title: Serious neck injuries in U19 rugby union players: an audit of admissions to spinal injury units in Great Britain and Ireland.
abstract: OBJECTIVE
  To obtain data regarding admissions of U19 rugby players to spinal injury units in Great Britain and Ireland and to compare this with a recent peak in presentation in Scotland. To assess the current state of data collection and subsequent analysis of serious neck injuries. To analyse the mechanism of injury in this group of at-risk players.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Spinal injury units in Great Britain and Ireland.
  
  
  METHODS
  Annual frequency of serious neck injuries. Analysis of injury types, neurological deficit and mechanism of injury.
  
  
  RESULTS
  36 Injuries were recorded. 10 Of these occurred in Scotland since 1996 of which six have occurred in the past 4 years. This compared with 14 in Ireland over the same period. 12 Cases were traced in England and Wales since 2000; records were not available before this date. No prospective collation of data is performed by the home unions and inconsistency of data collection exists. The mean age was 16.2 years. 16 Of the 36 admissions had complete neurological loss, 9 had incomplete neurological injury and 11 had cervical column injury without spinal cord damage. The mechanism of injury was tackle in 17 (47%), scrum in 13 (36%), two each due to the maul and collision, and one each due to a kick and a ruck. Some degree of spinal cord injury occurred in 92% of scrum injuries (61% complete) and 53% of tackle injuries (29% complete).
  
  
  CONCLUSIONS
  U19 rugby players continue to sustain serious neck injuries necessitating admission to spinal injury units with a low but persistent frequency. The recent rate of admission in Scotland is disproportionately high when the respective estimated playing populations are considered. While more injuries were sustained in the tackle, spinal cord injury was significantly more common in neck injury sustained in the scrum (p<0.001). No register of catastrophic neck injuries exists despite repeated calls over the past three decades, and a study such as this has not been reported before. Data collection of this serious category of injury is incomplete and very variable across the home unions, as a consequence a large proportion of the serious neck injuries that have occurred in U19 players over the past 14 years have not been analysed. Rigorous data collection and analysis have to be established so that problem areas of the game such as scrum engagement and the tackle can be made safer.
authors.affiliation: Department of Orthopaedics, Perth Royal Infi rmary, UK. jamie.maclean@nhs.net
authors.forename: James G B
authors.initials: JG
authors.lastname: MacLean
authors.forename: James D
authors.initials: JD
authors.lastname: Hutchison
mesh_terms: D000293:Adolescent; D002574:Cervical Vertebrae / Q000293:injuries; D002648:Child; D005538:Football / Q000293:injuries*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D004204:Joint Dislocations / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D008297:Male; D008485:Medical Audit; D019838:Neck Injuries / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D006113:United Kingdom / Q000453:epidemiology