RESUMEN
Soccer-related concussions (SRC) have increased despite an overall reduction of concussions across all sports activities. Few papers have studied the mechanism of injury, and have been mostly done in high-income countries or focused on small populations, preventing generalization. Our goal was to analyze the available data published about SRC over the past 10 years, independent of the country's income level. A narrative review was performed. The definition of sport-related concussion from the American Academy of Neurology and studies published between 2013 and 2023 were used. Of 1210 articles, 45 met the inclusion criteria. The results showed that SRC was more frequent in females (57.6%) than males (44.3%). Player-to-player interaction was the most common mechanism of injury, with midfielders being the most affected position. The first providers to diagnose were certified athletic trainers, within the first 24 hours. Neurological evaluations, including SCAT (Sport Assessment Concussion Tool) and ImPact (Immediate Post-concussion Assessment and Cognitive Testing), were included in 42.2% of the studies, with SCAT and ImPact specifically used in 15.5% and 11% of cases, respectively. Need for hospitalization was found in 8.9% of participants and one player required surgical intervention. At the time of the concussion, confusion, dizziness, and amnesia were reported frequently. However, after the concussion, headaches and dizziness were prevalent. Follow-up data were included in 35.5% of the studies. On average, children missed 15 practice days and returned to school after 8 days. In conclusion, future research should focus on the circumstances around head-to-head injuries by age, sex, and level of professionalism as well as the importance of early diagnosis and careful follow-up, to protect the players and improve their outcomes.
RESUMEN
AIM: Every year, there are an estimated 1.7 to 3.8 million sports-related traumatic brain injuries. A sports concussion results from an external force or a blow to the head or body, causing cranial encephalic trauma that can affect motor skills and brain function, producing varying symptoms related to an alteration in neurological functioning. Soccer poses a risk of concussions due to heading, where the player's head directly hits the ball to redirect or accelerate it. However, most concussions are caused by contact between players, such as head-to-head or head-to-elbow contact. This study analyzed the incidence of concussions or mild traumatic brain injuries in professional soccer during the "Copa America 2019" to understand the feasibility of soccer concussion protocols and propose evidence-based enhancements. METHODS: The data were previously collected by our first two authors, O. Pangrazio and F. Forriol, during the 46th edition of the "Copa America 2019," where the South American Football Confederation implemented the Concussion Fast Recognition Protocol to detect traumatic brain injuries. The descriptive basic data will help to raise awareness and motivate further research in this field. We have analyzed and correlated it with global data to provide a comprehensive review and tangible evidence of the population size where soccer protocols are typically applied, thus calculating incidence rates to measure it mathematically. RESULTS: Our study reveals that the incidence rate of concussions during the "Copa America 2019" was 5.3 per 1,000 athlete exposures, with a total of three concussions occurring among 567 players. Despite the effectiveness of current protocols in detecting concussions rapidly and accurately, the relatively low incidence rate at this level of professional competition poses a challenge to validating these protocols. These results indicate that while the protocols in place are efficient, the testing and validation of new tools and approaches would be more beneficial at different levels of play where the incidence rates of concussions are higher. In environments with a greater frequency of concussions, the robustness and reliability of these protocols can be more thoroughly evaluated, ensuring they provide optimal protection and care for athletes. CONCLUSION: The incidence of concussions is low in professional soccer tournaments. Protocols are necessary to protect players and educate sports professionals. However, their validation is difficult given the low incidence of concussions at this level of competition. Our proposed protocol helps unify a basic approach in the field and an advanced approach in any emergency department, providing better detection of concussions and improved outcomes for players. This protocol should be validated in populations with higher incidence rates to demonstrate its effectiveness.
