Video Review and Clinical Screening of Suspected and Medically Diagnosed Concussions in the National Rugby League Women's Premiership.

backgroundThe National Rugby League Women's (NRLW) Premiership, created in 2018 as a professional Australian women's rugby league competition, administers the Sport Concussion Assessment Tool-5th Edition (SCAT5) as part of the game day Head Injury Assessment (HIA). This study aimed to: (i) examine the frequency of video signs of potential concussion in players removed for an HIA, (ii) compare the in-game medical evaluation results between players with concussion and those returned to play, and (iii) report the games missed before returning to match play following concussion in NRLW players.

methodsMedical personnel and sideline video operators tagged all head impact events requiring medical evaluation via a HIA during three NRLW Premiership seasons (2018-2020). If players were suspected of sustaining a concussion, they were removed from the field for a medical assessment, which included the SCAT5. Two independent reviewers retrospectively coded the video footage of each HIA. Inter-rater reliability of video signs was calculated using Cohen's kappa (κ) and absolute percentage agreement. Video signs and medical evaluation findings were examined descriptively, and results were compared between concussed players and uninjured players who returned to the field.

resultsDuring the three NRLW Premiership seasons (2018-2020), there were 24 HIAs, with seven players medically diagnosed with concussion. As such, there was one HIA for every 0.88 matches and one medically diagnosed concussion every 3.00 matches. Inter-rater reliability between the two independent video reviewers was high, with the absolute percentage agreement for all concussions signs at 96.3%. On retrospective review, most NRLW players (n = 20, 83.3%) removed for a HIA did not have any consensus video signs, with three players (12.5%) displaying motor incoordination and two players (8.3%) having a blank or vacant look. On the SCAT5, concussed players had lower cognitive scores (M = 21.8 vs. 27.8, p = .01, d = 1.62) and reported more symptoms (M = 4.3 vs.1.0, p = .02, d = 1.09) with greater severity (M = 9.71 vs. 1.41, p = .02, d = 0.96) compared to those who were not diagnosed with a concussion. All players diagnosed with a concussion returned to play within two weeks of their injury.

conclusionFewer than 20% of women removed from play for HIAs showed consensus video signs of possible concussion. Concussed players obtained lower cognitive tests scores and reported more symptoms, with greater severity, compared with uninjured players. Further studies with larger samples are needed to evaluate the video signs of concussion, with in-game SCAT5 scores, to improve the acute identification and management of concussions in the NRLW Premiership.