Only 1 in 7 of all GAA inter-county players who displayed one or more recognised medical signs of concussion while playing a competitive Gaelic football match were withdrawn from taking any further part in a game, according to a new study.
Researchers at University College of Cork’s School of Medicine found the vast majority of Gaelic footballers who suffer possible concussion only receive a brief examination and almost always return to play without a standardised assessment of their condition.
They claimed “a deep-rooted culture that promotes toughness” in the sport could be adding to the problem.
The study, which is published in the Irish Journal of Medical Science, concluded the results show that practices in Gaelic football, like soccer, with regard to checks for possible concussion, do not comply with international best practice as well as the GAA’s own guidelines.
One of the study’s co-authors, Mario Pasquale Rotundo, said timely identification and effective assessment of concussion in Gaelic football were important for lowering the potential risk of both immediate and long-term adverse effects.
Researchers analysed a total of 242 potential concussive events which occurred during 111 National League and All-Ireland championship fixtures played in 2018 and 2019.
They found a player showed signs of concussion in a quarter of all incidents where there had been some form of head contact.
However, only nine out of 61 senior players who had displayed at least one internationally recognised sign of concussion were removed from play following an on-pitch assessment.
Six out of ten players who returned to play after being taken to the sideline to be checked were visibly bleeding from head wounds.
Awareness of sports-related concussion (SRC) has increased in recent years and led to the GAA introducing guidelines which recommend players with suspected concussion be removed immediately from play and medically assessed as well as not returning to play on the same day.
However, the UCC researchers said they were unable to identify any assessments which resembled the GAA’s recommended management of concussion.
“The findings suggest there is a problem with the sport that needs to be studied further. They highlight a need to better educate medical personnel on standardised assessment protocols,” said Mr Rotundo.
He added: “The importance of accurate identification, assessment and removal of athletes suspected of having suffered an SRC cannot be understated.” The report’s other co-author, Darek Sokol-Randell, said the results showed 5% of Gaelic footballers took no further part in a match after being involved in an incident where there had been some head contact, while a similar study for soccer showed the figure was 2%.
In contrast, Mr Sokol-Randell said separate research on rugby found 40% of players with a head injury did not return to play.
The UCC study found 87% of players were assessed by medical personnel, but the remainder received no assessment before returning to play.
The vast majority of on-pitch examinations of players involved in potential concussive incidents were limited with 82% lasting less than one minute.
Mr Sokol-Randell said a study on rugby players found 98% of assessments for head injuries were conducted off the pitch using a protocol that takes a minimum of ten minutes to complete.
“Cursory and remarkably brief assessments may be in the interests of managers and fans who want to see their players continue playing in the game but may be detrimental in the long run to all stakeholders, especially the athlete,” he observed.
The UCC study did find that there was a strong association between the number of concussion signs and the length of the assessment.
“Players displaying multiple signs of concussion were significantly more likely to receive a longer assessment,” said Mr Sokol-Randell.
He said there was limited research investigating whether international recommendations on the treatment of concussion were being followed in Gaelic football.
The study said its findings highlighted how medical personnel must be vigilant to the large number of players who only display one sign of concussion and who are allowed to continue to play the remainder of a match as only 6.5% of players with one sign were removed from play compared to 40% with two or more signs.
The UCC researchers noted that suffering multiple concussions in a short period of time can result in second impact syndrome – a potentially fatal condition characterised by rapid swelling of the brain – while a series of concussions over the longer term can lead to neurodegenerative disease.
They claimed there were a number of barriers to concussion being identified by medical staff on the sideline in Gaelic football including “a deep-rooted culture that promotes toughness, perseverance and loyalty to one’s team” which leads players to downplay their symptoms.
“Increased pressure from fans, players and referees to make rapid clinical decisions may increase the likelihood of inappropriate diagnosis and return-to-play decisions,” said Mr Sokol-Randell.
The study recommended the use of video incident analysis by sideline personnel, concussion substitutions and training referees to spot players with potential concussion as measures to benefit the sport.
“A cumulative effort from the GAA, player associations, sponsors, managers, players and the public must be encouraged to promote a change in culture surrounding concussion,” said Mr Sokol-Randell.
A separate study of GAA players in 2017 found that 54% had experienced concussion with 44% having suffered a blackout on two or more occasions.