Abstract
BackgroundVideo review has been introduced in many professional sports worldwide to help recognize concussions. However, to date, there has been very little research on the accuracy of using video analysis to identify signs of concussion and the various combinations of observed signs.MethodsThe objective of the study is to determine the accuracy of combinations of clinical signs of concussion identified using video analysis to identify concussions in the National Rugby League (NRL). Incidences of players using of the concussion interchange rule (CIR) (n = 156), including those where athletes were diagnosed with a concussion (n = 60), were used to calculate sensitivity and specificity of various combinations of concussion signs (unresponsiveness, slow to get up, clutching/shaking head, gait ataxia, vacant stare, and apparent seizure) and their independent association with an eventual diagnosis of concussion.ResultsUsing video analysis, players who were diagnosed with a concussion showed a significantly greater total number of signs at the time of injury (mean = 3.4, SD = 1.3) than those who were removed from play but not diagnosed with a concussion (mean = 3.0, SD = 0.9 signs; p = .046). Players who did not return to play during the same game demonstrated a significantly greater number of total signs than those who did return to play in the same game following CIR activation (mean = 3.4, SD = 1.2 versus mean = 2.9, SD = 0.9; p = 0.002). The most common combination of signs that was observed was clutching/shaking the head and slowness in getting up (17.3%). The sensitivity of the total number of signs observed decreased as the number of signs increased (range = 0.13–0.62), while the specificity increased as more signs were observed (range = 0.29–0.90). Most of the combinations of different observed signs at the time of potential injury were highly specific (> 0.80), but not sensitive to an eventual diagnosis of concussion. When considering all potential predictor variables in a logistic regression model, anticipating the oncoming collision (OR = 3.92, 95% CI = 1.28–12.03), fewer number of defenders involved in the tackle (OR = 0.58, 95% CI = 0.36–0.92), and the presence of a blank or vacant stare (OR = 2.97, 95% CI = 1.26–7.01) were each significantly associated with concussion diagnoses.ConclusionsThe use of video review in the NRL is challenging, but being aware of the combinations of possible concussion signs and the likelihood that various presentations result in a concussion diagnosis can provide a useful addition to sideline concussion identification and removal from play decisions.
Highlights
Video review has been introduced in many professional sports worldwide to help recognize concussions
Being aware of the combinations of possible concussion signs and the likelihood that various presentations result in a concussion diagnosis can provide a useful addition to sideline concussion identification
The purposes of this study were to determine (i) the combination of observable signs occurring in the National Rugby League (NRL) using video review and (ii) the combination of observable signs and match play characteristics that were associated with a concussion diagnosis when the concussion interchange rule (CIR) was activated
Summary
Video review has been introduced in many professional sports worldwide to help recognize concussions. Because athletes may demonstrate several signs of a concussion simultaneously following a head impact, one way to maximize the application of sideline video review systems is to examine the risk for concussion associated with the presence of various combinations of concussion signs observed with video replay. Reviewing these combinations of signs in the context of match play characteristics (such as anticipating the oncoming impact, tackler versus ball carrier, tackle height, and the number of defenders involved in the tackle) may assist with maximizing the usefulness of sideline video review systems. The purposes of this study were to determine (i) the combination of observable signs occurring in the NRL using video review and (ii) the combination of observable signs and match play characteristics that were associated with a concussion diagnosis when the concussion interchange rule (CIR) was activated
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