The Use of Sideline Video Review to Facilitate Management Decisions Following Head Trauma in Super Rugby

Andrew J Gardner; Ryan Kohler; Warren McDonald; Gordon W Fuller; Ross Tucker; Michael Makdissi

doi:10.1186/s40798-018-0133-4

The Use of Sideline Video Review to Facilitate Management Decisions Following Head Trauma in Super Rugby

Sports Med Open. 2018 May 24;4(1):20. doi: 10.1186/s40798-018-0133-4.

Authors

Andrew J Gardner^{1

2

3}, Ryan Kohler⁴, Warren McDonald^{5

6}, Gordon W Fuller⁷, Ross Tucker^{8

9}, Michael Makdissi^{10

11}

Affiliations

¹ Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia. Andrew.Gardner@neurogard.com.au.
² Hunter New England Local Health District Sports Concussion Program, Newcastle, NSW, Australia. Andrew.Gardner@neurogard.com.au.
³ Priority Research Centre for Stroke and Brain Injury, Calvary Mater Hospital, Level 5, McAuley Building, Waratah, NSW, 2298, Australia. Andrew.Gardner@neurogard.com.au.
⁴ HeadSmart™ Sports Concussion Program, Head Office 4 Helensvale Road, Helensvale, Gold Coast, Australia.
⁵ Australian Rugby Union (ARU), Moore Park, NSW, Australia.
⁶ Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, ACT, Australia.
⁷ Emergency Medicine Research in Sheffield Group, School of Health and Related Research, University of Sheffield, Sheffield, UK.
⁸ School of Management Studies, Faculty of Commerce, University of Cape Town, Cape Town, South Africa.
⁹ World Rugby, Pty (Ltd), Dublin, Ireland.
¹⁰ Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, VIC, Australia.
¹¹ La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, VIC, Australia.

Abstract

Background: Sideline video review has been increasingly used to evaluate risk of concussive injury during match play of a number of collision sports, with the view to reducing the incidence of match play concussion injuries. The purpose of this study was to evaluate the effectiveness of sideline video review for identifying and evaluating head impact events in Rugby Union.

Methods: All Australian teams' 2015 Super Rugby season matches were studied. Meaningful head impact events (HIEs) were identified, comprising events identified and acted upon during matches and events identified through a post-season retrospective review. Video footage of each HIE was coded by two experienced independent sports medicine clinicians to evaluate management decisions made by match-day (MDD) and team doctors (TD). HIE incidences for matches with and without sideline video were compared, and the agreement between game-day video interpretation and the independent clinician opinion calculated.

Results: Seventy HIEs were identified in 83 matches (47 identified during matches and 23 identified post-season), equating to 42.5 HIEs per 1000 player match hours. When video review was available, an unnoticed HIE occurred once every 4.3 matches, compared to once every 2.3 matches when the sideline video review was unavailable. Of the 47 identified in-match HIEs evaluated by TD and MDD during the season, 18 resulted in an immediate and permanent removal, 28 resulted in temporary removal for an off-field assessment, and one resulted in the player continuing the game. Game-day head injury assessment process video decisions agreed with the independent clinician view in 72% of cases, κ = 0.49 (95% CI 0.38-0.59, weak agreement).

Conclusions: These findings suggest that access to sideline video review is an important supplementary component to identify potential concussions; however, there is a critical need for improved systems and processes to reduce the likelihood of missing an incident.

Keywords: Concussion; In-match concussion management; Rugby; Video analysis.