title: Cervical spinal cord injury in rugby union and rugby league: are incidence rates declining in NSW?
abstract: OBJECTIVE
  To estimate trends in incidence rates of rugby code-related severe cervical spinal cord injuries in New South Wales (NSW) from 1986 to 2003. To evaluate the Australian Spinal Cord Injury Register (ASCIR) for injury surveillance by comparison with two published studies.
  
  
  METHODS
  Data were cases of complete and incomplete tetraplegia in rugby union and rugby league admitted to the two spinal units in NSW. Trends in incidence rates were estimated using Poisson regression modelling.
  
  
  RESULTS
  There was a small, non-significant decline from 1986 to 2003 in the incidence rate of tetraplegia in rugby union (9.8 vs. 6.1 per 100,000 player-years; p = 0.378) and rugby league (2.3 vs. 1.6 per 100,000 player-years; p = 0.564). The most common causes of injury were scrums for rugby union (35%) and tackles for rugby league (78%). This did not change over time (rugby union, p = 0.118; rugby league, p = 0.288). The ASCIR identified more cases of tetraplegia than insurance claims data and at least 75% of the cases ascertained by medical record review.
  
  
  CONCLUSIONS
  There remains an urgent need to further improve safety in rugby union and rugby league. Scrummage in union and tackles in league remain the leading causes of tetraplegia. Rates of tetraplegia were significantly higher and more variable in rugby union than in rugby league.
  
  
  CONCLUSIONS
  The ASCIR is a useful tool to monitor trends in spinal cord injury incidence in both rugby codes. Its potential value is constrained by the lack of accurate estimates of player numbers.
authors.affiliation: Research Centre for Injury Studies and AIHW National Injury Surveillance Unit, Flinders University, GPO Box 2100, Adelaide, South Australia 5001. jesia.berry@flinders.edu.au
authors.forename: Jesia G
authors.initials: JG
authors.lastname: Berry
authors.forename: James E
authors.initials: JE
authors.lastname: Harrison
authors.forename: John D
authors.initials: JD
authors.lastname: Yeo
authors.forename: Raymond A
authors.initials: RA
authors.lastname: Cripps
authors.forename: Shaun C R
authors.initials: SC
authors.lastname: Stephenson
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001265:Athletic Injuries / Q000453:epidemiology*; D015984:Causality; D002574:Cervical Vertebrae / Q000293:injuries*; D005538:Football / Q000293:injuries* / Q000639:trends*; D006801:Humans; D015994:Incidence; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods; D011782:Quadriplegia / Q000453:epidemiology; D012042:Registries; D012044:Regression Analysis; D013119:Spinal Cord Injuries / Q000453:epidemiology*