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Characteristics of potential concussive events in three elite football tournaments
  1. Nicholas Armstrong1,
  2. Mario Rotundo1,
  3. Jason Aubrey1,
  4. Christopher Tarzi1,
  5. Michael D Cusimano1,2,3
  1. 1Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada
  2. 2Neurosurgery, University of Toronto, Toronto, Ontario, Canada
  3. 3Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Michael D Cusimano, Neurosurgery, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada; cusimanom{at}


Objective Identify patterns in the nature and characteristics of potential concussive events (PCEs) in football.

Methods This study analysed the incidence and characteristics of PCEs that occurred during the 2014 and 2018 Fédération Internationale de Football Association World Cups, and the 2016 UEFA Euro Cup. PCEs were defined as direct head collision incidents resulting in the athlete being unable to immediately resume play for at least 5 sec following impact.

Results A total of 218 incidents were identified in 179 matches (1.22 per match, 36.91 per 1000 hours of exposure). The most common mechanism of PCE was elbow-to-head (28.7%, n=68). The frontal region was the most frequently affected location of impact with 22.8% (n=54).

Conclusion Our study defined the identification, prevalence and nature of PCEs in professional international soccer tournaments. Our findings indicate the different contexts and mechanisms of head contact and contact to different regions of the head can be associated with varying signs of concussion. The results highlight targets for future injury prevention strategies.

  • concussion
  • traumatic brain injury
  • enforcement
  • health education
  • physical medicine

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • NA and MR contributed equally.

  • 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 Data are available upon reasonable request.

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