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Football-Specific On-Pitch Concussion Assessment Protocol-International Consensus Recommendations
Kerry Peek1,2, Andy Massey1, Ruairi Connolly3
1FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland.
JAMA Neurology
|July 1, 2026
Summary
A new Football-Specific Standardized On-Pitch Concussion Assessment Protocol (FOCUS) was developed to address the challenges of diagnosing concussions in football. This evidence-informed protocol aims to improve player health and safety globally.
Area of Science:
- Sports Medicine
- Neurology
- Public Health
Background:
- Concussion assessment in football is challenging due to the lack of a standardized, evidence-based protocol for on-pitch evaluation.
- Existing assessment methods are not optimized for the time-constrained environment of a football match.
Purpose of the Study:
- To develop a football-specific, standardized on-pitch concussion assessment protocol.
- To create an evidence-informed tool for rapid evaluation of suspected concussions in football players.
Main Methods:
- An international consensus process involving medical experts from global football confederations was employed.
- A 2-round Delphi questionnaire was used to score potential assessment items, requiring ≥80% agreement for inclusion.
- Steering committee review and item merging were conducted to finalize the protocol.
Main Results:
- The final Football-Specific Standardized On-Pitch Concussion Assessment Protocol (FOCUS) comprises 45 items across 11 domains.
- Domains include medical history, mechanism of injury, visible signs, consciousness, cervical spine, symptoms, orientation, balance, proprioception, oculomotor function, and activity-based assessment.
- The protocol is structured for rapid on-pitch evaluation.
Conclusions:
- FOCUS offers a standardized, evidence-informed protocol for on-pitch concussion assessment in football, addressing a critical gap in player safety.
- The protocol has the potential to harmonize global concussion management.
- Further evaluation of FOCUS implementation feasibility and diagnostic accuracy is necessary.
