Head collision rates at World Cups similar but women received more medical assessments

Female and male soccer players had similar rates of head collision events during elite tournaments such as the World Cup but half of the female players involved received medical assessments, compared with only one third of the impacted male players, according to research led by St. Michael's Hospital of Unity Health Toronto.

The study, publishing in JAMA on Jan. 21, 2020, did not find significant differences in the numbers of female players removed from play compared with male players. The median time that play was stopped for a medical assessment in women's tournaments was 70 seconds compared to about 50 seconds in men's matches. Researchers pointed out a minimum 10 minutes is required to perform a concussion assessment.

"There is international consensus that athletes who sustain a potentially concussive head collision should be given a proper medical assessment and be removed from play until a qualified professional can determine that it is safe for them to return to play," said Dr. Michael Cusimano, lead researcher and a neurosurgeon at St. Michael's Hospital.

"It is clear that this is not happening in elite women's or men's play at this time."

Researchers reviewed 52 matches of the 2019 FIFA Women's World Cup and monitored for the frequency and medical assessment of head collision events, time stopped for assessment, and visible concussion signs. The data was compared against the 2014 and 2018 FIFA Men's World Cup and the 2016 UEFA Euro Cup. In the matches reviewed, 84 per cent of female athletes and 88 per cent of male athletes showed two or more visible signs of concussion after a head collision event, including clutching of the head or disequilibrium.

Dr. Cusimano, who is also a scientist at the Li Ka Shing Knowledge Institute of St. Michael's, said the popularity of soccer internationally, as well as the frequency of concussions in the sport, creates an urgency to address this issue. He suggested increasing the role of video assistant referees, employing independent medical assessors, or allowing temporary player substitutions to provide sufficient time for medical assessments.

"Hundreds of millions of people play soccer—it is the world's largest and fastest growing sport. Tournaments like the FIFA World Cup attract millions of viewers, and the examples set by elite athletes and officials affect how players and officials globally, at any level, deal with concussions."