Traumatic Brain Injury among football players in 2017 Series A Brazilian Football Championship – The gap between concussion protocols and the current medical practices

ABSTRACT Background Sideline assessment of football players with a potential concussion is a challenging concern. Video analysis is an important tool to recognize traumatic brain injury (TBI), including sports-related concussions, among football players. Aim To report the characteristics of TBI among football players in 2017 Brazilian Series A Football Championship and to discuss the evaluation protocols of football players with concussion. Methods This is an observational study concerning video analysis of all matches on 2017 Series A Brazilian Football Championship. The videos were first analyzed by a team of 10 trained medical students. All suspected TBIs were reviewed by the research’s coordinator. Concussion diagnosis was defined by one of the following events: lying motionless, loss of responsiveness, impact seizure, disorientation and motor incoordination. The length of sideline medical assessment was systematically recorded. Results In a whole of 380 matches, it was verified 374 TBIs. The most common etiology was “head-to-head” impact. Twelve players were replaced after TBI. Thirteen players (3,5% of TBIs) had concussion, but only four of them were replaced. The overall mean time for medical assessment was 1’35” (range: 48” to 7’40”). Considering the twelve players who had a concussion and the thirteen players who were replaced, the mean time for medical evaluation was 3’19” and 3’26”, respectively. Conclusion This study confirms that there is a gap between formal protocols for concussion assessment on sideline in Brazilian Elite Football and current medical practices. It also discusses changes on football rules of player replacement to an adequate sideline medical evaluation.