World Rugby Head Injury Assessment Protocol

Sensitivity and specificity of combinations of HIA1 assessment subtrials with and without clinical evaluation. The theoretical TPR and RPF are indicated by circles, while the actual TPR and FPR are represented by square symbols. Legend: (A) all abnormal modes, (B) five abnormal modes, (C) four abnormal modes, (D) three abnormal modes, (E) two abnormal modes, (F) abnormal single mode. FPR, false positive rate; TPR, rate of true positives. A second video review is then carried out in the presence of the MDD and the team doctor. If the criteria for instant removal of HIA1 (criterion 1) are identified, the player will be permanently removed from the game without further evaluation. If there is no sign of criterion 1 on the video, the player will be subject to the off-field evaluation supported by the scoring tool. This information is used to determine the extent to which the off-field assessment detects concussions and whether the head injury assessment process is working as intended. What happens if the player is injured at the same time? We want to use the information collected by the team physicians as part of the head injury assessment process. In addition to the assessments typically carried out by team doctors, the rugby match analysis department will identify incidents where players may have suffered a head injury during a match.

This is done by reviewing video footage of games, which may involve processing your personal data. These incidents will be brought to the attention of team doctors and they will be asked to provide feedback on the incident, which may include the processing of players` personal data. This can lead to a concussion in the player after the game. If you consent to your information being used for the above purposes, please complete the attached consent form. We rely on your consent to carry out this processing and your participation in this research is optional. You have the right to withdraw from your studies at any time without consequences. To do so, simply report your resignation to Dr. Eanna Falvey by sending an email to eanna.falvey@worldrugby.org A player who undergoes an off-field evaluation must report to the 4th official within 12 minutes, but cannot play again before the end of the 12-minute period.

The GRTP (Graduate Return To Play) program involves a progressive training program that gradually reintroduces a player to the sport. This should not be started until the player has completed the required period of physical rest and has no symptoms and discontinues treatments and/or medications that may alter or mask concussion symptoms, such as medication for headaches or sleeping pills. The overall diagnostic accuracy of the HIA1 assessment for actual and theoretical performance under strict application of the results of the baseline subtests has already been published by Fuller et al.7 This study extends this earlier analysis to examine specific subtests and clinical assessment scenarios in more detail, including their impact on the performance of the HIA assessment1. The analysis was carried out in three stages. First, a description of the derivation of the study cohort. Second, a study of the frequency of application of clinical assessments to HIA assessment subtests1. Third, a calculation of the impact of clinical assessment on single and combined HIA1 assessment subtests on test accuracy. This study examined these clinical evaluation decisions in more detail to advise clinicians on when to exercise caution when applying clinical judgments. At any time, in case of doubt, at least one player must be withdrawn for evaluation; If there is any doubt after the evaluation, the player should not return to the game. However, this caution should also not unduly discourage clinicians from making potentially beneficial assessment decisions and requires balance and clinical discretion to optimize overall screening accuracy.

The definition of break depends on the time after injury Tournament or match organisers wishing to have access to a temporary Head Injury Assessment (PIA) replacement must apply to World Rugby for permission. We assessed the impact of clinical evaluation on the performance of HIA1 assessment by calculating a ratio of the change in overall accuracy of HIA1 assessment when clinical assessment was applied. A ratio greater than one implies greater diagnostic accuracy when clinical judgment has been applied, while a ratio less than one indicates that diagnostic accuracy has been impaired. We applied this analysis to different exploratory scenarios for specific combinations of HIA1 evaluation subtests. We independently calculated the accuracy of the HIA1 score for the subtests and did not take into account the presence of other subtests that may correspond to each subtest. Our large CAT reference dataset was used to quantify performance on cognitive and balance tests. These data were used to determine an approximate population-derived 95th percentile cut-off for each subtest. We recommend using these reference limits to determine when a reference subtest should be reassessed (Table 1 and Figure 1). This reassessment was introduced into the investigation process to address issues related to „player effort“ and to improve the basic validity and reliability of the CAT. Other concussion management methods are used in other professional sports.

Off-field screening can be performed on all players after a significant head impact, whether or not there are obvious signs of concussion [2].