Concussion Injuries in Elite South African Youth Rugby Union

Abstract

Understanding and preventing concussion in youth contact sport is important. The incidence of concussion in South African youth rugby is largely unknown. PURPOSE: The aim of this study was to determine the incidence of concussion in South African youth rugby players. METHODS: Injury surveillance was completed at the South African Rugby Union (SARU) Youth Week tournaments at three different age-grades (under-13, under-16 and under-18) between 2011 and 2014. All concussion/suspected concussion injuries were diagnosed by SARU appointed Tournament Doctors using standard clinical criteria. The concussion/suspected concussion injuries were combined for the analysis. The resulting combined concussion incidence was calculated per 1000 player-match-hours with a 95% confidence interval (95% CI). Poisson regression analysis was used to identify possible factors associated with concussion. RESULTS: In total, 108 concussions were documented at an incidence of 6.8/1000 player-match-hours (95% CI 5.5 - 8.1). Concussion accounted for 12.3% of all injuries and 30.8% of all time-loss injuries. A concussion occurred on average once every 4.9 games. The under-16 age group had a higher concussion rate than the under-18 age group (IRR: 1.7, 95% CI 1.1 - 2.6, p=0.025). The concussion rate progressively increased in the four quarters of the game with a higher rate in the fourth compared to the first quarter (IRR: 2.5, 95% CI 1.2 - 4.1, p=0.011). The majority of concussions were tackle-related (57%), with a four-fold higher risk of concussion while executing a tackle, as opposed to being tackled (IRR: 4.3, 95% CI 2.0 - 9.2, p<0.001). The hooker had a higher incidence than other player positions (p<0.05), while the scrumhalf displayed a lower incidence than other player positions (p<0.05). CONCLUSIONS: The concussion incidence is within the broad range of youth rugby concussion data previously reported, but is higher than several rates reported in the adult game. The under-16 age group had a greater risk for concussion and the reasons behind this require further exploration. The act of executing a tackle was the mechanism most associated with concussion. Coaches must place a greater emphasis on coaching correct, safe and effective tackling techniques, where the head is less exposed to impact and concussion risk.