Sports-Related Concussion describes immediate and transient symptoms of mild-Traumatic Brain Injury during sport (Mooney et al., 2020, Concussion, 5(3)). Some sports have educational interventions enhancing knowledge and understanding of SRC (Rugby Football Union [RFU], 2021; Football Association [FA], 2023). Previous research has shown external influences on clinical decision making when SRC is involved (Gouttebarge, 2021, BMJ Open Sport & Exercise Medicine, 7, 1-4). This project aimed to understand knowledge and attitudes towards con cussion in referees and medical professionals in football mea suring awareness of FA concussion guidelines and concussion education engagement. With institutional ethical approval, a cross-sectional design utilised online surveys sent to referees and medical professionals with snowball sampling. Surveys utilised short answer, multiple-choice, multiple-answer and Likert scale questions based on previous research. Medical professionals from the top four English leagues (n = 27) and referees from across the English football pyramid (n = 32) responded with 9.25% and 10.42% response rates respectively to role-specific questionnaires designed to measure knowl edge, understanding and attitudes towards concussion and management protocols. Neither group understood benefits of removal from play or graduated return to play. Correct identi fication of all signs and symptoms of concussion were 41% and 89% in referees and medical staff respectively. On average 96.5% thought signs and symptoms of severe brain injury indicated concussion. Medical professionals were dependent on presentation of signs and symptoms (93%) to inform under taking diagnostic assessments, the most common of which was the SCAT-5 assessment. Responses indicate poor ability to dif ferentiate between signs and symptoms of concussion and severe brain injury. Both groupsdemonstrated imparied under standing of the benefits of removing players from play and undertaking graduated return to play protocols. A majority of medical professionals (51.9%) indicated they had felt pressure to keep a player in competition despite suspecting a concussion. Of referees 37.5% had no first aid or additional training on concussion. Both groups showed openness to undertaking concussion-specific training in future with 90.6% of referees and 96.3% of medical professionals responding favorably. Knowledge and understanding of concussion in pro fessional football medical staff and football referees has not been previously researched. Previous findings indicated less experience of pressure to keep suspected concussied players on the pitch (Gouttebarge, 2021). Methods of clinical reasoning aligned with previous findings in professional football (Broglio et al., 2011). Future research should aim to better understanding knowledge, understanding and attuitudes in players as well as the effectiveness of education interventions on knowledge, attitudes and behaviours.
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