Recommendations for initial examination, differential diagnosis, and management of concussion and other head injuries in high‐level football

Abstract

Head injuries can result in substantially different outcomes, ranging from no detectable effect to transient functional impairments to life‐threatening structural lesions. In high‐level international football (soccer) tournaments, on average, one head injury occurs in every third match. Making the diagnosis and determining the severity of a head injury immediately on‐pitch or off‐field is a major challenge for team physicians, especially because clinical signs of a brain injury can develop over several minutes, hours, or even days after the injury. A standardized approach is useful to support team physicians in their decision whether the player should be allowed to continue to play or should be removed from play after head injury. A systematic, football‐specific procedure for examination and management during the first 72 hours after head injuries and a graduated Return‐to‐Football program for high‐level players have been developed by an international group of experts based on current national and international guidelines for the management of acute head injuries. The procedure includes seven stages from the initial on‐pitch examination to the graduated Return‐to‐Football program. Details of the assessments and the consequences of different outcomes are described for each stage. Criteria for emergency management (red flags), removal from play (orange flags), and referral to specialists for further diagnosis and treatment (persistent orange flags) are provided. The guidelines for return to sport after concussion‐type head injury are specified for football. Thus, the present paper presents a comprehensive procedure for team physicians after a head injury in high‐level football.

A retrospective analysis of all‐cause and cause‐specific mortality rates in French male professional footballers

“…Indeed, the present and the Scottish report only followed players up until 2015 and 2016, respectively. The disciplinary rule change for intentional elbow‐head contact has led to a reduction in the risk of head injury in men's professional football 30 in addition to the evolution in concussion diagnosis and management of return to play, 31 the use of lighter footballs, and the introduction of restrictions on heading the ball in younger age groups, could positively influence future neurodegenerative disease risk.…”

“…Indeed, the present and the Scottish report only followed players up until 2015 and 2016, respectively. The disciplinary rule change for intentional elbow-head contact has led to a reduction in the risk of head injury in men's professional football 30 in addition to the evolution in concussion diagnosis and management of return to play, 31 the use of lighter footballs, and the introduction of restrictions on heading the ball in younger age groups, could positively influence future neurodegenerative disease risk. As regards motor neuron disease and amyotrophic lateral sclerosis, investigations conducted in Italian professional football settings 7,[32][33][34] have consistently shown that players are at significant risk of developing ALS and notably at a younger than expected age 35 (risk rate range: 1.91 35 -18.18 6 ).…”

FIFA Initiatives Improved Survival After Loss of Consciousness During Football Games

“…Even though the survival rate in developing countries significantly improved from 33% to 64% after the FMEB application, it is still far from the impressive current survival rate of 98% in developed countries. We assume that distinguishing between cardiogenic or traumatic LOC and different responses to each cause of the LOC may be of great importance for the future to further improve the outcome for injured players 23 24 25 .…”

Sub-Concussive Head Impacts From Heading Footballs Do Not Acutely Alter Brain Excitability As Compared to a Control Group

“…Similar to work on concussions (Feddermann-Demont et al, 2020), such systematic investigations could ultimately lead to recommendations to attenuate (or manage) the detrimental effects of head impacts on brain health.…”