New pitch-side protocol standardizes soccer concussion decisions

Clinical takeaway: When concussion is suspected in soccer, immediate removal and a structured, multimodal on-pitch assessment—with clear “no‑go” signs—should guide decisions, prioritizing player safety over rapid return to play.

A new international consensus published in JAMA Neurology introduces a standardized, soccer-specific protocol for on-pitch concussion assessment, aiming to address longstanding inconsistencies in how head injuries are recognized and managed during matches.

The recommendations emphasize a structured, time-efficient approach tailored to the realities of soccer, where clinicians often have only minutes to evaluate players under pressure.

Central to the guidance is a tiered assessment process beginning with immediate recognition of suspected concussion based on mechanism of injury, visible signs, or reported symptoms. Players with clear “no-go” features—such as loss of consciousness, ataxia, or seizure-like activity—should be removed from play immediately with no same-game return.

For players without definitive exclusion signs, the protocol recommends a brief on-pitch screening followed by a more comprehensive off-field evaluation using multimodal tools. These include symptom checklists, cognitive screening, balance testing, and oculomotor assessment, reflecting the lack of a single diagnostic gold standard and the need for combined clinical measures.

The consensus also underscores the value of video review to aid decision-making, particularly in identifying subtle signs or confirming injury mechanisms—an approach increasingly supported by clinicians but inconsistently implemented.

Importantly, the authors advocate for rule changes to support medical decision-making, including temporary concussion substitutes or extended evaluation windows, allowing adequate assessment without disadvantaging teams. This addresses a major barrier cited in prior research: insufficient time for proper sideline evaluation.

The protocol aligns with broader concussion principles—“if in doubt, sit them out”—and reinforces the need for subsequent serial assessments and formal return-to-play pathways off the pitch.

A key message from the consensus: player safety must take precedence over match dynamics. As the authors note, “no match situation should override the clinical judgment required to protect brain health.”

Key recommendations

• Introduces a soccer-specific, standardized on-pitch assessment algorithm rather than relying on general sports concussion tools
• Formalizes “no-go” criteria mandating immediate, permanent removal from play
• Emphasizes multimodal assessment (symptoms, cognition, balance, oculomotor function) over single-test screening
• Recommends routine use of video review to support diagnosis
• Calls for structural changes (e.g., temporary substitutions) to enable adequate evaluation time

Overall, the consensus provides a practical, sport-specific framework that bridges the gap between ideal concussion care and the constraints of live match play, with the goal of reducing missed diagnoses and preventing premature return to play.

Source: Peek K, et al. (2026 July 1) JAMA Neurol. Football-Specific On-Pitch Concussion Assessment Protocol—International Consensus Recommendations