World Rugby welcomes the publication of a major new consensus statement on concussion in sport, which confirms that rugby continues to be aligned with recommended best-practice in the identification and management of concussive injuries. 
Rugby’s governing body, represented by its chief medical officer Dr Martin Raftery and leading union physicians, joined the IOC, FIFA, IIHF and FEI and eminent independent medical experts to participate in the Berlin International Consensus Conference on concussion in sport last October. The aim of the conference is to further develop a cross-sport approach to best-practice in this important area. 
The objective was to present a summary of new evidence-based research that covers all aspects of concussions including definition, management, investigations, treatment, return-to-sport protocol, prevention, and knowledge transfer. The second objective was to reach agreement on each topic. 

The statement, covering 12 questions, is a result of a detailed review of more than 60,000 scientific papers reviewed by expert groups. This review and the latest concussion consensus statement delivered by the Concussion in Sports Group (CISG) demonstrates that rugby’s approach continues to be aligned with recommended best practice:

  • The CISG underscores the importance of an evidence-based approach: This principle is fundamental to developing rugby’s head injury education, prevention and management strategies. Law-making activities are driven by robust research and player welfare considerations.
  • The CISG underscores the importance of the Recognise and Remove principle: This is at the heart of World Rugby’s education strategy completed by nearly 400,000 players, coaches, parents and medics worldwide.
  • The CISG confirms that any player with suspected concussion must be immediately and permanently removed from competition: This is the foundation of rugby’s ‘Recognise and Remove’ approach, operational at all levels of the game.
  • The CISG recognises that the SCAT tool currently represents the most well established and rigorously developed instrument available for side-line assessment: Rugby’s three-point-in time head injury assessment (HIA) process, is based on the components of the SCAT tool, with evidence showing it is highly effective in identifying suspected concussion, significantly reducing the risk of a concussed player remaining on the field or returning to play. 
  • The CISG recognises the importance of early exercise in return-to-play protocols: This is another key step in rugby’s graduated-return-to-play protocols providing a robust framework to protect injured players through assessment, review and progressive return to contact and competition.

World Rugby Chairman Bill Beaumont, who addressed the conference, said: “Concussion is a top priority for all sports and we continue to collaborate with other sports and leading medical and scientific experts to ensure the very best programmes are implemented to protect participants at all levels.

“The Berlin consensus statement is important in providing expert insight and alignment with the latest recognised best practice in order that we can continue to develop further educational, management and preventative strategies that reduce the risk of concussion in rugby.”

World Rugby Chief Medical Officer Dr Martin Raftery added: “Guided by the concussion consensus statements, independent experts and an evidence-based approach, rugby has developed a framework that is protecting and supporting players in this priority area. 

Protecting players: World Rugby concussion special
By its very nature rugby is a physical game and as players at the elite level are getting stronger, World Rugby is taking a proactive evidence-based approach to player welfare to protect players at all levels.

“Our approach has been in step with the recommendations of previous consensus statements and the Berlin statement confirms that rugby continues to be aligned with best-practice, incorporating an evidence-based approach to concussion education, prevention, management and research.

“However, we must never be complacent and will continue to draw on the evidence, expert guidance and continued collaboration with our colleagues in other sports to further the protection of rugby players at all levels of the game.”

The Berlin CISG statement includes an update on the Concussion Recognition Tool (CRT5), the Sport Concussion Assessment Tool (SCAT5) and the Child Sport Concussion Assessment Tool (Child SCAT5), all three of which are currently being employed in a large number of sport federations and professional leagues.

This update to the SCAT3 (now called SCAT5 following the fifth edition of the conference) includes new methods designed to improve the clinical and cognitive examination, as well as recommendations for return to sport and school following concussion. 

The Berlin CISG statement also gave updates on ‘Return to Sport’, the point by which an athlete is recovered from injury and can participate again in his or her sport. It noted that athletes recovering from concussion should be exercising earlier following the injury, provided that this does not cause concussion symptoms to reappear. Specific therapy for vestibular (balance) problems or cervical spine problems was also highlighted. 

The new additions to the child SCAT5 addressed ‘Return to School’, specifically stating that children 12 years old and under who suffer concussions should be encouraged to resume normal activity and return to school as soon as possible within a 3-5 day window as long as symptoms do not flare up. The Berlin CISG statement also recommends that all schools develop concussion policies, provide academic accommodations for injured students, and educate staff on the effects of concussion on learning during the recovery phase. 

The Berlin Consensus also stated that the link between chronic traumatic encephalopathy and concussions or sub-concussive impacts is inconclusive and that research needs to continue to understand the area better.