty-one (35.6%) PCEs were professionally assessed, resulting in the removal of three (3.5%) players from the match. Six (6.9%) PCEs showed one sign of concussion, 60 (69.0%) showed two signs, 20 (23.0%) showed three signs and 1 (1.2%) showed four or more signs. The mean time stopped for assessment was 63.3 s. No significant change in the percentage of professional assessments (mean=33.4%, 95% CI 20.7% to 46.1%) were identified across tournaments (p=0.42).

Interpretation These findings demonstrate a need for adherence to concussion protocols in order to improve the brain-health of athletes. Proper enforcement of the ICCS protocols during these tournaments and promoting player health and safety can influence the officiating, coaching and playing of football worldwide by promoting player safety.

  • concussion
  • traumatic brain injury
  • hand injury

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  • CT and JA contributed equally.

  • Contributors Research concept, design and supervised by MDC. Data collection and analysis by CT, JA, MR, NA and AS. Manuscript writing by CT, JA, MR, NA and MDC.

  • Funding This work is supported by the Canadian Institutes of Health Research Strategic Team Grant in Applied Injury Research #TIR-103946 and the Ontario Neurotrauma Foundation.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval St. Michael’s research ethics board waived the need for approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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