A 2-round international Delphi consensus process among FIFA-member association medical representatives was used to develop FOCUS — a Football-Specific Standardized On-Pitch Concussion Assessment Protocol — for evaluating suspected concussion during football (soccer) match play within time-constrained conditions.
From 101 candidate assessment items, 47 reached ≥80% consensus across two Delphi rounds; 4 more were added by steering committee review, and 12 were merged to eliminate duplicates — yielding a final 45-item protocol across 11 domains (player medical history, mechanism of injury, visible signs, level of consciousness, cervical spine assessment, symptoms, orientation, balance, proprioception, oculomotor function, and activity-based assessment).
- Implementation feasibility in live match conditions has not yet been tested. - Diagnostic accuracy of the FOCUS protocol is unvalidated. - Consensus-based methods reflect expert opinion; the protocol is not yet supported by prospective outcome data.
Team physicians and medical staff working in football should familiarize themselves with FOCUS as the emerging global standard for on-pitch concussion assessment, covering 11 structured domains designed for rapid evaluation. Formal validation studies are still needed before its diagnostic performance can be assumed.
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