Injuries in a Senior Amateur Rugby Union Team Over Two Competition Seasons Resulted in a Ratio of 1:5 Witnessed to Unwitnessed Concussions

Abstract

Aim: To determine the type, site and rate of injuries in men’s senior amateur rugby union matches, with focus on concussion.

Methods: A prospective observational cohort study was conducted on a men’s senior amateur rugby union team (n=36 players in 2012 and 35 players in 2013) in New Zealand. Types, sites, and frequency of injuries were recorded by a sports medic. Concussions (witnessed or unwitnessed) were only recorded if they were formally diagnosed by a health practitioner. Assessment of SCAT scores for baseline and post-concussive events was conducted. Unwitnessed concussions were determined using changes >3 seconds for pre- to post-match King-Devick test scores with associated changes pre- to post-match SCAT.

Results: 203 injuries were recorded (236.6; 95%CI: 206.2 to 271.5 per 1,000 match hr) over the study of 71 players. An injury was sustained on average every 17 minutes of a match. Most concussions were unwitnessed (RR: 23.9; 95%CI: 11.3 to 50.5; p<0.0001) during play but were identified initially post-match using the SCAT tool. Therefore, whilst a witnessed concussion occurred once every five matches a concussion occurred every match on average. The head/neck region was most frequently injured (88.6; 95%CI: 70.8 to 110.9 per 1,000 match hr), followed by the upper limb (74.6; 95%CI: 58.4 to 95.3 per 1,000 match hr), lower limb (50.1; 95%CI: 37.2 to 67.6 per 1,000 match hr) and chest/back/abdomen (23.3; 95%CI: 15.0 to 36.1 per 1,000 match hr). The ball carrier most frequently sustained concussion injuries.

Discussion: Amateur New Zealand senior men’s rugby union is a contact sport where an injury occurs on average every 17 minutes. Most injuries were transient sprains/strains. However, of concern was a concussion occurring on average once a match, most of which were unwitnessed. The ratio of witnessed to unwitnessed concussions was 1:5.3. Major injuries occurred at a rate of 35.0 (95% CI: 24.5 to 50.0) per 1,000 match hr.

Conclusion: The witnessed to unwitnessed concussion ratio of ~1:5 found in this study indicates that concussion is a largely “hidden” injury. Given that concussion injuries were not seen to occur during play, with diagnosis of concussion made only upon players presenting after the game for assessment with the King-Devick tool, it is important for pre-season baseline testing and post-game testing of cognitive function to be