A comparison of clinical assessment with common diagnostic tools for monitoring concussion recovery in adolescent rugby union players.

OBJECTIVES: To characterise the incidence, severity and recovery of sport-related concussion (SRC) in schoolboy rugby players and explore whether the Sports Concussion Assessment Tool (SCAT), Cogstate Brief Battery (CBB) and the King-Devick test (K-D test) can be used to monitor concussion status through to full recovery. DESIGN: Prospective cohort study. SETTING: Rugby union has a high rate of SRC; however, there is little research investigating how concussion affects adolescent rugby players. PARTICIPANTS: Schoolboy rugby players. MAIN OUTCOME MEASURES: Participants completed baseline tests in the preseason. Participants diagnosed with SRC during the season attended for post-concussion testing on a weekly basis until recovered. RESULTS: 135 schoolboy rugby players (16.7 ± 0.82y) participated in the study. There were 18 SRCs in 16 participants. Concussion incidence was 9/1000 player hours. CBB and K-D tests were poorly associated with clinical assessment and produced high false negative rates (0.58 and 0.52 respectively). CONCLUSIONS: This study reports a relatively high match SRC incidence for an adolescent population. Analysis of clinical recovery with CBB and K-D test revealed a relatively poor ability to accurately monitor concussion status compared to clinical assessment suggesting that these tools should not be used in isolation for monitoring SRC recovery in adolescents.

The epidemiology of concussion in professional rugby union in Ireland.

OBJECTIVES: To determine incidence rates, severity and the nature of concussion in professional rugby union in Ireland. DESIGN: Retrospective observational study of time-loss concussion. SETTING: Professional rugby union in Ireland. PARTICIPANTS: 160 male professional rugby union players. OUTCOME MEASURES: Incidence rates (concussion/1000 player-match-hours) and mean/median severity (days absence) of concussion. RESULTS: This study observed 60 concussions in 47 players over the course of the 2016/17 season. The match concussion incidence rate was 18.4/1000 player-match-hours. Mean and median severity was 12 and 10 days respectively. Overall burden of match concussion was 5 days absence per team per match. Concussion severity (days absence) correlated positively with the number of symptoms (rs 0.32, p = 0.022) and symptom severity score (rs 0.28, p = 0.045) on HIA2/SCAT3 forms. A negative correlation was observed between symptom severity score and the number of days until subsequent injury (rs -0.28, p = 0.049). Tackling was the most common inciting event responsible for concussion. CONCLUSIONS: The burden of concussion in professional rugby union is high. Incidence rates appear to be increasing year on year while severity is unchanged. Return to play results in this study highlight the need for caution in concussion recovery and return to play protocols.