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After more than four out of every five head collisions during the 2014 FIFA World Cup, soccer players didn't get recommended concussion checks on the sidelines, an analysis of game videos suggests.
"To our knowledge, this is the first study of its kind at this level of play," said lead author Dr. Michael Cusimano, a neurosurgeon at St. Michael's Hospital and the University of Toronto.
Guidelines adopted by the Federation Internationale de Football Association (FIFA) require players showing any potential signs of concussion after a head collision to be immediately withdrawn from play and assessed by sideline healthcare personnel, researchers note in the Journal of the American Medical Association.
But when they examined video footage of all 64 matches in the 2014 World Cup held in Brazil, researchers only saw medical professionals examine players for concussions in 12 instances accounting for just 15 percent of the head collisions seen on the field.
"Patients suspected of concussion need to be properly assessed by medical professionals prior to being potentially exposed to repeated injury in rapid succession," Cusimano said by e-mail. "In some instances these repeated injuries can lead to fatal or lifelong disabling consequences."
Researchers focused on players who had at least two observable signs of concussion such as athletes clutching their heads, being slow to get up, disoriented, displaying obvious disequilibrium, unconsciousness or seizure-like movements.
A total of 61 athletes had 81 head collisions in 72 separate events, the study found.
Among the minority of athletes examined by healthcare professionals, 11 were cleared to return to play and three were removed from the match or tournament, the study found.
Exams done by health providers averaged just 107 seconds, though assessments ranged from 64 seconds to 180 seconds.
Of the 81 collisions researchers observed in the game video, 14 players showed one or no signs of concussion, 45 had two signs and 22 had three or more signs.
Out of the 67 cases when players showed at least two signs of potential concussion, 11 received no assessment and returned to play immediately, while 27 got checked out by another player or referee and then went back to the game.
For the 22 players with three or more concussion signs, 19 returned to play during the same game after an average exam time of 84 seconds.
Limitations of the study include the potential that exams were not recorded by game video that followed action on the field rather than activity on the sidelines, the authors note. Not all collisions involve injuries, and athletes may feign injury to draw a foul or downplay injury to remain in the game.
It's also possible that video footage didn't show every collision, and may have underestimated how many occurred, said Tamara Valovich McLeod, co-author of the National Athletic Trainers' Association position statement on management of sport concussion and director of athletic training programs at A.T. Still University's Arizona School of Health Sciences in Mesa.
Even so, too few players got checked out and none were examined long enough, McLeod told Reuters by e-mail. A thorough concussion assessment takes about 10 minutes, she said.
FIFA guidelines now dictate that play halt for three minutes to allow an on-pitch concussion assessment, noted Anthony Kontos, research director of the University of Pittsburgh's Sports Medicine Concussion Program.
"There has been an increased focus on concussions in soccer at all levels," Kontos, who wasn't involved in the study, said by e-mail. "However, there are lingering issues regarding substitutions rules and lack of time stoppages in soccer to allow for evaluation of players without disrupting the game and potentially disadvantaging a team who has to play short while a player is evaluated.
The trouble is youth soccer leagues may take their cues on concussions from the World Cup, said Dr. Sara Chrisman of the Harborview Injury Prevention and Research Center in Seattle.
"Most competitive youth sport athletes follow professional teams and look to them to set the norms as to how to handle injury," Chrisman, who wasn't involved in the study, said by e-mail. "If a professional sporting organization does not take concussion seriously, it sends a message that youth athletes should also not take concussion seriously."
Previously in concussions:
* Bob Probert's Broken Brain.
-More from Beachwood Sports »