title: The epidemiology of head injuries in English professional rugby union.
abstract: OBJECTIVE
  To undertake a detailed epidemiological study of head injuries sustained by professional rugby union players in order to define their incidence, nature, severity, and causes.
  
  
  METHODS
  A 3-season prospective cohort design.
  
  
  METHODS
  13 English Premiership rugby union clubs.
  
  
  METHODS
  757 male rugby union players.
  
  
  METHODS
  Anatomical location, diagnosis, severity (number of days unavailable for training and match play), injury incident, and incidence of match and training injuries (injuries/1000 player-hours).
  
  
  METHODS
  Playing position, use of headgear, and activity.
  
  
  RESULTS
  The overall incidence of match head injury was 6.6 injuries/1000 player-hours, and each injury resulted, on average, in 14 days lost-time. The overall incidence of match concussions was 4.1 injuries/1000 player-hours resulting, on average, in 13 days lost-time. Concussion was the third most common match injury for all players. A large proportion of the players (48%) were able to return to play safely within 7 days. Match concussions were most commonly associated with tackling head-on (28%), collisions (20%), and being tackled head-on (19%). The midfield backs were the playing position at the greatest risk of sustaining a concussion. Only 42% of players were removed from the field of play immediately after a concussion. Foul play was reported by the player to be associated with match head injury in 17% of cases. Mouthguard and headgear usage was associated with a reduced incidence of concussive injury. The overall incidence of training head injury was 0.05 injuries/1000 player-hours, and the overall incidence of training concussions was 0.02 injuries/1000 player-hours.
  
  
  CONCLUSIONS
  The results showed that rugby union players were exposed to a high risk of noncatastrophic head injury and concussion, particularly whilst tackling and being tackled head-on. In all, 48% of players sustaining a concussion were able to return to play in less than 7 days. The clinical challenge when assessing the potentially concussed player during a game is compounded by the current regulations regarding the permanent replacement of injured players. Injury prevention strategies should be focussed on minimizing the risk and force of direct contact to the head in the tackle.
authors.affiliation: Rugby Football Union, Twickenham, UK.
authors.forename: Simon P T
authors.initials: SP
authors.lastname: Kemp
authors.forename: Zoë
authors.initials: Z
authors.lastname: Hudson
authors.forename: John H M
authors.initials: JH
authors.lastname: Brooks
authors.forename: Colin W
authors.initials: CW
authors.lastname: Fuller
mesh_terms: D001924:Brain Concussion / Q000175:diagnosis / Q000453:epidemiology; D015331:Cohort Studies; D004739:England / Q000453:epidemiology; D005538:Football / Q000293:injuries*; D016489:Head Injuries, Closed / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D015599:Trauma Severity Indices