International guidelines on treating athletes with possible concussions weren鈥檛 followed during the 2014 FIFA World Cup in Brazil, according to new research led by a Canadian neurosurgeon who says that soccer鈥檚 governing body has set a 鈥渂ad example鈥� on how to handle potential brain injuries.

Dr. Michael Cusimano at St. Michael鈥檚 Hospital in Toronto and his research partners reviewed video footage of all 64 games played in the international soccer tournament that was watched by an estimated 3.2 billion people around the world.

The researchers found that 61 players had 81 head collisions in 72 separate events, or 1.13 times per match.

Of the 81 collisions, forty-five players had two signs of a concussion and 22 exhibited three or more signs. The signs include being dazed, confused, clutching their heads, or falling unconscious.

But Dr. Cusimano鈥檚 review found that health-care personnel assessed players on the sidelines in only 12 cases, or 15 per cent of head collisions, and the length of those assessments ranged from 64 to 180 seconds.

鈥淚 find it hard to believe you can do a proper assessment in a noisy environment like a soccer pitch in 180 seconds,鈥� Dr. Cusimano said.

Only two players 鈥� three per cent -- appeared to receive a proper, thorough medical concussion check-up, Dr. Cusimano added. While not all the players may have had actual concussions, he said it鈥檚 鈥渃oncerning鈥� to him as a neurosurgeon and physician.

鈥淭hey鈥檙e not getting properly assessed,鈥� he said.

Another 45 players (56 per cent) were assessed by another player, referee or personnel on the field, and 21 players (26 per cent) received no assessment, his review found. The findings were published Tuesday in the journal JAMA.

鈥淚 think this kind of research has implications, not only to the professionals, but also to kids all around the world that play this sport,鈥� Dr. Cusimano said in an interview. 鈥淚f it occurs at the elite levels, it is occurring at other levels and everything trickles down from the top.鈥�

Guidelines adopted by the Federation Internationale de Football Association (FIFA), soccer鈥檚 international governing body, say that players showing any signs of concussion should be immediately withdrawn from play and assessed by sideline health-care professionals.

Signs and symptoms of a sports-related concussion, according to a consensus statement from the 2012 and 2016 International Conference on Concussion in Sports, include:

  • Headache
  • Feeling like being in a fog
  • Loss of consciousness
  • An unsteady gait
  • Slowed reaction times

Dr. Cusimano said there are a number of likely reasons why FIFA did not follow the guidelines it adopted.

鈥淚 think at elite levels, there are a lot of pressures on players, on coaches, on doctors of teams to bypass those types of things,鈥� he said. 鈥淭hey need to put their actions where their mouth is. They need to do what they say they are going to do, otherwise it is a sham.鈥�

Dr. Cusimano added that players may also underreport their symptoms because they don鈥檛 want to be pulled from a game, especially during the World Cup.

In a statement to 麻豆传媒, a FIFA spokesperson said the soccer federation 鈥渞egularly monitors the situation of head injuries.鈥�

Shortly after the 2014 World Cup, FIFA that requires a three-minute break in the game to allow injured players to be assessed.

The protocol was introduced following reports that Germany鈥檚 midfielder Christoph Kramer played on for 14 minutes against Argentina 鈥� although he was clearly disoriented 鈥� before being pulled from the game.

 鈥淧rotecting the health of football players is and will remain a top priority in developing the game,鈥� the FIFA spokesperson said in the statement.

Currently, team doctors assess players as necessary during FIFA games. Dr. Cusimano recommends that independent physicians make concussion assessments instead. He said he would like to see those changes happen before the 2018 World Cup, scheduled to begin next June in Russia.

The NFL, for example, has a stricter protocol.  In the event of a suspected concussion, the player is taken to the locker room for a full assessment, not assessed on the field. 

With files from CTV鈥檚 medical specialist Avis Favaro and producer Elizabeth St. Philip