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Objectively Assessing Sports Concussion Utilizing Visual Evoked Potentials
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The performance of the World Rugby Head Injury Assessment Screening Tool: a diagnostic accuracy study.
G W Fuller1, R Tucker2, L Starling3
1Centre for Urgent and Emergency Care Research, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK. g.fuller@sheffield.ac.uk.
Sports Medicine - Open
|January 11, 2020
Summary
This study evaluated the real-world effectiveness of the World Rugby Head Injury Assessment (HIA01) tool for identifying concussions in elite rugby. Findings suggest clinical judgment is crucial, as some sub-tests like tandem gait and immediate memory offer limited diagnostic value for concussion.
Area of Science:
- Sports Medicine
- Neurology
- Orthopedics
Background:
- Off-field screening tools, such as the Sports Concussion Assessment Tool (SCAT), are recommended for identifying potential concussions after head impacts.
- The real-world performance and diagnostic accuracy of SCAT sub-tests require further characterization.
Purpose of the Study:
- To investigate the real-life performance and diagnostic accuracy of the World Rugby Head Injury Assessment (HIA01) screening tool.
- To evaluate the diagnostic value of individual HIA01 sub-tests in elite Rugby Union players.
Main Methods:
- A retrospective cohort study analyzed data from elite Rugby Union competitions (September 2015 - June 2018).
- The study included players with head impacts assessed using the HIA01 tool, an abridged SCAT3 version.
- Concussion was diagnosed by medical professionals; HIA01 performance was assessed against removal-from-play decisions and theoretical accuracy using baseline/normative data.
Main Results:
- 1,118 head impacts led to 448 concussions. Real-life removal-from-play decisions showed 76.8% sensitivity and 86.6% specificity for concussion.
- Theoretical HIA01 tool performance decreased significantly when strictly applying pre-season baseline (89.6% sensitivity, 33.9% specificity) or normative thresholds (80.4% sensitivity, 69.0% specificity).
- Symptoms and clinical signs were most predictive; immediate memory and tandem gait provided minimal additional diagnostic value for concussion.
Conclusions:
- Expert recommendations supporting clinical judgment in post-head impact assessments are reinforced.
- Replacing tandem gait and 5-word immediate memory sub-tests could potentially enhance screening tool efficacy for concussion detection.
