BokSmart: Pre-participation screening of rugby players by coaches based on internationally accepted medical standards

A comprehensive medical history forms a significant part of any medical assessment or screening. In the athlete, pre-participation screening is aimed at determining those aspects of personal and family history that place the participant at greater risk of sudden death, serious illness or musculoskeletal injury. In rugby union, where the incidence of head and neck injuries is higher than in other sports, emphasis needs to be placed on screening for potential risk factors for neurological injury. In a South African rugby environment, pre-season medical screening is not standard and indeed rarely practised. In most club and school settings, the rugby coach may well be the person most in contact with players and therefore in the best position to conduct an initial screening. This article reviews the relevant literature pertinent to such a guideline

Sports-related concussion relevant to the South African rugby environment – A review

Guidelines for returning a concussed player to sport had been somewhat controversial and nebulous until the emergence of a series of international consensus meetings and statements initiated in 2001. The Vienna (2001), Prague (2004) and Zurich (2009 statements as well as the American National Athletic Trainers Association (2004) and the American College of Sports Medicine (2005) position stands have given all clinicians better guidance that is more evidence-based than the somewhat subjective guidelines of the latter 20th century. Some impetus to research and the re-evaluation of assessment and management guidelines has been provided by the emergence of computerised neuropsychological test batteries as a useful barometer of cognitive recovery. However, the clinical evaluation of a concussed player remains the cornerstone of management and should incorporate a thorough symptom analysis, general, cognitive and neurological examination, and balance testing. The Sports Concussion Assessment Tool (SCAT) 2 card is a clinical evaluation tool intended to summarise the most significant aspects of clinical assessment. In addition, and as an essential ‘final stress’ test, the athlete must be subjected to a series of graded exercise sessions, increasing in severity, before being returned to contact or collision sport. A structured clinical evaluation is particularly important in the South African context, where computerised testing may not be accessible to many. This article serves to collate and highlight the evidence-based and consensus data available for management of the concussed rugby player in 2010

Implementation of the 2017 Berlin Concussion in Sport Group Consensus Statement in contact and collision sports: a joint position statement from 11 national and international sports organisations.

The 2017 Berlin Concussion in Sport Group Consensus Statement provides a global summary of best practice in concussion prevention, diagnosis and management, underpinned by systematic reviews and expert consensus. Due to their different settings and rules, individual sports need to adapt concussion guidelines according to their specific regulatory environment. At the same time, consistent application of the Berlin Consensus Statement's themes across sporting codes is likely to facilitate superior and uniform diagnosis and management, improve concussion education and highlight collaborative research opportunities. This document summarises the approaches discussed by medical representatives from the governing bodies of 10 different contact and collision sports in Dublin, Ireland in July 2017. Those sports are: American football, Australian football, basketball, cricket, equestrian sports, football/soccer, ice hockey, rugby league, rugby union and skiing. This document had been endorsed by 11 sport governing bodies/national federations at the time of being published

The Use of Sideline Video Review to Facilitate Management Decisions Following Head Trauma in Super Rugby

Background Sideline video review has been increasingly used to evaluate risk of concussive injury during match play of a number of collision sports, with the view to reducing the incidence of match play concussion injuries. The purpose of this study was to evaluate the effectiveness of sideline video review for identifying and evaluating head impact events in Rugby Union. Methods All Australian teams’ 2015 Super Rugby season matches were studied. Meaningful head impact events (HIEs) were identified, comprising events identified and acted upon during matches and events identified through a post-season retrospective review. Video footage of each HIE was coded by two experienced independent sports medicine clinicians to evaluate management decisions made by match-day (MDD) and team doctors (TD). HIE incidences for matches with and without sideline video were compared, and the agreement between game-day video interpretation and the independent clinician opinion calculated. Results Seventy HIEs were identified in 83 matches (47 identified during matches and 23 identified post-season), equating to 42.5 HIEs per 1000 player match hours. When video review was available, an unnoticed HIE occurred once every 4.3 matches, compared to once every 2.3 matches when the sideline video review was unavailable. Of the 47 identified in-match HIEs evaluated by TD and MDD during the season, 18 resulted in an immediate and permanent removal, 28 resulted in temporary removal for an off-field assessment, and one resulted in the player continuing the game. Game-day head injury assessment process video decisions agreed with the independent clinician view in 72% of cases, κ = 0.49 (95% CI 0.38–0.59, weak agreement). Conclusions These findings suggest that access to sideline video review is an important supplementary component to identify potential concussions; however, there is a critical need for improved systems and processes to reduce the likelihood of missing an incident

The performance of the World Rugby Head Injury Assessment Screening Tool: a diagnostic accuracy study

Abstract Background Off-field screening tools, such as the Sports Concussion Assessment Tool (SCAT), have been recommended to identify possible concussion following a head impact where the consequences are unclear. However, real-life performance, and diagnostic accuracy of constituent sub-tests, have not been well characterized. Methods A retrospective cohort study was performed in elite Rugby Union competitions between September 2015 and June 2018. The study population comprised consecutive players identified with a head impact event undergoing off-field assessments with the World Rugby Head Injury Assessment (HIA01) screening tool, an abridged version of the SCAT3. Off-field screening performance was investigated by evaluating real-life removal-from-play outcomes and determining the theoretical diagnostic accuracy of the HIA01 tool, and individual sub-tests, if player-specific baseline or normative sub-test thresholds were strictly applied. The reference standard was clinically diagnosed concussion determined by serial medical assessments. Results One thousand one hundred eighteen head impacts events requiring off-field assessments were identified, resulting in 448 concussions. Real-life removal-from-play decisions demonstrated a sensitivity of 76.8% (95% CI 72.6–80.6) and a specificity of 86.6% (95% CI 83.7–89.1) for concussion (AUROC 0.82, 95% CI 0.79–0.84). Theoretical HIA01 tool performance worsened if pre-season baseline values (sensitivity 89.6%, specificity 33.9%, AUROC 0.62, p < 0.01) or normative thresholds (sensitivity 80.4%, specificity 69.0%, AUROC 0.75, p < 0.01) were strictly applied. Symptoms and clinical signs were the HIA01 screening tool sub-tests most predictive for concussion; with immediate memory and tandem gait providing little additional diagnostic value. Conclusions These findings support expert recommendations that clinical judgement should be used in the assessment of athletes following head impact events. Substitution of the tandem gait and 5-word immediate memory sub-tests with alternative modes could potentially improve screening tool performance

Effort thrombosis: A case study and discussion

Paget-Schroetter syndrome or effort thrombosis is a rare condition with potentially severe consequences, affecting young and otherwise healthy athletes. Its classic clinical presentation should be rapidly identified to promote early diagnosis and treatment. This prevents recurrences and long-term complications such as persistent swelling of the affected arm. In a 1-year period we saw two young male athletes with this condition. One was treated conservatively and the other surgically, with vastly different outcomes. We therefore present their cases as well as a review of relevant literature to emphasise treatment of this rare condition