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Rugby World Cup 2015 Head Injury Assessment programme boosted welfare for world's top players

The world's top rugby players have endorsed World Rugby's head injury education and management approach following successful outcomes at Rugby World Cup 2015.

The programme of on-field head injury identification and management, combined with the Head Injury Assessment process, resulted in no concussed players returning to the field of play at rugby's showcase event.

At the heart of this approach was the introduction of the comprehensive player welfare standards programme featuring six head injury-specific modules that have advanced the level of care for the world's top players and have now been adopted by World Rugby across its events, as well as by other tournament organisers.

The programme, which has standardised player welfare procedures, features the following head injury assessment policies:

•The first international sporting event to insist on completion of mandatory concussion education modules for players, management, match officials and medics

•The first international sporting event to ensure that all medics achieve accreditation through compliance with World Rugby's permanent and temporary removal criteria for head impacts

•Completion of baseline concussion assessment – as a minimum SCAT 3 was compulsory with teams encouraged to also include computer neuro-cognitive baselines

•Completion of concussion risk stratification on all players

•Implementation of an Untoward Incident Review system for potential medical mismanagement issues including mismanagement of head injuries

•Acknowledgement that the independent Match Day Doctor had the power to unilaterally remove an injured player from further match participation

The statistics, identified by World Rugby injury surveillance, demonstrate that the organisation is better at identifying more cases of confirmed concussions compared with 2011, ensuring that no players with confirmed cases are returned to the field of play, which is crucial in protecting players. During Rugby World Cup 2011, 53 per cent of players assessed on the field and cleared to play on were later determined to have sustained a concussion, while in 2014 that figure was 12 per cent.

The Rugby World Cup 2015 HIA programme determined:

•Of the 19 players who returned to play following a HIA 1, all were cleared of a concussion following a post-match SCAT 3 assessment and 36-hour SCAT 3 and computer neuro-cognitive assessment

•Approximately 50 per cent of the players who were removed following their head injury were confirmed as having a diagnosed concussion

•The number of concussed players identified via observation and/or video as having a clear concussion and therefore no off-pitch assessment being required was 62 per cent, underscoring the importance of video in identifying suspected concussions and removing players

•World Rugby's three-point in-time diagnostic approach (HIA, post-match SCAT and 36-48 hour re-assessment using SCAT and computer neuro-cognitive), the most rigid in world sport, proved invaluable in a holistic approach to supporting players

•Independent concussion experts were involved in nine return to play cases, demonstrating the value of additional expert opinion

World Rugby have also rolled out an innovative HIA App (developed by New Zealand company CSx) to participating teams and within international competitions, simplifying the recording and management of head injuries. These processes were supported by Hawk-Eye video replay technology, which was adopted to assist with the spotting and assessment of head impacts and the implementation of independent concussion consultants to adjudicate on return to play following the completion of a stand down period after a confirmed or suspected concussion.

The technology identified head impacts in 56 per cent of incidents that were referred for medical review, while it proved highly-successful in determining permanent removal or temporary removal criteria. In total, 24.5 per cent of all assessments involved video replay to make a final decision regarding removal.

Former Ireland and British and Irish Lions captain Paul O'Connell, who was a Rugby Athletes' Commission representative to World Rugby's recent Rugby Committee meeting, said: "The results are a significant improvement on the past and demonstrate the huge progress made within the sport. We now need to see similar results replicated throughout all the game's elite competitions and continue to look for further improvement in concussion management.”

World Rugby Chief Executive Brett Gosper said: "World Rugby is committed to delivering the best-possible level of education, protection and support in the priority area of head injuries. These hugely positive outcomes reaffirm our evidence-based approach to player welfare. They underscore the importance of a rigorous approach using a combination of baseline testing, mandatory education, video technology, innovative assessment software and independent doctors and concussion experts.

"Just as significantly, the outcomes also demonstrate the cultural shift that is taking place within our sport and I would like to thank the teams, players, coaches and medics for their support and compliance. However, we are not complacent and must continue to ensure that our approach is aligned to the latest scientific and medical evidence and therefore continue to prioritise prevention, education, management and research, guided by independent field experts, reaffirming our support of players at all levels of the game.”

International Rugby Players' Association Chief Executive Rob Nichol added: "These positive results provide confidence that as a game we are improving concussion management. We are looking forward to continuing to work with the game's administration to produce ongoing improvements in concussion management and further refining and implementing the player welfare standards developed for Rugby World Cup throughout the game's elite competitions.”

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