{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T17:23:08Z","timestamp":1787160188755,"version":"build-2736575974"},"reference-count":22,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2022,7,5]],"date-time":"2022-07-05T00:00:00Z","timestamp":1656979200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["TIR-103946"],"award-info":[{"award-number":["TIR-103946"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Inj Prev"],"accepted":{"date-parts":[[2022,6,10]]},"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To 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\u20132021 Premier League season. The present APCS rule allows players with a suspected concussion to be removed from a match without counting towards a team\u2019s allocated substitutions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Eighty 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During the 2020\u20132021 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/ip-2022-044580","type":"journal-article","created":{"date-parts":[[2022,7,5]],"date-time":"2022-07-05T13:27:20Z","timestamp":1657027640000},"page":"521-525","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Effect of a new concussion substitute rule on medical assessment of head collision events in Premier League football"],"prefix":"10.1136","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1497-2359","authenticated-orcid":false,"given":"Gabriel","family":"Tarzi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0809-8391","authenticated-orcid":false,"given":"Christopher","family":"Tarzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Mirsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eileen","family":"Dadashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana","family":"El-Sabbagh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Austin","family":"Gerhart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D","family":"Cusimano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,7,5]]},"reference":[{"key":"2024053009140041000_28.6.521.1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2012-091941"},{"key":"2024053009140041000_28.6.521.2","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.ncl.2017.03.003","article-title":"Sideline sports concussion assessment","volume":"35","author":"Podell","year":"2017","journal-title":"Neurol Clin"},{"key":"2024053009140041000_28.6.521.3","doi-asserted-by":"crossref","first-page":"2548","DOI":"10.1001\/jama.2017.6204","article-title":"Assessment of head collision events during the 2014 FIFA World cup tournament","volume":"317","author":"Cusimano","year":"2017","journal-title":"JAMA"},{"key":"2024053009140041000_28.6.521.4","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-024607"},{"key":"2024053009140041000_28.6.521.5","doi-asserted-by":"publisher","DOI":"10.1136\/injuryprev-2019-043397"},{"key":"2024053009140041000_28.6.521.6","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1001\/jama.2019.19919","article-title":"Medical assessment of head collision events in elite women's and men's soccer","volume":"323","author":"Tarzi","year":"2020","journal-title":"JAMA"},{"key":"2024053009140041000_28.6.521.7","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1111\/sms.13852","article-title":"Video analysis of concussion mechanisms and immediate management in French men's professional football (soccer) from 2015 to 2019","volume":"31","author":"Cassoudesalle","year":"2021","journal-title":"Scand J Med Sci Sports"},{"key":"2024053009140041000_28.6.521.8","doi-asserted-by":"crossref","first-page":"2035","DOI":"10.1001\/jama.2018.14165","article-title":"Association between the experimental Kickoff rule and concussion rates in ivy League football","volume":"320","author":"Wiebe","year":"2018","journal-title":"JAMA"},{"key":"2024053009140041000_28.6.521.9","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1080\/00913847.2020.1718565","article-title":"Does the MLB's collision at home plate rule change prevent concussion injuries in catchers?","volume":"48","author":"Baker","year":"2020","journal-title":"Phys Sportsmed"},{"key":"2024053009140041000_28.6.521.10","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1055\/s-0035-1565203","article-title":"A Video Analysis of Use of the New 'Concussion Interchange Rule' in the National Rugby League","volume":"37","author":"Gardner","year":"2016","journal-title":"Int J Sports Med"},{"key":"2024053009140041000_28.6.521.11","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1080\/02699052.2020.1782473","article-title":"The medical observer in American football: a survey of use and efficacy","volume":"34","author":"Kent","year":"2020","journal-title":"Brain Inj"},{"key":"2024053009140041000_28.6.521.12","doi-asserted-by":"crossref","first-page":"A65.3","DOI":"10.1136\/bjsports-2016-097270.170","article-title":"Efficacy of a football rule to prevent concussion","volume":"51","author":"Beaudouin","year":"2017","journal-title":"Br J Sports Med"},{"key":"2024053009140041000_28.6.521.13","unstructured":"Concussion Substitutes . 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