Objective Recognition and management of concussion within sport is a hot topic as research suggests that the mismanagement can lead to extended time out of play and morbidity after retirement. This study aimed to identify the incidence and risk following concussion within the Rugby Football League and if full recovery from concussion increases the risk of subsequent concussions.

Design Retrospective study

Method Participant players were those who held a professional contract between 2006–2012. It is mandatory to provide an annual baseline test and following any diagnosed concussion, with full symptom resolution, a valid return to play test. Concussion test data was provided by CogState Australia from tests performed over 7 seasons.

Results Over the 7 seasons 4762 players suffered 470 concussion (2.65/1000 hours, 95% Confidence Interval 2.4 to 2.9). The odds of sustaining 1 concussion was 7%, the odds of receiving 2 or more was 1%, and 0.3% 3 or more concussions. The time between concussions for any individual who suffered two or more concussions was on average 355 days. The average return to play time was 1.46 days following the first return to play test.

Conclusions This report is the first to follow rugby league players over a prolonged period and, the first to demonstrate the risk of subsequent concussions. In rugby league, concussions managed correctly and fully resolved were not shown to have detrimental effects on future concussions, and in general there is a lack of evidence linking appropriately managed concussions in other sports to detrimental future effects.

Competing interests Lisa Hodgson, Conor Gissane, Peter Walker David Darby – None.

Paul Maruff – Full time employee of CogState.

David Darby – Former Founder and Director of Cogstate.