For Immediate Release
August 8, 2013

Expert Concussion Group Endorses Rugby Approach

  • Pitch-side Suspected Concussion Assessment (PSCA) puts players first
  • 25 per cent more players being removed from the field of play
  • Doctors urged to recognise and remove

Independent neurologists, Rugby medics and the players Union have given their unanimous backing to the IRB’s Pitch-side Suspected Concussion Assessment (PSCA), recommending continuation of the current global trial in elite Rugby.

The concussion management working group unanimously agreed that the trial should be extended for another 12 months as it is working, benefiting the Game and mitigating the risk of mismanagement of suspected concussion in Rugby. Under the trial there has been a 25 per cent increase in players being permanently removed from the field of play following a head impact.

The recommendation follows the scheduled year-one review of data from over 180 examples of head injury management from matches under the trial and included feedback from team doctors implementing the protocols.

IRB Chairman Bernard Lapasset said: “The IRB and its Member Unions consider the area of player welfare to be paramount in Rugby and welcome the results of this thorough review of the outcomes of the first year of the global trial of the Pitch-side Suspected Concussion Assessment.”

The PSCA was developed as a supportive welfare tool by a specialist independent working group and is designed to give teams and match doctors time to assess cases in which concussion is not immediately apparent. Previously, players were being left on the field if it was unclear if a player was concussed.

The IRB has also moved to address recent misconceptions regarding the Rugby concussion management approach.

IRB Chief Medical Officer Dr Martin Raftery said: “There has been commentary in recent weeks regarding Rugby’s approach to concussion management and incorrect assumptions have been made. The IRB would like to reiterate that PSCA process was developed in line with industry best practice to support the Team Doctors in assessing head injuries. It has not been developed to allow time for medics to look for reasons to clear a concussed player. If a player is clearly displaying concussive symptoms, then that player should be removed permanently, there is no need for the PSCA.”

The IRB is a signatory to the 2012 Zurich Consensus statement on concussion, widely recognised as the world's leading sports concussion forum. The statement confirms that athletes should not be allowed to return to play after a diagnosed concussion and should not return to play or train on the same day and goes on to outline an approach to help physicians determine when an athlete might be safe to return to sport.

The IRB’s approach under the guidance of the IRB Medical Commission, featuring top sports physicians and independent experts is entirely consistent with Zurich. The commission has driven key revisions to IRB Regulation 10 including concussion management and return to play protocol guidelines and importantly education best-practice for elite and community Rugby.

Dr. Raftery added: “The IRB and its Unions continue to take a proactive and protective approach to the management of suspected concussion as there is no perfect diagnostic test or marker in medicine that doctors can rely on for an immediate diagnosis. Further research is required and the IRB will continue to support initiatives in this important area."

Pitchside Suspected Concussion Assessment (PSCA)

  • ➤ A PSCA can be requested by the player's team doctor and the match referee if they suspect that a player may have suspected concussion.
  • ➤ Match referee will signal, via comms device and hand signal of three taps to the head, that a PSCA has been called. PSCA carried out at pre-agreed place, medical room or alternative if not easily accessible, with a temporary replacement taking the field.
  • ➤ The substitution will become permanent should a player fail the test, while temporary replacements are not allowed to take kicks at goal.
  • ➤ PSCA must be completed inside five minutes - commencing with the player leaving the field at the half-way line and ending with presentation to the reserve official after being cleared to play.
  • ➤ PSCA incorporates the Maddocks Questions (cognition), a balance assessment and a 'symptoms and signs' assessment.
  • ➤ Maddocks Questions: At what venue are we today? Which half is it now? Who scored last in this match? What team did you play last game? Did your team win the last game?
  • ➤ One failed Maddocks question, four balance errors and the presence of one or more signs will see the player removed from the game. A 15-minute period is allowed for players suffering suspected concussion and a blood injury.

About Regulation 10

Regulation 10 features a two-pronged approach to protect players at both the elite and community levels. Where concussion is diagnosed, a player must be removed from the field of play and not return to play or train on the same day and must be guided through a dedicated return to play protocol.

All players with suspected concussion where there is no appropriately qualified person is present to diagnose concussion must be removed from the field of play and not return to play or train on the same day and should be reviewed by an appropriately qualified person and then should complete the graduated return to play protocol described in the IRB Concussion Guidelines.

Putting Players First: The Rugby Concussion Management Approach

  • The IRB concussion protocols, under Regulation 10 and outlined at cover approaches for the community and elite game.
  • The graduated return to play protocols were introduced to eradicate non compliance issues surrounding the previous mandatory three-week rule.
  • The PSCA was developed by an independent expert group including two neurologists to standardize the procedure of assessment of head injuries where concussion is suspected, but unclear. Previously doctors had 0 minutes to assess players on the run on the field, which potentially endangered the welfare of those players.
  • Rugby acknowledges the relevance of research into the long-term effects of repeated blows to the head, particularly CTE and is being proactive.
  • Currently, there is no scientific link between concussion and long-term brain injury, but IRB has been proactive in launching a long-term study in 2012 with the University of Auckland.

Common Misconceptions

  • Rugby does not take concussion seriously. FALSE. The IRB and its Member Union take all areas of player welfare extremely seriously and concussion is of particular importance. The IRB has engaged the world’s leading experts, independent neurologists and leading team doctors to develop and critique protocols that are already benefiting the game.
  • The PSCA was designed to allow doctors to clear players of concussion. FALSE. The PSCA was developed to provide Doctors with extra time to assess a player who has a head injury where the diagnosis of concussion is not immediately apparent. Under the PSCA it has been proven that team doctors are twice as likely to remove players and that there has been a 25% increase in the removal of players from the field of play.
  • The players do not support the protocols. FALSE. The International Rugby Players Association has been central to the development of the Rugby concussion management protocols and they are fully supportive of the proactive work that the IRB, the concussion working group and the Unions have undertaken.
  • There is a definite link between repeated blows to the head in Rugby and long-term cognitive impediment (CTE) just as in NFL. FALSE. Currently, there is no scientific link between concussion and long-term brain injury, but IRB has been proactive in launching a long-term study in 2012 with the University of Auckland. Rugby is not American football and blows to the head are not permitted under the laws to the game. NFL only outlawed blows to the head in 2010. We need to take a balanced and long-term approach.
  • It should be easy do diagnose concussion. FALSE. As highlighted in the 2012 Zurich Consensus Statement: "Concussion is considered to be among the most complex injuries in sports medicine to diagnose, assess and manage” and “There is no perfect diagnostic test or marker that clinicians can rely on for an immediate diagnosis.” The IRB and its Unions therefore take a proactive approach that mitigates risk wherever possible, including best practice assessment, research and consultation with leading experts in the field.