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. objectives: evaluate a standardized management of brain concussion among rugby players to prevent the recurrence. patients and 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.