Breakthrough on a concussion test appears close but in the meantime there are questions about the treatment of head injuries

Risk is part of life’s fabric and a big part of football’s attraction but when it comes to suspected concussion, even the most calculated gambles have no place in the game.

Stringent protocols adopted by the Football Association perform a largely excellent job in protecting players with possible head injuries, while Fifa and Uefa competitions fall under the umbrella of separate, but broadly similar, guidelines.

Unfortunately all such safety nets harbour one key flaw: there is no accurate diagnostic tool for concussion and assessment is determined on the judgment of individual doctors reliant primarily on potentially unreliable balance and memory checks.

Although a Birmingham University research team are close to a breakthrough and have a saliva test on trial in the Premier League, the mantra is to err on the side of extreme caution. In the words of the FA’s concussion guidelines: “If in doubt, sit them out.”

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Unfortunately Fabian Schär seemed to become an exception to this zero-tolerance approach when the Newcastle defender completed Switzerland’s 2-0 win against Georgia in Tbilisi, despite having briefly lost consciousness during a first-half clash of heads.

Schär said he had been “knocked out for a few minutes” and added “my skull is buzzing”. Switzerland’s failure to withdraw him appeared so completely out of step with concussion guidelines Newcastle’s medical team, led by the club doctor Paul Catterson, were sufficiently alarmed to make urgent calls to Tbilisi.

A “joint decision” was taken and Switzerland announced they were withdrawing Schär from Tuesday’s game with Denmark but the real puzzle was why the Uefa protocols had not been immediately activated. As with the FA and the Premier League there should be a minimum six-day rest period before a player “returns to play” following a suspected concussion. Non-professionals lacking “enhanced care” should wait 19 days.

Uefa protocol states: “In the event of a suspected concussion, the referee stops the game for up to three minutes to allow the player to be assessed by the doctor. A player will only be allowed to continue playing on specific confirmation by the team doctor to the referee of the player’s fitness to carry on.” In Schär’s case there was a five-minute break before the referee was reassured, with everything apparently hinging on Switzerland’s team doctor.

Although a third, independent, “tunnel doctor” must be present at Premier League games to support and advise their two club counterparts, this rule is not mandatory elsewhere and there have been calls – notably from the former Newcastle and England captain Alan Shearer and the global players’ union, Fifpro – for a third “neutral” physician to be present at internationals and given the final say on head injuries. Such a presence could have altered the outcome in Georgia.

Switzerland have defended themselves, saying Schär was examined in accordance with the “sport concussion assessment tool” and “no neurological deficits could be detected”. Moreover, post-game checks highlighted “no abnormalities”, they said.

Facebook Twitter Pinterest Napoli goalkeeper David Ospina collapsed after sustaining a blow to the head in a collision with Udinese’s forward Ignacio Pussetto. Photograph: Carlo Hermann/AFP/Getty Images

Comparable controversy recently surrounded the collapse of David Ospina, the Arsenal goalkeeper on loan at Napoli, during a Serie A game against Udinese. Ospina had played on, with head heavily bandaged following a collision, before fainting and being taken to hospital where scans mercifully proved clear.

It is hard to envisage similar scenarios unfolding at St James’ Park where – in common with other Premier League clubs – Newcastle have not only a tunnel doctor augmenting club counterparts but operate a live video and audio feed linking the pitch and dugout to the club’s treatment room. From it medical staff offer frontline colleagues advice, typically helping assess the severity of injuries using a red, amber and green traffic-light system.

Newcastle’s manager, Rafael Benítez is happy to cede autonomy in this sphere to Catterson, a highly qualified trauma expert who fully appreciates that, like Schär, players are often reluctant to be replaced after head injuries. He and Benítez became embroiled in extraordinary scenes involving the club’s former striker Aleksandar Mitrovic during the 2016 Tyne-Wear derby. With the score 1-1 in a vital relegation home match against Sam Allardyce’s Sunderland and all substitutes used, Mitrovic briefly lost consciousness following a blow to the head and was sidelined. Undeterred, the Serb swiftly attempted to return to the pitch and had to be restrained by a combination of Catterson and Benítez.

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If Headway, the brain injury campaign group, was suitably unimpressed, its chief executive, Peter McCabe, was shocked by the Schär case. “What is it going to take to make football take concussion seriously?” he asked. “Put simply, the decision to allow Fabian Schär to return to the field of play after suffering a clear concussion was not only incredibly dangerous but also a clear dereliction of duty.”

Headway has urged Uefa to open an inquiry into Schär’s head injury but on Wednesday European football’s governing body said it had no update on whether such an investigation would be forthcoming.

The Premier League Doctors’ Group hopes to simplify the enforcement of concussion protocols courtesy of a diagnostic trial running in conjunction with Birmingham University throughout this season. Welcomed by the Professional Footballers’ Association, it involves the collection of saliva, blood and urine from injured players and uninjured “control” teammates.

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These samples are exposed to the groundbreaking “Birmingham concussion test” developed by the academic neurosurgeon professor Tony Belli, which seeks molecules acting as biomarkers indicating whether the brain has suffered injury. The hope is a handheld saliva monitor will be introduced, possibly within two years.

“This is a really big breakthrough and it’s been developed in Britain,” Belli said. “Sports around the world have been looking for a more reliable and objective assessment for concussion than the current balance and memory tests. They are just not very accurate.”