A brain injury charity has criticised the decision not to immediately substitute Manchester City goalkeeper Ederson after his collision with Tottenham’s Cristian Romero on Tuesday night.

The Brazilian initially lay motionless as medics treated him following the clash with Romero, with City manager Pep Guardiola later saying medical staff had told him Ederson could not see properly after Romero’s leg made contact with his head.

However, Ederson did not immediately leave the field and played on for several minutes before being replaced by Stefan Ortega.

Luke Griggs, the chief executive of the brain injury charity Headway, said: “The fundamental principle of any concussion protocol is ‘if in doubt, sit it out.’

“The concern from players of both teams in the immediate aftermath of the injury, as well as from the medical team and the fact a stretcher was brought on to the pitch, would suggest a clear concern for Ederson’s well-being.

“The fact that he was not immediately removed would suggest a concussion was not suspected. This is hard to understand, especially as symptoms can be delayed in their presentation.

“While we were relieved to see the player taken off a few minutes later, it is hard to fathom why this was not an immediate decision.

“It is yet another example of when a temporary concussion substitute would have been helpful.”

The Premier League has sought to trial temporary concussion substitutes, but this has been repeatedly refused by the game’s lawmakers in favour of trials of additional permanent concussion subs, which will become a permanent option for competitions to adopt from July 1.

Ederson was visibly upset and angry after being taken off in what was a crucial game for his club, kicking out at some water bottles close to the City technical area.

“Ederson’s angry reaction is no surprise given the competitive nature of players who want to take part in massive games like this one, though his reaction underscores the need to take such decisions out of the players’ hands,” Griggs added.

Guardiola said after Tuesday’s match: “Ederson has a kick in the eye and it is swollen. He could not see properly. The doctor came to me and said, ‘Pep, he cannot see properly and he has to be replaced’. When the doctor says that, I don’t have an alternative.”

City and the Premier League have been contacted for comment.

Ederson’s replacement Ortega went on to make several key saves as City won 2-0 in London to put them in pole position to secure the title on Sunday.