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An investigation of the role of a rapid sideline head injury assessment form (hiaf) in the clinical diagnosis of concussion in elite australian football
  1. Patrick Clifton1,
  2. Peter Harcourt OAM1,
  3. Tom Gastin1,
  4. Michael Makdissi2,3
  1. 1Australian Football League (AFL), Docklands VIC, 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


Objective To investigate the role of a rapid sideline Head Injury Assessment Form (HIAF) in the clinical diagnosis of concussion in elite Australian football.

Design Validation study

Setting/participants The study was conducted in all 207 matches of the professional competition during the 2015 season.

Interventions The HIAF comprised 12 individual tests based on previously validated clinical features1 and video signs2 of concussion. Experienced team physicians were required to complete the HIAF for any incident potentially resulting in a concussion. The HIAF directs team physicians to either permanently remove the player (9 of 12 tests), or conduct a more detailed assessment (e.g. SCAT3, 3 of 12 tests). Where possible, the tests were conducted by both direct assessment and video review of the incident. At the end of the season, data on all clinically confirmed concussions was collected from team physicians.

Main results 135 HIAFs were submitted throughout the 2015 season resulting in 44 players permanently removed from play for concussion. 8 confirmed concussions were not identified during the match. When compared to information on clinically confirmed concussions, the HIAF captured concussive incidents with 89% sensitivity (95% CI: 75.44% – 96.21%) and 98% specificity (95% CI: 92.03% – 99.72%).

Conclusions The HIAF was demonstrated to have a high level of sensitivity and specificity. It is a useful precursor to the SCAT3 for the sideline diagnosis of concussion, in most cases providing a faster and more prescriptive assessment. A modified version of the HIAF may be useful in lower levels of competition.

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