Most 2014 World Cup Head Impacts Didn't Receive Concussion Protocols, Study Says

CNN/ Newswire | 6/29/2017, 11:46 a.m.
More than 3 billion people around the world tuned in to watch soccer's 2014 FIFA World Cup, during which there ...

By Daniella Emanuel


(CNN) -- More than 3 billion people around the world tuned in to watch soccer's 2014 FIFA World Cup, during which there were 81 head collisions. And only 15% of those injured players received a concussion assessment from health care personnel, according to a report published Tuesday in JAMA.

"I was hoping to find that people would be properly assessed for potential concussions, just like if they were injured in their ankle or their knee, that they would be properly assessed for that medical injury," said Dr. Michael D. Cusimano, a co-author of the study and a staff neurosurgeon at St. Michael's Hospital in Toronto.

He and four trained reviewers observed video footage of all 64 matches in the 2014 World Cup, soccer's prestigious international championship. They took a close look at players who exhibited two or more signs of concussion, such as head-clutching, being slow to get up, disorientation and seizure-like movements, according to the study.

Cusimano found that of the 67 occasions in which players exhibited two or more signs of a concussion (of the 81 total head collisions during the matches), 79% returned to play. Only three of the affected players were removed from the match.

The 2012 international consensus statement on concussion in sport, which was applied to the 2014 World Cup, says that "when a player shows ANY features of a concussion: The player should be evaluated by a physician or other licensed healthcare provider onsite using standard emergency management principles. ... Sideline evaluation of cognitive function is an essential component in the assessment of this injury." It also states that players with diagnosed concussions should not be allowed to return to play on the same day.

"There's a laissez-faire attitude about our brain," Cusimano said. "If they suffer a brain injury, there's still a tremendous lack of awareness. There's still a tremendous stigma about the player reporting their symptoms, never mind seeking help. It's kind of an invisible injury, and I think FIFA has a challenge and an opportunity here that they can step up and meet."

FIFA, international soccer's governing body, said in a statement in response to the new study that it "regularly monitors the situation of head injuries, maintaining constant contact with current and on-going studies on this matter and reviewing our protocols. Please note that following a series of cases at the 2014 FIFA World Cup, FIFA introduced in September 2014 a new head injury protocol to be applied to all FIFA competitions."

Under the protocol, a referee has the ability to stop the game for three minutes after a suspected incident of concussion occurs, allowing time for a team doctor to complete an on-site assessment. The referee can only allow the player to return to the game with authorization from the doctor, who makes the final decision.

In February, an unrelated study said that four former soccer players with advanced dementia were also found to have chronic traumatic encephalopathy, commonly known as CTE. This neurodegenerative disease is found in people who have suffered repeated blows to the head, which commonly occurs in contact sports.