Evaluation of World Rugby's concussion management process: results from Rugby World Cup 2015

• Published in: British journal of sports medicine Vol. 51; no. 1; pp. 64 - 69
• Main Authors: Fuller, Colin W, Fuller, Gordon W, Kemp, Simon P T, Raftery, Martin
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.01.2017
• Subjects: Athletes; Athletic Injuries - diagnosis; Brain Concussion - diagnosis; Concussion; Decision making; Football - injuries; Head injuries; Humans; Prospective Studies; Return to Sport; Rugby; Sports injuries; Sports Medicine - methods; Surveillance; Tournaments & championships; Contact sports; Rugby; Concussion; Epidemiology; Risk factor
• ISSN: 0306-3674; 1473-0480
• DOI: 10.1136/bjsports-2016-096461

ObjectiveTo evaluate World Rugby's concussion management process during Rugby World Cup (RWC) 2015.DesignA prospective, whole population study.Population639 international rugby players representing 20 countries.MethodThe concussion management process consisted of 3 time-based, multifaceted stages: an initial on-pitch and/or pitch-side assessment of the injury, a follow-up assessment within 3 hours and an assessment at 36–48 hours. The initial on-pitch assessment targeted obvious signs of concussion, which, if identified, lead to a ‘permanent removal from play’ decision and a diagnosis of concussion. If the on-pitch diagnosis was unclear, a 10-min off-pitch assessment was undertaken for signs and symptoms of concussion leading to a ‘suspected concussion with permanent removal from play’ or a ‘no indication of concussion with return to play’ decision. Evaluations at 3 and 36–48 hours postmatch lead to diagnoses of ‘confirmed concussion’ or ‘no concussion’. Medical staff's decision-making was supported during each stage by real-time video review of events. Players diagnosed with confirmed concussion followed a 5-stage graduated-return-to-play protocol before being allowed to return to training and/or competition.ResultsPlayers were evaluated for concussion on 49 occasions, of which 24 resulted in diagnoses of concussion. Fourteen players showing on-pitch signs of concussion were permanently removed from play: 4 of the 5 players removed from play following off-pitch medical room evaluation were later diagnosed with a confirmed concussion. Five players not exhibiting in-match signs or symptoms of concussion were later diagnosed with concussion. The overall incidence of concussion during RWC 2015 was 12.5 concussions/1000 player-match-hours.ConclusionsThis study supports the implementation of a multimodal, multitime-based concussion evaluation process to ensure that immediate and late developing concussions are captured.