Objective to investigate the knowledge and practice of Rugby Union referees regarding the recognition and management of concussion in English professional and semi-professional rugby.

Design email survey questionnaire.

Setting English Rugby Union Premiership, Championship and National Leagues.

Participants All 180 actively practicing referees in England in the Premiership, Championship and National Leagues.

Outcome measures Actual and perceived knowledge of concussion, and subjective confidence in diagnosing concussion.

Main results 22 referees with an average age 34.77 years (Range 26-49 SD 6.13) and returned surveys. The referees’ level of officiating ranged from Premiership (Level 1) to regional games (Level 8) with the highest proportion of referees officiating at Level 1 (31.80%). A high percentage of referees recognised functional disturbances including loss of balance (90%), slurred speech (73%), dizziness (95%) and blurred vision (100%) as signs of concussion. 59.09% rated their knowledge of concussion as average and 18.18%% good or excellent. Overall, 72% of referees felt they could subjectively diagnose concussion, the professional referees were more confident in diagnosing a concussion versus the amateur referees.

Conclusions Referees generally have a good knowledge of concussion and its management although 54.54% have had no previous education. The majority wanted to learn more on the subject (90.90%) but the methods which they are currently using to learn are varied and not standardised. Practical group sessions (59.09%) and online resources (45.45%) were recognised as the most popular method of learning. Further education regarding recognition and on-field management of concussion is recommended for rugby union referees. Future studies should focus on participant information retention after using such resources as HeadCase.

Competing interests None.