Concussions in amateur rugby union identified with the use of a rapid visual screening tool

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Abstract

Aim

To use the King-Devick (KD) test and Sports Concussion Assessment Tool 2 (SCAT2) in amateur rugby union players to identify witnessed and unrecognised episodes of concussion that occurred from match participation.

Methods

A prospective observational cohort study was conducted on a premier club level amateur rugby union team during the 2012 competition in New Zealand. Every player completed a pre-competition questionnaire on concussion history, a baseline PCSS and two trials of the KD before they participated in any match activities.

Results

For players reporting a concussion in the previous three years there was an average of 4.0 ± 2.8 concussions per player. There were 22 concussive incidents recorded over the duration of the competition (46 per 1000 match hours). Five concussive incidents were witnessed (11 per 1000 match hours) and 17 unrecognised concussive incidents were identified with the KD (37 per 1000 match hours). Witnessed concussions recorded, on average, a longer KD on the day of injury (5.5 ± 2.4 s) than unrecognised concussions (4.4 ± 0.9 s) when compared with their baseline KD.

Discussion

The KD was able to identify players that had not shown, or reported, any signs or symptoms of a concussion but who had meaningful head injury. The current rate of concussion reported was a ten-fold increase in previously reported concussion injury rates. This makes the KD suitable for rapid assessment in a limited time frame on the sideline such as a five-minute window to assess and review suspected concussed players in rugby union.

Introduction

Rugby union is one of the most popular contact team sports in the world with nearly 200 countries affiliated to the International Rugby Board [1], [2]. Rugby is played at the professional, amateur and junior levels by both males and females [3]. Rugby also has a modification of the match rules for the different age groups and competition types (i.e. international, junior, sevens and masters' competitions) that are competed in [3]. As with any contact or collision sport there is a risk of an injury occurring when playing due to the number of collisions and contacts that are integral to the game [3]. One injury that has received attention in rugby union is concussion or mild traumatic brain injury. Studies reporting on concussion injuries in rugby union have identified that the incidence was relatively low with reports varying from 0.2 [4] to 4.3 [5] per 1000 playing hours, and 3.8 [6] to 5.7 [7] per 1000 athlete exposures.

A tool that may assist sideline assessment of sport-related concussion, the Sports Concussion Assessment Tool (SCAT), was produced as part of the summary and agreement statement of those attending the Concussion in Sport (CIS) Consensus Group in 2004 [8]. The third international conference on CIS in Zurich [9] resulted in the SCAT being amended to the SCAT2. The SCAT2 represents the only new sideline assessment tool published since 2009 [9]. The SCAT2 is a longer sideline concussion tool and, although is an improvement over the original SCAT, it requires approximately 20 min to complete on the sideline making this more of a training room assessment tool as opposed to a readily available sideline assessment tool [10].

Another sideline tool, the King-Devick (KD), has been reported as a rapid assessment tool that can assist in the identification of concussion [11], [12] and is reportedly not affected by fatigue [11]. Originally developed as a reading tool to assess the relationship between poor oculomotor functions and learning disabilities, the KD uses a series of charts of numbers that progressively become more difficult to read in a flowing manner [13]. Poor oculomotor function has been reported as one of the most robust discriminators for the identification of a mild-traumatic brain injury [14].

Recently the KD has been utilised in representative rugby league [12] and identified non-witnessed concussions. Players identified with changes in their baseline KD were further assessed with the SCAT2 and the identification of a sport-related concussion was confirmed. Although completed over a short duration, this study highlighted the potential to detect sub-concussive impacts that may accumulate over a period and can lead to neurological changes [12]. With this in mind this study undertook to use the KD sideline test with the SCAT2 in amateur rugby union players over a domestic competition season to see if it could identify witnessed and incidentally identified episodes of concussion that occurred from match participation.

Section snippets

Methods

A prospective observational cohort study was conducted on a premier club level amateur rugby union team during the 2012 competition in New Zealand. All players were considered amateur as they received no remuneration for participating in rugby union activities and derived their main source of income from other employment activities. The matches were played under the rules and regulations of the New Zealand Rugby Football Union. The Auckland University of Technology Ethics Committee approved all

Results

Over the duration of the competition 37 players (mean ± SD age; 22.0 ± 4.0 yr.) participated in the premier team. The team competed in 24 games (5 pre-season and 19 competition games) over the period of the study resulting in a match exposure of 478.8 h.

Discussion

This study was conducted to assess the KD in an amateur rugby union environment for the sideline screening of concussion. The KD has been reported [11] to be a practical sideline screening tool that is quicker than other concussion screening tools such as the Immediate Post-Concussion and Cognitive Testing (ImPACT), Cognitive Status Sport (Cog Sport), [21] the Standardized Assessment of Concussion (SAC) [22] and the Sports Concussion Assessment Tool 2 (SCAT2) [9]. Although these screening tools

Conflict of interest

The undersigned authors of the enclosed article declare that they do not have potential conflicts of interest regarding this article submitted to Journal of Neurological Sciences.

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