Return to rugby after brain concussion: a prospective study in 35 high level rugby players.
BACKGROUND
Although guidelines based on expert opinions have been developed for the immediate management and return to play of athletes after a concussion, data are lacking on this issue.


OBJECTIVE
Evaluate a standardized management of brain concussion among rugby players to prevent the recurrence.


METHODS
A prospective study was performed from September 2009 to June 2012. All rugby players who had a concussion when playing rugby were included. Patients were managed by a specialized hospital team with a specific protocol developed in collaboration with the medical staff of the rugby clubs included in the study. The series included 35 rugby players, with 23 professionals and 12 high-level players, 30 men and 5 women, mean age 23.1 ± 5.5 years old. The median number of previous concussions was 2 (0-30) episodes. According to the Cantu concussion severity classification, 3 athletes were grade 1, 12 were grade 2 and 20 were grade 3. None of the injured athletes was lost to follow-up. The primary endpoint was the occurrence of a new concussion within 3 months after the first in patients who returned to rugby.


RESULTS
Thirty-three patients returned to rugby after a mean 22.1 ± 10 days. The recurrence rate within 3 months was 2/33 (6.1%). The median delay before returning to rugby was 21 (7-45) days. Factors associated with a delayed return to play were young age, initial loss of consciousness, severity Cantu grade 3 and post-concussive syndrome of more than 5 days. Analysis of two failures showed that the initial injury was grade 3 and that both were professional athletes and had a history of concussion.


CONCLUSIONS
This prospective study validated the study protocol for the management of concussion in rugby players.
Department of Neurology, Leopold Bellan Hospital, Paris, France.
Jean Francois
JF
Chermann
Department of Orthopedic Surgery, Musculoskeletal Institute of Nollet, Paris, France ; Department of Orthopedic Surgery, Paris Sports Clinic, Paris, France.
Shahnaz
S
Klouche
Medical Staff, Stade Français Rugby, Paris, France.
Alexis
A
Savigny
Department of Orthopedic Surgery, Musculoskeletal Institute of Nollet, Paris, France ; Department of Orthopedic Surgery, Paris Sports Clinic, Paris, France.
Nicolas
N
Lefevre
Department of Orthopedic Surgery, Musculoskeletal Institute of Nollet, Paris, France ; Department of Orthopedic Surgery, Paris Sports Clinic, Paris, France.
Serge
S
Herman
Department of Orthopedic Surgery, Musculoskeletal Institute of Nollet, Paris, France ; Department of Orthopedic Surgery, Paris Sports Clinic, Paris, France ; Medical Staff, Racing-Metro 92, Le Plessis-Robinson, France.
Yoann
Y
Bohu
Athletics Injuries; Brain Concussion; Post-concussion syndrome; Recurrence; Rugby; Trail Making Test