Éanna Cian Falvey

Objective Within World Rugby's Head Injury Assessment (HIA) protocol for elite rugby union, if a player scores one worse than his/her baseline, it is deemed an abnormal test. This analysis aims to quantify year-to-year test-retest reliability and establish a minimal detectable change (MDC) from the Sports Concussion Assessment Tool (SCAT) baseline testing that is used within the HIA protocol. Methods SCAT baseline and clinical data are captured by World Rugby's SCRM App and database for professional men's and women's global domestic competitions. Baseline and clinical data were linked on a unique SCRM ID. Test-retest reliability of annual baselines was evaluated using absolute agreement, single-measure intraclass correlation coefficients and standard error of measurement. MDC at a 90% level (MDC90) were calculated using a distribution-based approach, comparing players with and without an intervening concussion. Results Data from 7,686 players (20% women) were analysed, including 2,003 with recorded concussions. Reliability metrics did not differ between players with and without an intervening concussion. Rounded MDC90 estimates exceeded one unit for immediate memory, delayed recall and single leg balance, whereas digits backwards, concentration and tandem gait all equalled one unit. Conclusion These analyses show that annual SCAT baselines in professional rugby union are generally stable across seasons, irrespective of interim concussion. However, the MDC90 thresholds of certain SCAT tests suggest that greater Medical Doctor discretion could be allowed when considering if an abnormal test is clinically relevant.

In World Rugby's Head Injury Assessment (HIA) protocol, a modified Sports Concussion Assessment Tool (SCAT) is completed during the pre‐season (baseline) and when a player has a suspected head injury. The symptom component of the SCAT, which involves comparing current to baseline symptoms, has been shown to be the most predictive component for concussion diagnosis. Because the clinical comparison of symptom report to baseline is a key determinant of concussion diagnosis, this study aims to explore the relationship between symptoms endorsement at baseline and during HIA. Mean and standard deviation (SD) or median and interquartile ranges (IQR) are presented along with relevant bivariate analyses. Logistic regressions compared proportions of symptom endorsement profiles between men and women. At baseline, ‘Trouble sleeping’ and ‘Fatigue or low energy’ were commonly reported symptoms for men and women. At baseline, women (mean + SD) reported more symptoms than men (mean + SD) on average. During the HIA, women players were nearly 3 times (Relative risk: 2.98 95% CIs: 2.47–3.60) more likely than men to report fewer symptoms immediately after the match than at baseline (47% women vs. 16% men). While this study highlights the importance of collecting baseline assessment as a medical overview of players, it de‐emphasises the relevance of baseline symptoms when using the SCAT as a clinical assessment tool in professional rugby players. This study also highlights important differences in men and women's rugby players in symptom reporting, and recommends de‐coupling baseline symptom reporting from the diagnostic part of the HIA.

Objective: This review aimed to establish the contributors to negative biopsychosocial outcomes in rugby, defined as unexpected adverse changes in players’ physical, psychological, social or health status. Design: Systematic review. Data sources: PubMed, Scopus, MEDLINE, SPORTDiscus and CINAHL. Eligibility criteria: Studies were eligible if they investigated a physical, psychological or social factor which results in a negative biopsychosocial outcome in men’s or women’s rugby union, league or sevens. Studies were excluded if they did not differentiate outcome measures between rugby and other sports or did not differentiate outcome measures (ie, positive or negative) between physical/psychological/social factors and other factors. Results: 9165 studies were identified in the initial search and two studies were identified from reference lists, 151 of which met the inclusion criteria (104 rugby union, 46 rugby league, 6 rugby sevens; 141 men, 16 women; 37 youth populations). 29 contributor groups and eight negative biopsychosocial outcome groups were identified. Previous injury (n=26), physical characteristics (n=32), training and match load (n=30) and factors within the contact event (n=22) were the most identified contributor groups. The negative biopsychosocial outcome of injury was investigated by 84% of studies. Conclusion: Overall, the systematic review summarises the contributors to negative biopsychosocial outcomes within the current evidence base. There is a focus on previous injury, physical characteristics, training and match load and factors within the contact event as contributors to negative biopsychosocial outcomes. Eight studies investigated women’s cohorts independently from men; this underrepresentation within the literature could lead to the potential omittance of women-specific contributors. Prospero registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42022346751

Background Rugby Union has attracted increased scrutiny because of concerns over head acceleration events (HAEs), particularly regarding their frequency, severity and potential long-term health implications. While substantial efforts by governing bodies have focused on reducing head impact risks through education, regulatory changes and the introduction of instrumented mouthguards, limited data exist for the community rugby context, especially across different age grades and playing positions. Objective We aimed to quantify HAE across playing positions, age grades and contact phases in community rugby and to identify match scenarios associated with high-magnitude head loading. Methods A prospective observational cohort study included 259 male players across U13, U15, U19, and Premier senior men’s grades. Players were fitted with instrumented mouthguards, and match play was video recorded for verification. Head acceleration events were identified from instrumented mouthguard-triggered sensor acceleration events > 5 g and coded for match context, player position and contact event characteristics. Statistical models evaluated differences in HAE frequency, incidence rates and head kinematics (peak linear acceleration, peak angular acceleration, rotational velocity change index) across grades, positions and contact scenarios. Results A total of 7358 HAEs were verified from 8593 sensor acceleration events across 72 matches. Tackles and rucks accounted for ~ 60% of all HAEs. High tackles significantly increased head loading in ball carriers (peak linear acceleration: + 4.16 g, p = 0.02; peak angular acceleration: + 443 rad/s², p = 0.002; rotational velocity change index: + 1.87 rad/s, p = 0.04), while low tackles elevated head loading in tacklers (peak linear acceleration: + 4.9 g, p = 0.004). Upright tacklers were more likely to produce high tackles (p < 0.001) and head-to-head contacts (p = 0.019). U13 ball carriers showed higher rotational loading than tacklers (rotational velocity change index: + 5.01 rad/s, p = 0.008), likely reflecting frequent secondary mechanisms such as head-to-ground and body-to-ground. Defensive rucks carried a greater HAE risk than attacking rucks (all p < 0.05), particularly for U19 jacklers (incidence rate ratio = 2.27, p < 0.0001). Conclusions Tackles and rucks are primary sources of HAEs, with risk shaped by posture, tackle height and player role. Lower tackle heights reduce ball carrier load but increase tackler exposure, indicating a potential safety trade-off. Younger players, particularly U13s, were more susceptible to secondary impacts (e.g. head-to-ground), potentially because of limited task-specific experience and underdeveloped control during the tackled phase. Position- and age-specific strategies may be required to optimise safety and reduce HAE risk across all levels of community rugby.

Background: Rugby Union has attracted increased scrutiny due to concerns over head acceleration events (HAEs), particularly regarding their frequency, severity, and potential long-term health implications. While substantial efforts by governing bodies have focused on reducing head impact risks through education, regulatory changes, and the introduction of instrumented mouthguards (iMGs), limited data exist for the community rugby context, especially across different age grades and playing positions. Objective: To quantify HAE across playing positions, age grades, and contact phases in community rugby, and to identify match scenarios associated with high-magnitude head loading. Methods: A prospective observational cohort study included 259 male players across U13, U15, U19, and Premier senior men’s grades. Players were fitted with iMGs, and match play was video recorded for verification. HAEs were identified from iMG-triggered acceleration events (SAEs) >5g and coded for match context, player position, and contact event characteristics. Statistical models evaluated differences in HAE frequency, incidence rates, and head kinematics (Peak Linear Acceleration [PLA], Peak Angular Acceleration [PAA], Rotational Velocity Change Index [RVCI]) across grades, positions, and contact scenarios. Results: A total of 7358 HAEs were verified from 8593 SAEs across 72 matches. Tackles and rucks accounted for ~60% of all HAEs. High tackles significantly increased head loading in ball carriers (PLA: +4.16 g, p = 0.02; PAA: +443 rad/s², p = 0.002; RVCI: +1.87 rad/s, p = 0.04), while low tackles elevated head loading in tacklers (PLA: +4.9 g, p = 0.004). Upright tacklers were more likely to produce high tackles (p < 0.001) and head-to-head contacts (p = 0.019). U13 ball carriers showed higher rotational loading than tacklers (RVCI: +5.01 rad/s, p = 0.008), likely reflecting frequent secondary mechanisms such as head-to-ground and body-to-ground. Defensive rucks carried greater HAE risk than attacking rucks (all p < 0.05), particularly for U19 jacklers (IRR = 2.27, p < 0.0001). Conclusions:Tackles and rucks are primary sources of HAEs, with risk shaped by posture, tackle height, and player role. Lower tackle heights reduce ball carrier load but increase tackler exposure, indicating a potential safety trade-off. Younger players, particularly U13s, were more susceptible to secondary impacts (e.g., head-to-ground), potentially due to limited task-specific experience and underdeveloped control during the tackled phase. Position- and age-specific strategies may be required to optimise safety and reduce HAE risk across all levels of community rugby.

Smooth pursuit eye movements may be affected by head impacts. The EyeGuide Focus system is a simple, portable, test of visual tracking. This study investigated the diagnostic accuracy of EyeGuide measurements for detection of concussion during elite Rugby matches. A prospective diagnostic case-control study was performed in the elite 2021/2022 XXXXX [anonymized for peer-review] competition. The study population comprised consecutive players identified with match-related head impact events during the World Rugby Head Injury Assessment process, randomly chosen uninjured players, and players with match-related musculoskeletal injuries. The index test was blinded EyeGuide assessment performed by independent assessors. The reference standard was concussion diagnosed by the team doctor. Distributions of EyeGuide scores were compared between concussed and non-concussed players and receiver operator characteristic curves constructed. EyeGuide testing was performed in 262 cases, comprising 55 concussed players and 207 non concussed players (33 head impact events, 97 uninjured controls, and 79 musculoskeletal injury controls). The distributions of EyeGuide score were similar between concussed and non-concussed cases (medians 20,120 Vs 21,522, p = 0.3; difference -1,402, 95% CI -5,332 - 3,865). The c-index for the receiver operating characteristic curve was 0.46 (95% CI 0.36-0.55). EyeGuide Focus scores did not appear to discriminate between concussed and non-concussed players in a cohort of elite Rugby players.

Objective To examine the likelihood of head acceleration events (HAEs) as a function of previously identified risk factors: match time, player status (starter or substitute) and pitch location in elite-level men’s and women’s rugby union matches. Methods Instrumented mouthguard data were collected from 179 and 107 players in the men’s and women’s games and synchronised to video-coded match footage. Head peak resultant linear acceleration (PLA) and peak resultant angular acceleration were extracted from each HAE. Field location was determined for HAEs linked to a tackle, carry or ruck. HAE incidence was calculated per player hour across PLA recording thresholds with 95% CIs estimated. Propensity was calculated as the percentage of contact events that caused HAEs across PLA recording thresholds, with a 95% CI estimated. Significance was assessed by non-overlapping 95% CIs. Results 29 099 and 6277 HAEs were collected from 1214 and 577 player-matches in the men’s and women’s games. No significant differences in match quarter HAE incidence or propensity were found. Substitutes had higher HAE incidence than starters at lower PLA recording thresholds for men but similar HAE propensity. HAEs were more likely to occur in field locations with high contact event occurrence. Conclusion Strategies to reduce HAE incidence need not consider match time or status as a substitute or starter as HAE rates are similar throughout matches, without differences in propensity between starters and substitutes. HAE incidence is proportional to contact frequency, and strategies that reduce either frequency or propensity for contact to cause head contact may be explored.