Conmociones cerebrales en el fútbol: avances recientes y desafíos en la gestión clínica y preventiva

Abstract

Concussions in soccer are a key challenge for neurological health due to their high incidence, diagnostic complexity, and risk of long-term sequelae. This article provides a narrative review of their definition, epidemiology, pathophysiology, diagnosis, management, and prevention, integrating the most recent international guidelines. A search was conducted in Medline and Scopus (2013-2025) using terms related to "sports concussion", "traumatic brain injury," and "soccer"; 48 studies were selected. The 6th International Conference on Concussion in Sport and the criteria of the American Congress of Rehabilitation Medicine provide complementary frameworks for defining mild traumatic brain injury, based mainly on observational evidence and expert consensus. In soccer, concussions are mainly caused by head-to-head, head-to-ball, or head-to-ground impacts, with an approximate incidence of 0.5 per 1,000 hours of play and differences in recovery depending on gender. Diagnosis remains clinical and is supported by tools such as the Sport Concussion Assessment Tool 6 (SCAT6), its pediatric version (Child SCAT6), and the Concussion Recognition Tool 6 (CRT6). Current management emphasizes immediate removal from play, an initial period of relative rest, early subthreshold physical activity, and individualized rehabilitation. Biomarkers such as ubiquitin C-terminal hydrolase-L1 (UCHL1), glial fibrillary acidic protein (GFAP), and new tools such as SCOAT6 show potential but are not yet routinely recommended. The review identifies gaps in evidence for female players, youth populations, and the effects of repetitive heading, which guide future research priorities.