Occurrence and clinical utility of observable signs for concussion assessment in elite cricket.

Background: Observable signs are an important component of multimodal concussion assessment, with further research needed to understand and improve their applicability to cricket. Methods: Participants were elite Australian cricket players who sustained a concussive head impact during a match between July 2015 and June 2024 with video of the incident available. Videos were coded for established signs of concussion and cricket-specific signs potentially indicative of concussion. A random selection of concussive and non-concussive match head impacts were coded to investigate clinical utility of observable signs. Results: From 53 videos of concussive incidents (male n = 41, female n = 12), the median number of established observable signs was 0 (IQR 0-0). The median number of cricket-specific signs per concussive incident was 2 (IQR 1-4). Ten (19%) concussive incidents had no established or cricket-specific signs. The positive predictive value of each video sign for concussion was not significant. Other players or umpire showing urgent concern for the impacted player was the most commonly observed cricket-specific sign. One video angle was sufficient to observe signs in most instances. Conclusions: Elite cricket players who sustain a concussive head trauma infrequently present with established observable signs. Practitioners should be alert to other observable signs to guide whether a player needs to be immediately removed from the field of play for further assessment. Advancements in video quality and availability would further support the match-day doctor.