Soccer-specific on-pitch concussion assessment: international consensus recommendations

This article was initially published in the 7/23/26 edition of our Concussion Update newsletter; please consider subscribing.

Experts across 57 FIFA member associations recently developed a soccer-specific on-pitch concussion assessment protocol, called FOCUS. Published in JAMA Neurology, FOCUS was created through a Delphi process, which is a rigorous and structured way to build consensus among different groups. Although general assessments exist to evaluate players with a possible concussion, there is no standardized assessment that is soccer-specific and designed for immediate, on-field use. To address this gap, researchers Kerry Peek et al. conducted a three-stage process, including a systematic review of existing concussion assessment tools (with a focus on soccer) and two rounds of feedback on the assessment items from the review. The resulting assessment includes 45 items across 11 domains, and the median time to complete the protocol is 2 minutes and 52 seconds. 

Items were included or excluded from the final protocol if at least 80% of the participating experts agreed on the inclusion or exclusion, and items that reached 75%-79% agreement were discussed by a steering committee. Key concerns included the protocol’s speed of use as well as its coherence with soccer-specific rules and culture. For example, in sports where there is an incentive to get up quickly after impact, being slow to get up may be a sign of a possible concussion. However, in soccer, it is common to get up slowly to extend recovery time or increase the chances of getting a penalty kick. Thus, being slow to get up was not included as a possible sign of concussion in FOCUS. 

The researchers note that FOCUS is not meant to diagnose concussion, but rather to identify whether a player is showing signs or reporting symptoms associated with concussion so they can be removed from the game and further assessed. Evidence shows that players who continue to play after a suspected concussion are at increased risk of prolonged recovery, deterioration in performance, and further injury, so it is important to have an assessment that can be completed immediately and quickly. The researchers also mention that further changes may be made to FOCUS as it is currently being assessed in an implementation study.