Objective A video analysis of 201 National Rugby League (NRL) matches to document all signs of possible concussion during the 2014 season.

Setting All match play from the 2014 NRL season.

Participants All professional players participating in the 2014 season

Outcome measures The total frequency of six concussion signs (unresponsiveness/loss of consciousness, slow to get up, clutching head, unsteadiness of gait, vacant stare, and seizure).

Main results The concussion interchange rule was used 156 times, with 60 medically diagnosed concussions. The incidence rate for concussion was 17.26 (95% CI=13.44–22.16) per 1,000 player match hours, or approximately one concussion every 3.35 games. There were 127,062 tackles reviewed in the 201 matches, for an average of 632.1 tackles per match. Being slow to get up was observed 2,240 times, clutching the head 361 times, unsteadiness of gait 102 times, vacant stare 98 times, possible loss of consciousness (LOC) 52 times, and a seizure 4 times. Of the 2,240 instances of being slow to get up following a tackle, only 2.7% of those cases involved a medically diagnosed concussion. Of the 52 instances in which a player appeared to have brief LOC, 50 players were removed under the concussion interchange rule (96.2%). Of those 50, 24 were medically diagnosed as having sustained a concussion (48%).

Conclusions Reviewing match video footage can be a useful addition to the sideline assessment of concussion.

Competing interests 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 Australia 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 funded through the HMRI, supported by Anne Greaves.

Grant Iverson has been reimbursed by the government, professional scientific bodies, and commercial organisations for discussing or presenting research relating to mild TBI and sport-related concussion at meetings, scientific conferences, and symposiums. He has a clinical and consulting practice in forensic neuropsychology involving individuals who have sustained mild TBIs (including professional athletes).

Christopher Levi none.