Head injuries can result in substantially different outcomes, ranging from no detectable
effect to transient functional impairments to life-threatening structural lesions.
In high-level international football (soccer) tournaments, on average, one head
injury occurs in every third match. Making the diagnosis and determining the severity
of a head injury immediately on-pitch or off-field is a major challenge for
team physicians, especially because clinical signs of a brain injury can develop over
several minutes, hours, or even days after the injury. A standardized approach is
useful to support team physicians in their decision whether the player should be
allowed to continue to play or should be removed from play after head injury. A
systematic, football-specific procedure for examination and management during the
first 72 hours after head injuries and a graduated Return-to-Football program for
high-level players have been developed by an international group of experts based
on current national and international guidelines for the management of acute head
injuries. The procedure includes seven stages from the initial on-pitch examination
to the graduated Return-to-Football program. Details of the assessments and the consequences
of different outcomes are described for each stage. Criteria for emergency management (red flags), removal from play (orange flags), and referral to specialists
for further diagnosis and treatment (persistent orange flags) are provided. The guidelines
for return to sport after concussion-type head injury are specified for football.
Thus, the present paper presents a comprehensive procedure for team physicians after
a head injury in high-level football.