title: Evaluation of World Rugby's concussion management process: results from Rugby World Cup 2015.
abstract: OBJECTIVE
  To evaluate World Rugby's concussion management process during Rugby World Cup (RWC) 2015.
  
  
  METHODS
  A prospective, whole population study.
  
  
  METHODS
  639 international rugby players representing 20 countries.
  
  
  METHODS
  The concussion management process consisted of 3 time-based, multifaceted stages: an initial on-pitch and/or pitch-side assessment of the injury, a follow-up assessment within 3 hours and an assessment at 36-48 hours. The initial on-pitch assessment targeted obvious signs of concussion, which, if identified, lead to a 'permanent removal from play' decision and a diagnosis of concussion. If the on-pitch diagnosis was unclear, a 10-min off-pitch assessment was undertaken for signs and symptoms of concussion leading to a 'suspected concussion with permanent removal from play' or a 'no indication of concussion with return to play' decision. Evaluations at 3 and 36-48 hours postmatch lead to diagnoses of 'confirmed concussion' or 'no concussion'. Medical staff's decision-making was supported during each stage by real-time video review of events. Players diagnosed with confirmed concussion followed a 5-stage graduated-return-to-play protocol before being allowed to return to training and/or competition.
  
  
  RESULTS
  Players were evaluated for concussion on 49 occasions, of which 24 resulted in diagnoses of concussion. Fourteen players showing on-pitch signs of concussion were permanently removed from play: 4 of the 5 players removed from play following off-pitch medical room evaluation were later diagnosed with a confirmed concussion. Five players not exhibiting in-match signs or symptoms of concussion were later diagnosed with concussion. The overall incidence of concussion during RWC 2015 was 12.5 concussions/1000 player-match-hours.
  
  
  CONCLUSIONS
  This study supports the implementation of a multimodal, multitime-based concussion evaluation process to ensure that immediate and late developing concussions are captured.
authors: Colin Fuller Consultancy Ltd, Sutton Bonington, UK.
authors: Colin W
authors: CW
authors: Fuller
authors: Emergency Medicine Research in Sheffield Group, School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors: Gordon W
authors: GW
authors: Fuller
authors: Rugby Football Union, London, UK.
authors: Simon P T
authors: SP
authors: Kemp
authors: World Rugby, Dublin, Ireland.
authors: Martin
authors: M
authors: Raftery
mesh_terms: D001265:Athletic Injuries / Q000175:diagnosis*; D001924:Brain Concussion / Q000175:diagnosis*; D005538:Football / Q000293:injuries*; D006801:Humans; D011446:Prospective Studies; D000068958:Return to Sport; D013178:Sports Medicine / Q000379:methods
keywords: Concussion; Contact sports; Epidemiology; Risk factor; Rugby