When do Mild Traumatic Brain Injuries Occur in Community Rugby?

Objective: To investigate whether mild traumatic brain injuries (mTBI) occur at a particular time in the playing season among community rugby players and whether there are factors that shorten the injury-free period. Design: Cohort study. Details are included in the previous study.1,2 Setting: Competitive nonprofessional rugby clubs and private high schools in the Sydney metropolitan area during 2005-2007. Participants: Male players, 15 to 48 years of age, were recruited from 8 schools and 26 rugby clubs (total n = 3207; mean age, 23 years; 77% trained for 3 hours per week or more). Assessment of Risk Factors: The players reported, on short questionnaires, information on demographic, anthropomorphic, and play-related factors (rugby experience, playing positions, and use of protective equipment). They also gave a history of concussions in the previous year. Main Outcome Measures: The main outcome measure was the time to first mTBI; that is, the total number of hours of game exposure before the player sustained a concussion. An mTBI was defined as a knock to the head that resulted in dizziness, confusion, loss of coordination, and/or a loss of consciousness that required stoppage of play, stoppage of play with the player needing medical attention, or the player needing to leave the field. Players found to be in a different league or with missing or unreliable data were removed from the analysis (final n = 1958). The included players were similar to the excluded players on a wide range of risk factors, but were older in age (23 years vs 22 years), which was adjusted for in the analyses. Main Results The mean game time to first mTBI (10% of players, n = 187) was 8 hours (SD, 6.2 hours; median, 6.8 hours; interquartile range, 2.9-11.7 hours). Of these players, 163 sustained 1 mTBI and 24 sustained from 1 to 4 mTBI. Within 10 hours (just less than the average number of game-hours per player per season), 7% of the cohort had sustained a first mTBI, and within 20 hours (approximate length of 1 season for adults), 14% had a concussion. In survival regression analysis, the proportion of players who remained mTBI-free over time (up to 70 hours of game play) was higher among those who had no recent history of concussion (P < 0.001), had a body mass index (BMI) of ≥27 kg/m2 (P = 0.003), who trained for ≥3 hours per week (P = 0.012), or who played school rugby (where the game-hours played were fewer) compared with adult rugby (P = 0.033). Conclusions: Mild traumatic brain injuries occurred in approximately 7% of players in the first 10 hours of community rugby game play and continued at the same rate through the season. Players who had a recent history of concussion, a lower BMI, trained less, or played adult rugby were most at risk.

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