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Evaluation of World Rugby's concussion management process: results from Rugby World Cup 2015
  1. Colin W Fuller1,
  2. Gordon W Fuller2,
  3. Simon P T Kemp3,
  4. Martin Raftery4
  1. 1Colin Fuller Consultancy Ltd, Sutton Bonington, UK
  2. 2Emergency Medicine Research in Sheffield Group, School of Health and Related Research, University of Sheffield, Sheffield, UK
  3. 3Rugby Football Union, London, UK
  4. 4World Rugby, Dublin, Ireland
  1. Correspondence to Dr Colin Fuller, Colin Fuller Consultancy , Sutton Bonington, UK; ColinFullerConsultancy{at}


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.

  • Concussion
  • Contact sports
  • Epidemiology
  • Rugby
  • Risk factor

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  • Contributors CWF, GWF, SPTK and MR contributed equally to the design, implementation and evaluation of the study. CWF prepared the first draft of the manuscript and all authors contributed to and approved the final manuscript.

  • Funding The study was funded by World Rugby and supported by England Rugby 2015.

  • Competing interests CWF is an independent research consultant providing support to World Rugby. SPTK is the Chief Medical Officer for the Rugby Football Union. MR is the Chief Medical Officer for World Rugby.

  • Ethics approval World Rugby Institutional Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.