Exploring knowledge and experiences of sports-related concussion in football referees in Northern Ireland: A cross-sectional study

Concussion in football is a serious injury, requiring prompt recognition and removal from play. In football, also known as soccer, referees play a key role in concussion management, alongside players, coaches, medical staff and governing bodies, by observing a head impact and stopping play to allow medical personnel to enter the field of play. However, their knowledge and attitudes surrounding concussion remain underexplored. This cross-sectional study assessed concussion knowledge and attitudes among football referees in Northern Ireland using the Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS), together with items on concussion education, personal experience, and perceived role. Fifty-four referees affiliated with the Irish Football Association completed an online survey (a response rate of approximately 7%; 53 male, 1 female; mean age 44 years). Referees demonstrated good overall knowledge (Concussion Knowledge Index 19.6 ± 2.0 of 25) and safe attitudes (Concussion Attitude Index 12.9 ± 1.9 of 15), despite only 7.4% (n = 4) having received any formal concussion training. Overall, results support the need to implement concussion education within referee development pathways to enhance player safety and concussion management practices.