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A preliminary video review of in-game head injury incidents (hii) and use of the head injury assessment (hia) from the 2015 super rugby season
  1. Ryan Kohler1,
  2. Michael Makdissi2,3,
  3. Warren McDonald4,5,
  4. Bradley Partridge6,
  5. Andrew J Gardner7,8
  1. 1Sport Injuries Specialist; HeadSmartTM Sports Concussion Program, University of Canberra, Australian Capital Territory, Australia
  2. 2Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Vic, Australia
  3. 3La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Vic, Australia
  4. 4Chief Medical Officer, Australian Rugby Union (ARU), St Leonards, NSW, Australia
  5. 5Sport and Exercise Science, Faculty of Health, University of Canberra, ACT, Australia
  6. 6Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD, Australia
  7. 7Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
  8. 8Hunter New England Sports Concussion Program, John Hunter Hospital, New Lambton Heights, NSW, Australia


Objective To complete a video evaluation of the management of players suspected of sustaining concussion in professional Rugby Union during the 2015 season.

Design Retrospective, observational study.

Setting Super Rugby match play.

Participants Players representing Australian Super Rugby franchises who were evaluated by their team doctor (TD) and an independent match day doctor (MDD) for concussion during the 2015 season.

Outcome measures In-game ‘head injury incidents’ (HII) and use of the World Rugby (WR) Head Injury Assessment (HIA) process were recorded. TD and MDD had access to video during games which allowed review of HIIs as part of their decision making process. A retrospective review of the video of each incident by three experienced clinicians was conducted to assess the decision-making process (i.e., permanent removal, remain-in-play, or return-to-play).

Main results There were 47 ‘head injury incidents’ (HII) evaluated by TD and MDD. Using WR HIA criteria, 18 incidents resulted in a player’s permanent removal, of which 16 were subsequently diagnosed with concussion. On retrospective video review, the in-game decision to permanently remove a player was agreed upon in 78% (14/18) of cases. Using WR HIA criteria, there were 28 decisions to temporarily remove a player and conduct a HIA. On retrospective review, the in-game decision to complete a HIA was agreed upon in 68% (19/28) of cases.

Conclusions Reviewing match video footage can be a useful addition to the TDs’ and MDDs’ in-game clinical assessment of concussion. The clinical relevance of some brief signs on video review warrants further investigation.

Competing interests Ryan Kohler, Bradley Partridge – None.

Michael Makdissi (see declaration form for full disclosures)

Warren McDonald is the Chief Medical Officer of the Australian Rugby Union (ARU). He also operates his own private sports and exercise medicine practice in Canberra, Australia.

Andrew Gardner has a clinical practice in neuropsychology involving individuals who have sustained sport-related concussion (including current and former athletes). He serves, in a voluntary capacity, as a member of the Australian Rugby Union (ARU) concussion advisory group. He has received travel funding from the Australian Football League (AFL) to present at the Concussion in Football Conference in 2013. Previous grant funding includes the NSW Sporting Injuries Committee, the Brain Foundation and the Hunter Medical Research Institute (HMRI), supported by Jennie Thomas. He is currently receiving research funding through the HMRI, supported by Anne Greaves.

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