Football’s lawmakers have been accused of losing “further credibility” by a leading brain injury charity after a trial of temporary concussion substitutes was not approved last week.

The International Football Association Board (IFAB) confirmed the decision to reject a trial in the Premier League, France’s Ligue 1 and Major League Soccer in the United States at its annual general meeting in London on Saturday.

The Premier League and Professional Footballers’ Association spoke out against the decision and now charity Headway says the IFAB and football’s governing body FIFA have lacked leadership on the matter.

Headway’s chief executive Luke Griggs said: “We are disappointed that IFAB has yet again refused to introduce a temporary concussion substitute rule.

“FIFA president Gianni Infantino claims football is ‘making player health the main priority’ by extending the trial of permanent substitutes. But this system has repeatedly failed to protect players as it relies on either medics making an immediate judgement or for a player to risk exacerbating their brain injury by playing on for 10 to 15 minutes to see how they get on.

“FIFA’s claim that the current system represents a ‘zero risk’ approach is not supported by the repeated failures to take an ‘if in doubt, sit it out!’ approach to concussion.

“These failures are in part due to the pressure placed on medics to make binary and immediate decisions in brief on-pitch assessments thanks to the permanent subs rule.

“FIFA and IFAB have had multiple opportunities to show leadership and introduce this important step for player safety.

“Frankly, with every IFAB meeting that passes without introduction of this rule, they lose further credibility in the arena of brain health in football.”

The Premier League said it “cannot understand” the decision.

A Premier League spokesperson said: “We are disappointed that a temporary concussion substitute trial was not approved considering all available scientific evidence and the overwhelming support from Premier League club doctors.

“While we note that a trial has not been dismissed, we cannot understand the basis for which it has not been approved and remain convinced it should go ahead at the earliest possible opportunity in the interests of player welfare.”

Supporters of temporary concussion subs say allowing medics more time to assess a player away from the pitch will pick up more concussions and reduce the risk of a concussed player being sent back out to play.

The PFA’s head of brain health Dr Adam White said: “We remain committed to improving how brain injuries are managed during games and will continue to work with leagues and player associations from across world football to push for measures that prioritise player safety.”