Head Injury Assessment in the Elite Level Rugby Union in Japan:
                    Review of 3 Seasons

Takuya Tajima; Osamu Ota; Masataka Nagayama; Masayasu Takahashi; Mutsuo Yamada; Nobuo Ishiyama; Ichiro Yoshida; Masahiro Takemura; Kenji Hara; Takao Akama; Norio Mitsumori; Junichiro Higashihara; Yukimasa Toyama; Masahiro Furuya; Etsuo Chosa; Akihiko Nakamura

doi:10.1055/a-1810-6509

International Journal of Sports Medicine, Table of Contents

Int J Sports Med 2022; 43(10): 889-894
DOI: 10.1055/a-1810-6509

Training & Testing

Head Injury Assessment in the Elite Level Rugby Union in Japan: Review of 3 Seasons

Takuya Tajima

¹Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan

²Medical control committee, Japan Rugby Top League, Tokyo, Japan

,

Osamu Ota

³Japan Rugby Top League, Japan Rugby Football Union, Tokyo, Japan

,

Masataka Nagayama

⁴Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan

²Medical control committee, Japan Rugby Top League, Tokyo, Japan

,

Masayasu Takahashi

⁵Department of Orthopaedic Surgery, Konan Medical center, Kobe, Japan

²Medical control committee, Japan Rugby Top League, Tokyo, Japan

,

Mutsuo Yamada

⁶Injury prevention & Research unit, Japan Rugby Football Union, Tokyo, Japan

⁷Faculty of Health and Sports Sciences, Ryutsu Keizai University, Ryugasaki, Japan

,

Nobuo Ishiyama

⁸Faculty of Medical Science, Nippon Sport Science University, Setagaya-ku, Japan

²Medical control committee, Japan Rugby Top League, Tokyo, Japan

,

Ichiro Yoshida

²Medical control committee, Japan Rugby Top League, Tokyo, Japan

,

Masahiro Takemura

⁹Faculty of Health and Sports Sciences, University of Tsukuba, Tsukuba, Japan

²Medical control committee, Japan Rugby Top League, Tokyo, Japan

,

Kenji Hara

¹⁰Department of Sports Medicine and Science, Faculty of Human Health, Kurume University, Kurume, Japan

²Medical control committee, Japan Rugby Top League, Tokyo, Japan

,

Takao Akama

¹¹Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan

²Medical control committee, Japan Rugby Top League, Tokyo, Japan

,

Norio Mitsumori

¹²Department of Surgery, Jikei University School of Medicine, Minato-ku, Japan

²Medical control committee, Japan Rugby Top League, Tokyo, Japan

,

Junichiro Higashihara

¹³Gynecology, Higashihara clinic, Fukuoka, Japan

²Medical control committee, Japan Rugby Top League, Tokyo, Japan

,

Yukimasa Toyama

¹⁴Orthopaedic surgery, Toyama Orthopaedic clinic, Osaka, Japan

²Medical control committee, Japan Rugby Top League, Tokyo, Japan

,

Masahiro Furuya

¹⁵Orthopaedic Surgery, Furuya Orhopaedic clinic, Yokohama, Japan

²Medical control committee, Japan Rugby Top League, Tokyo, Japan

,

Etsuo Chosa

¹Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan

,

Akihiko Nakamura

¹⁶Department of Surgery, Nakamura Surgery and Pediatrics clinic, Tokyo, Japan

²Medical control committee, Japan Rugby Top League, Tokyo, Japan

› Author Affiliations

Abstract

Head Injury Assessment (HIA) is the screening tool for head injury during a rugby game. The purpose of this study was to investigate the epidemiology of HIA in the Japan Rugby Top League (JRTL). The incidences of HIA, defined concussion (per 1,000 player-hours) and repeated concussions were evaluated in three seasons (2016-17, 2017–18, 2018–19; total 360 games). The HIA incidence rates were 12.7 (95% confidence interval 9.5–15.9), 20.8 (16.8–24.9), and 25.0 (20.5–29.5) in each season. HIA-1 criteria 2, which is applied for suspected concussion cases, was performed for 46 cases in the 2016–17 season, 81 cases in the 2017–18 season, and 88 cases in the 2018–19 season. The concussion incidence rates were significantly greater in the 2017–18 season (9.6/1000 player-hours, 95% confidence interval 6.8–12.4) and the 2018–19 season (14.4, 11–17.8) compared to the 2016–17 season (4.8, 2.8–6.8). The number of repeated concussion cases in the same season was 1 in the 2016–17 season and 4 in both the 2017–18 and 2018–19 seasons. This study confirmed significantly higher HIA and concussion incidence rates over time. Although the HIA system might have been established in the three seasons in JRTL, comprehensive management needs to be improved to prevent repeated concussions.

Key words

rugby football - head injury assessment - concussion - graduated return to play

Full Text

References

References
1 Tajima T, Chosa E, Kawahara K. et al. Comprehensive safety management and assessment at rugby football competitions. Int J Sports Med 2014; 35: 1012-1016
2 Manley G, Gardner AJ, Schneider KJ. et al. A systematic review of potential long-term effects of sport-related concussion. Br J Sports Med 2017; 51: 969-977
3 Rice SM, Parker AG, Rosenbaum S. et al. Sport-related concussion and mental health outcomes in elite athletes: A systematic review. Sports Med 2018; 48: 447-465
4 Gouttebarge V, Kerkhoffs GMMJ. Sports career-related concussion and mental health symptoms in former elite athlete. Neurochirurgie 2021; 67: 280-282
5 Gallo V, Motley K, Kemp SPT. et al. Concussion and long-term cognitive impairment among professional or elite sport-persons: a systematic review. J Neurol Neurosurg Psychiatry 2020; 91: 455-468
6 International Rugby Board. Strategic plan: 2010-2020 https://resources.world.rugby/worldrugby/document/2014/11/12/77d26bdc-4a13-448c-a503-2c6f9b8b50a3/2041808_PDF.pdf Accessed 18 Jun 2021
7 World Rugby. Player Welfare; Putting Players First http://playerwelfare.worldrugby.org Accessed 18 Jun 2021
8 Fuller GW, Kemp SP, Decq P. The international rugby board (IRB) pitch side concussion assessment trial: a pilot test accuracy study. Br J Sports Med 2015; 49: 529-535
9 Fuller CW, Fuller GW, Kemp SP. et al. Evaluation of World Rugby’s concussion management process: results from Rugby World Cup 2015. Br J Sports Med 2017; 51: 64-69
10 Fuller GW, Tucker R, Starling L. et al. The performance of the World Rugby Head Injury Assessment Screening Tool: a diagnostic accuracy study. Sports Med Open 2020; 6: 2
11 Tucker R, Raftery M, Fuller GW. et al. A video analysis of head injuries satisfying the criteria for a head injury assessment in professional rugby union: a prospective cohort study. Br J Sports Med 2017; 51: 1147-1151
12 Tucker R, Raftery M, Kemp S. et al. Risk factors for head injury events in professional rugby union: a video analysis of 464 head injury events to inform proposed injury prevention strategies. Br J Sports Med 2017; 51: 1152-1157
13 Fuller GW, Kemp SPT, Raftery M. The accuracy and reproducibility of video assessment in the pitch-side management of concussion in elite rugby. J Sci Med Sport 2017; 20: 246-249
14 Fuller CW, Taylor A, Kemp SP. et al. Rugby World Cup 2015: World Rugby injury surveillance study. Br J Sports Med 2017; 51: 51-57
15 Harris DJ, Macsween A, Atkinson G. Ethical Standards in Sport and Exercise Research: 2020 Update. Int J Sports Med 2019; 40: 813-817
16 Cosgrave M, Williams S. The epidemiology of concussion in professional rugby union in Ireland. Phys Ther Sport 2019; 35: 99-105
17 Cross M, Kemp S, Smith A. et al. Professional Rugby Union players have a 60% greater risk of time loss injury after concussion: a 2-season prospective study of clinical outcomes. Br J Sports Med 2016; 50: 926-931
18 Fuller CW, Taylor A, Raftery M. Epidemiology of concussion in men’s elite Rugby-7s (Sevens World Series) and Rugby-15s (Rugby World Cup, Junior World Championship, and Rugby Trophy, Pacific Nations Cup and English Premiership). Br J Sports Med 2015; 49: 478-483
19 Rafferty J, Ranson C, Oatley G. et al. On average, a professional rugby union player is more likely than not to sustain a concussion after 25 matches. Br J Sports Med 2019; 53: 969-973
20 Yamada M. The road to Rugby World Cup 2019 in Japan. Br J Sports Med Blog. 2019 https://blogs.bmj.com/bjsm/2019/09/18/the-road-to-rugby-world-cup-2019-in-japan/
21 Giza C, Greco T, Prins ML. Concussion: Pathophysiology and clinical translation. Handb Clin Neurol 2018; 158: 51-61
22 Hinton-Bayre AD, Geffen G, Friis P. Presentation and mechanisms of concussion in professional rugby league football. J Sci Med Sport 2004; 7: 400-404
23 Chong CD, Wang L, Wang K. et al. Homotopic region connectivity during concussion recovery: A longitudinal fMRI study. PLoS One 2019; 14: e0221892
24 Roberts SP, Trewartha G, England M. et al. Concussions and head injuries in English community rugby union match play. Am J Sports Med 2017; 45: 480-487
25 Oyegbile TO, Dougherty A, Tanveer S. et al. High sleep disturbance and longer concussion duration in repeat concussions. Behav Sleep Med 2020; 18: 241-248
26 Yrondi A, Brauge D, LeMen J. et al. Depression and sports-related concussion: A systematic review. Presse Med 2017; 46: 890-902
27 Sobue S, Kawasaki T, Hasegawa Y. et al. Tackler’s head position relative to the ball carrier is highly correlated with head and neck injury in rugby. Br J Sports Med 2018; 52: 353-358
28 Tierney GJ, Simms C. Can tackle height influence head injury assessment risk in elite rugby union?. J Sci Med Sport 2018; 12: 1210-1214
29 Echemendia RJ, Putukian M, Mackin RS. et al. Neuropsychological test performance prior to and following sports-related mild traumatic brain injury. Clin J Sport Med 2001; 11: 23-31
30 McCrea M, Guskiewicz K, Marshall S. et al. Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. JAMA 2003; 290: 2556-2563
31 Kamins J, Bigler E, Covassin T. et al. What is the physiological time to recovery after concussion? A systematic review. Br J Sports Med 2017; 51: 935-940