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A video analysis of head injuries satisfying the criteria for a head injury assessment in professional Rugby Union: a prospective cohort study
  1. Ross Tucker1,
  2. Martin Raftery1,
  3. Gordon Ward Fuller2,
  4. Ben Hester1,
  5. Simon Kemp3,
  6. Matthew J Cross3,4
  1. 1 World Rugby Pty (Ltd), Dublin, Ireland
  2. 2 School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK
  3. 3 Rugby Football Union, London, England, UK
  4. 4 Department for Health, University of Bath, Bath, UK
  1. Correspondence to Dr Ross Tucker, World Rugby Pty (Ltd), Dublin, Ireland; Ross.tucker{at}


Objectives Concussion is the most common match injury in professional Rugby Union, accounting for 25% of match injuries. The primary prevention of head injuries requires that the injury mechanism be known so that interventions can be targeted to specifically overall incidence by focusing on characteristics with the greatest propensity to cause a head injury.

Methods 611 head injury assessment (HIA) events in professional Rugby Union over a 3-year period were analysed, with specific reference to match events, position, time and nature of head contact.

Results 464 (76%) of HIA events occur during tackles, with the tackler experiencing a significantly greater propensity for an HIA than the ball carrier (1.40 HIAs/1000 tackles for the tackler vs 0.54 HIAs/1000 tackles for the ball carrier, incidence rate ratio (IRR) 2.59). Propensity was significantly greater for backline players than forwards (IRR 1.54, 95% CI 1.28 to 1.84), but did not increase over the course of the match. Head to head contact accounted for the most tackler HIAs, with the greatest propensity.

Conclusions By virtue of its high propensity and frequency, the tackle should be the focus for interventions that may include law change and technique education. A specific investigation of the characteristics of the tackle is warranted to refine the approach to preventative strategies.

  • rugby
  • concussion
  • injury
  • head
  • injury prevention

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  • Contributors RT and MR conceived the study and developed the framework for video analysis. SK and MJC provided edits on the proposal, hypothesis and coding framework. BH performed the coding. RT conducted the analysis and wrote the manuscript. MJC, MR, SK and GWF edited the manuscript.

  • Competing interests RT, MR and BH are employed by World Rugby Pty. World Rugby is the governing body for the sport of Rugby Union and responsible for law changes in the sport. SK and MC are employees of the Rugby Football Union, which is the body that runs the sport in England.

  • Patient consent Obtained.

  • Ethics approval World Rugby Internal Ethics Board.

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

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