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On average, a professional rugby union player is more likely than not to sustain a concussion after 25 matches
  1. James Rafferty1,
  2. Craig Ranson2,
  3. Giles Oatley3,
  4. Mohamed Mostafa4,
  5. Prabhat Mathema5,
  6. Tom Crick6,
  7. Isabel S Moore7
  1. 1 Medical School, Swansea University, Swansea, UK
  2. 2 English Institute of Sport, Manchester, UK
  3. 3 School of Engineering and Information Technology, Murdoch University, Perth, Western Australia, Australia
  4. 4 Social Data Science Lab, School of Computer Science and Informatics, Cardiff University, Cardiff, UK
  5. 5 Welsh Rugby Union, Cardiff, UK
  6. 6 Department of Computing and Information Systems, Cardiff Metropolitan University, Cardiff, UK
  7. 7 Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
  1. Correspondence to Dr Isabel S Moore, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff CF23 6XD, UK; imoore{at}


Objectives To investigate concussion injury rates, the likelihood of sustaining concussion relative to the number of rugby union matches and the risk of subsequent injury following concussion.

Methods A four-season (2012/2013–2015/2016) prospective cohort study of injuries in professional level (club and international) rugby union. Incidence (injuries/1000 player-match-hours), severity (days lost per injury) and number of professional matches conferring a large risk of concussion were determined. The risk of injury following concussion was assessed using a survival model.

Results Concussion incidence increased from 7.9 (95% CI 5.1 to 11.7) to 21.5 injuries/1000 player-match-hours (95% CI 16.4 to 27.6) over the four seasons for combined club and international rugby union. Concussion severity was unchanged over time (median: 9 days). Players were at a greater risk of sustaining a concussion than not after an exposure of 25 matches (95% CI 19 to 32). Injury risk (any injury) was 38% greater (HR 1.38; 95% CI 1.21 to 1.56) following concussion than after a non-concussive injury. Injuries to the head and neck (HR 1.34; 95% CI 1.06 to 1.70), upper limb (HR 1.59; 95% CI 1.19 to 2.12), pelvic region (HR 2.07; 95% CI 1.18 to 3.65) and the lower limb (HR 1.60; 95% CI 1.21 to 2.10) were more likely following concussion than after a non-concussive injury.

Conclusion Concussion incidence increased, while severity remained unchanged, during the 4 years of this study. Playing more than 25 matches in the 2015/2016 season meant that sustaining concussion was more likely than not sustaining concussion. The 38% greater injury risk after concussive injury (compared with non-concussive injury) suggests return to play protocols warrant investigation.

  • concussion
  • injury risk
  • subsequent injury
  • data science

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  • Contributors ISM, GO and CR conceived and designed the study. JR analysed and interpreted the data. ISM and JR prepared the first draft of the manuscript. JR, ISM, CR, GO, TC, MM and PM all made substantial contributions to the revision of the manuscript prior to submission.

  • Funding World Rugby and Welsh Rugby Union.

  • Competing interests ISM and CR have received a research grant from Welsh Rugby Union. ISM, CR, GO, MM and TC have received a research grant from World Rugby. PM is head of Medical Services at Welsh Rugby Union and CR was a physiotherapist for Welsh Rugby Union during the conduct of the study.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval Cardiff Metropolitan University School of Sport Ethics Committee.

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

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