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It is time to give concussion an operational definition: a 3-step process to diagnose (or rule out) concussion within 48 h of injury: World Rugby guideline
  1. Martin Raftery1,
  2. Simon Kemp2,
  3. Jon Patricios3,4,5,
  4. Michael Makdissi6,7,
  5. Philippe Decq8,9,10,11
  1. 1World Rugby, Dublin, Ireland
  2. 2Rugby Football Union, London, UK
  3. 3Sports Concussion South Africa, Johannesburg, South Africa
  4. 4Faculty of Health Sciences, The Section of Sports Medicine, University of Pretoria, Pretoria, South Africa
  5. 5Faculty of Health Sciences, The Department of Emergency Medicine, University of the Witwatersrand, Johannesburg, South Africa
  6. 6Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne Brain Centre, Heidelberg, Australia
  7. 7Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Australia
  8. 8Georges Charpak Human Biomecanics Institute, Arts et Métiers ParisTech
  9. 9René Diderot Paris 7 medical faculty
  10. 10Department of Neurosurgery, Assistance Publique Hôpitaux de Paris, Beaujon Hospital, Clichy, France
  11. 11French Rugby Federation Concussion Consultant
  1. Correspondence to Dr Martin Raftery, World Rugby, World Rugby House 8–10 Pembroke Street Lower, Dublin 2, Ireland; martin.raftery{at}

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Concussion is the number one injury risk in contact and collision sports. Identification of concussive events is critical to optimise injury management and, as identified by Quarrie and Murphy,1 to undertake accurate injury surveillance studies.

The Zurich Consensus Statement on Concussion2 provides an expanded theoretical or conceptual definition of concussion but there is not yet an operational definition of concussion.

In 2012 World Rugby introduced a new pitch side process for assessment of head injuries, called the head injury assessment (HIA).3 During the evolution of this process an operational definition of concussion has been developed and successfully implemented.

This World Rugby operational definition of concussion was developed with the intent of increasing recognition and sensitivity of diagnosis within the sport and subsequently to improve player welfare and safety. Confirmed cases of concussion must follow the recommended rest and graduated return to play programme that serves as a final part of the serial evaluation process.

An operational definition of concussion

During the development of this operational definition of concussion it was agreed that this definition should address the timing of concussion assessment(s), how the diagnosis of concussion is confirmed or excluded and the …

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