Prise en charge en médecine générale des rugbymen amateurs victimes d’une suspicion de commotion cérébrale : état des lieux en région Provence-Alpes-Côte d’Azur au cours de la saison 2016–2017

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IntroductionBrain concussions have undergone a fresh outbreak in the rugby world. They have indeed been known for a long time but have vaguely been taken charge of in the non-professional world. If they are poorly taken charge of and if we face a repetition of traumatisms, they can lead to irreversible after-effects, such as second-impact syndrom and chronic post-traumatic encephalopathy. The purpose of this study of to assess the future of a non-professional rugby player after having filled a concussion declaration form, and by putting an emphasis on the positive diagnosis, the medical follow-up, the rest period and the ways and means of the resumption of sport. Equipment and methodsOur sample was composed of the members of the French non-professional rugby federation (FFR) of the Provence-Alpes-Côte d’Azur (PACA) region, in all categories for the 2016–2017 season. We collected data from the declaration forms that suspected brain concussion and were filled in during non-professional matches. The players were then contacted by phone after having been explained the ways and means and the objectives of the study. Their consent was explicitly given. The professional players and the ones that did not agree to be part of the study were not included. 76 declaration forms that suspected concussion were collected. After a phone call, 6 of the players did not suffer from brain concussion, one refused to fill in the questionnaire and 12 did not answer. Our study focuses on a 57-player sample. The study protocol was approved by the scientific board of the FFR medical committee. ResultsThe players are mainly afflicted at the beginning of a season and at the beginning of the second half-time. The most hurt ones and the back-row players (n=18/57) and traumatisms mostly occur during tackling (44%). A doctor on the side of the pitch only carries out a clinical examination in 25% of the cases. The main symptoms are cephalgia (20%), a feeling of heavyheadedness (16%) and a photo-phonophobia (15%). 77% of the players were advised to stop sport but 53% of them did not follow the 6 steps when they resumed sport. Altogether, the recommandations of the FFR were followed in 47,5% of the cases (100% of the players left the pitch, 53% of them resumed sport step by step and 44% did not respect the adequate rest period). DiscussionDuring the 2016–2017 PACA season, the prevalence of the brain concussion reached 4%. The diagnosis for a concussion is usually made long after the traumatism because symptoms can appear up to 48hours after, and it requires the analysis of several tests that can be compared to the ones carried out during pre-season. However, this restrictive protocol – a pre-season test and 3 consecutive diagnosis tests – can only be undertaken in professional conditions. Taking charge of brain concussions adequately – leaving the pitch, rest period and step-by-step resumption of sport – allows us to reduce short-term consequences – second-impact syndrom – and long-term consequences, called chronic post-traumatic encephalopathy, and that can take the form of early neurodegenerative and neurocognitive disorders. ConclusionIt gradually lead the FFR to creating a uniform protocol when taking charge of the players, on the level of the medical follow-up, the rest period and the ways and means of resuming sport in the non-professional sector to avoid the long-term consequences of the repeated brain concussions. Since the beginning of the 2017–2018 season, the FFR implemented a blue card protocol for the men's Fédérale 1 and French women's Premier Division. The purpose is to make up for the lack of doctor on the side of the pitch during non-professional rugby matches.