ArticleInjury prevention : journal of the International Society for Child and Adolescent Injury Prevention2022
Effect of a new concussion substitute rule on medical assessment of head collision events in Premier League football.
Article in Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Brain health in association football: perspectives of professional players.Frontiers in sports and active living · 2026Article
- Potential Concussion Events of a Leading Team in the Spanish Male Professional Soccer League: Incidence, Refereeing Actions, Medical Consequences and Return-to-Play.Sports medicine - open · 2025Article
- Heads up for concussion, what do emergency physicians know? A scoping review.BMC sports science, medicine & rehabilitation · 2025Article
- On-pitch concussion management: a view of healthcare professionals in elite football.BMJ open sport & exercise medicine · 2025Article
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Authors and funding
8 authors.
Funding
Abstract
objectiveTo investigate the utilisation of additional permanent concussion substitutes (APCSs) and its efficacy with regards to rate and duration of medical assessment of head collision events (HCEs) in the 2020-2021 Premier League season. The present APCS rule allows players with a suspected concussion to be removed from a match without counting towards a team's allocated substitutions.
methodsEighty Premier League matches, 40 prior to additional permanent concussion substitutes implementation (Pre-APCS) and 40 after (Post-APCS), were randomly selected and analysed by a team of trained reviewers for HCEs. Data on HCE incidence, rates of medical assessment, duration of medical assessment and return to play were collected for each match. Data for the Pre-APCS and Post-APCS groups were compared to analyse differences in assessment of HCEs.
resultsDuring the 2020-2021 Premier League season, three APCSs were used. There were 38 HCEs identified in the Pre-APCS group (0.95 per match, 28.79 per 1000 athlete-hours of exposure) and 42 in the Post-APCS group (1.05 per match, 31.82 per 1000 athlete-hours of exposure). Incidence of HCEs (p=0.657), rates of medical assessment (23.7% Pre-APCS vs 21.4% Post-APCS; p=0.545) and duration of medical assessment (median 81 s Pre-APCS vs 102 s Post-APCS; p=0.466) did not significantly differ between the two groups.
conclusionsThe implementation of APCSs in the Premier League did not impact the rate or duration of medical assessement of HCEs. Despite the introduction of APCSs, the consensus protocols for HCE assessment were rarely followed. We recommend changes to APCS and its implementation that would be aimed at protecting player health.
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