Protect footballers from concussion risk, says journal
Decisions on whether a footballer can return to the pitch after a head injury should be taken by an independent doctor, and not the player or coach.
An editorial in The Lancet Neurology says these decisions should not be made "by those with a vested interest".
FIFPro, the footballers' union, has called for an investigation into concussion protocols.
This follows incidents during the World Cup where footballers played on after appearing to be concussed.
End Quote The Lancet editorial
Return-to-play decisions should be made on an individual basis”
"Because signs and symptoms of concussion can be delayed, removing an athlete when there is any suspicion of injury would seem to be the safest approach," the journal editors wrote.
They refer to a recent World Cup group match against England, when Uruguay's Alvaro Pereira returned to the pitch after appearing to be knocked unconscious by a blow to the head.
Pereira admitted to arguing with his team doctor, demanding that he should be allowed to continue playing.
The editors make the point that the decision on the player's "fitness to play" should not have been left in the hands of the Uruguayan team doctor and team officials.
Instead, "return-to-play decisions should be made on an individual basis", they said.
In the World Cup semi-final between Argentina and the Netherlands, Javier Mascherano stumbled about and then collapsed on the pitch after clashing heads with a Dutch player.
Despite appearing to suffer concussion, the Argentinean midfielder returned to the fray just minutes later.'Wrong message'
Fifa has been criticised for failing to deal with the incidents safely, by ensuring that the players were immediately taken off the pitch and removed from the game.
While many sporting organisations now recognise the potential damage that mild traumatic brain injury (TBI) can cause, the writers said more needs to be done to reduce how often these injuries occur.
Improving the assessment, monitoring and care of adults and children with sports-related concussion should also be a priority, it states.
Mr Antonio Belli, reader in neurotrauma at the University of Birmingham, said players don't understand how dangerous concussion can be.
"When players return to the pitch and continue playing, they are sending out the wrong message. There are lots of medical reasons not to continue."
The long-term consequences of mild traumatic brain injuries can include dementia and other neurological degenerative diseases.
Headaches and dizziness can appear in the short-term.
What is concussion?
Concussion is an abnormal brain function that results from an external blast, jolt or impact to the head. Even if the knock does not result in a skull fracture, the brain can still experience a violent rattling that leads to injury.
Because the brain is a soft gelatinous material surrounded by a rigid bony skull, such traumatic injuries can cause changes in brain function, such as bleeding, neuron damage and swelling. Research shows that repetitive concussions increase the risk of sustained memory loss, worsened concentration or prolonged headaches.