Video and clinical screening of national rugby league players suspected of sustaining concussion

ABSTRACT

Primary Objective: This study reviewed the available sideline Sport Concussion Assessment Tool-Third Edition (SCAT3) performance of players who were removed from play using the ‘concussion interchange rule’ (CIR), the available video footage of these incidences, and associated return to play and concussion diagnosis decisions. Research Design: Descriptive, observational case series. Methods and Procedures: Data were collected from all NRL players who used the CIR during the 2014 season. Main Outcomes and Results: Complete SCAT3 and video analysis data were available for 38 (23%) of 167 uses of the concussion interchange rule, of which 20 (52.6%) players were medically diagnosed with concussion. Those with video evidence of unresponsiveness performed more poorly on the modified Balance Error Scoring System (M-BESS; p = .04; Cohen’s d = .69) and reported greater symptoms (p = .03; d = .51). Similarly, players with a vacant stare reported greater symptoms (p = .05; d = .78). Those who demonstrated three signs (unresponsiveness, vacant stare and gait ataxia) performed more poorly on the M-BESS (p = .03; d = 1.4) and reported greater symptoms than those with no observable signs (p = .03; d = 1.4). Conclusions: The SCAT3 is sensitive to the acute effects of concussion in professional athletes; however, a minority of injured athletes might go undetected by this test.

KEYWORDS:

• Concussion
• sideline assessment
• SCAT3
• video analysis

Declaration of interest

Andrew Gardner has a clinical practice in neuropsychology involving individuals who have sustained sports-related concussion (including current and former athletes). He has operated as a contracted concussion consultant to the Australian Rugby Union (ARU) from July 2016. He has received travel funding from the Australian Football League (AFL) to present at the Concussion in Football Conference in 2013 and 2017. He acknowledges funding through the National Health and Medical Research Council (NHMRC), the School of Medicine and Public Health, University of Newcastle, the University of Newcastle’s Priority Research Centre for Stroke and Brain Injury, the Hunter New England Local Health District and the Hunter Medical Research Institute (HMRI), support by Jennie Thomas and support by Anne Greaves.

Magdalena Wojtowicz, Douglas Terry, and Christopher Levi report no declarations of interest.

Ross Zafonte serves on the scientific advisory boards of Oxeia Biopharmaceuticals, Inc., ElMindA Ltd., and Myomo Inc. He provides health care services to former professional athletes through the Massachusetts General Hospital Brain and Body Program which is funded by The Trust, a National Football League Players Association program.

Grant Iverson has been reimbursed by the government, professional scientific bodies and commercial organizations for discussing or presenting research relating to mild TBI and sports-related concussion at meetings, scientific conferences and symposiums. He has a clinical and consulting practice in forensic neuropsychology involving individuals who have sustained mild TBIs (including athletes). He acknowledges unrestricted philanthropic support from the Mooney-Reed Charitable Foundation and ImPACT Applications, Inc. He received past salary support for chairing the Brain and Behavior committee for the Harvard Integrated Program to Protect and Improve the Health of NFLPA Members.