Evaluation of World Rugby's concussion management process: results from Rugby World Cup 2015. Issue 1 (1st September 2016)

• Record Type: Journal Article
• Authors: Fuller, Colin W; Fuller, Gordon W; Kemp, Simon P T; Raftery, Martin
• Is Part Of: British journal of sports medicine. Volume 51:Issue 1(2017)
• Page Start: 64
• Page End: 69
• Publication Date: 2016-09-01
• Subjects: Concussion -- Contact sports -- Epidemiology -- Rugby -- Risk factor; Sports medicine -- Periodicals; 617.1027
• DOI: 10.1136/bjsports-2016-096461
• Languages: English
• ISSNs: 0306-3674

Abstract

Abstract : Objective: To evaluate World Rugby's concussion management process during Rugby World Cup (RWC) 2015. Design: A prospective, whole population study. Population: 639 international rugby players representing 20 countries. Method: The 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. Results: Players 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. Conclusions: This study supports the implementation of a multimodal, multitime-based concussion evaluation process to ensure that immediate and late developing concussions are captured.