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The International Rugby Board (IRB) Pitch Side Concussion Assessment trial: a pilot test accuracy study
  1. Gordon Ward Fuller1,
  2. Simon P T Kemp2,
  3. Philippe Decq3
  1. 1Emergency Medicine Research in Sheffield Group, School of Health and Related Research, University of Sheffield, Sheffield, UK
  2. 2Rugby Football Union, Middlesex, UK
  3. 3French Federation of Rugby, Neurosurgical Department, Medical School René Diderot Paris 7, Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Clichy, Paris, France
  1. Correspondence to Dr Gordon Ward Fuller, Emergency Medicine Research in Sheffield Group, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK; g.fuller{at}sheffield.ac.uk

Abstract

Background ‘On the field and on the run’ assessments of head impact events in professional rugby have resulted in a high proportion of players subsequently diagnosed with confirmed concussion not leaving the field of play at the time of injury. The International Rugby Board (IRB) consequently developed a process to support team doctors in the recognition and management of players at risk of concussion, including development of a multimodal assessment instrument—the Pitch Side Concussion Assessment (PSCA) tool.

Methods This was a pilot cohort study designed to determine the feasibility of assessing the accuracy of the IRB PSCA tool in elite male rugby. The study population comprised consecutive players identified with a head impact event with the potential to result in concussion during eight international/national competitions. Players were assessed off field by match-day or team doctors, following a temporary substitution. The accuracy of the PSCA tool was measured against a reference standard of postmatch confirmed concussion, based on clinical judgement aided by an established concussion support instrument.

Results A total of 165 head injury events with the potential to cause concussion were included in the study. The PSCA tool demonstrated a sensitivity of 84.6% (95% CI 73.5% to 92.4%) and a specificity of 74% (95% CI 64.3% to 82.3%) to identify players subsequently diagnosed with confirmed concussion. The negative predictive value was 88.1% (95% CI 79.2% to 94.1%); the positive predictive value was 67.9% (95% CI 56.6% to 77.8%). There were no major barriers identified that would prevent the evaluation of the PSCA process or tool in a future large-scale study.

Conclusions This pilot study has provided the first preliminary estimates for the performance of the PSCA tool, suggesting a potentially favourable balance between positive and negative predictive values. The study has also offered a strong basis to conduct a further larger trial, providing information for sample size calculations and highlighting areas for methodological development.

  • Concussion
  • Head Injuries
  • Injury Prevention
  • Rugby

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