The performance of the World Rugby Head Injury Assessment Screening Tool: a diagnostic accuracy study

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dc.contributor.authorFuller, G.
dc.contributor.authorTucker, R.
dc.contributor.authorStarling, L.
dc.contributor.authorFalvey, Éanna
dc.contributor.authorDouglas, M.
dc.contributor.authorRaftery, M.
dc.contributor.funderWorld Rugbyen
dc.date.accessioned2020-09-09T10:33:02Z
dc.date.available2020-09-09T10:33:02Z
dc.date.issued2020-01-09
dc.date.updated2020-09-09T10:20:57Z
dc.description.abstractBackground: Off-field screening tools, such as the Sports Concussion Assessment Tool (SCAT), have been recommended to identify possible concussion following a head impact where the consequences are unclear. However, real-life performance, and diagnostic accuracy of constituent sub-tests, have not been well characterized. Methods: A retrospective cohort study was performed in elite Rugby Union competitions between September 2015 and June 2018. The study population comprised consecutive players identified with a head impact event undergoing off-field assessments with the World Rugby Head Injury Assessment (HIA01) screening tool, an abridged version of the SCAT3. Off-field screening performance was investigated by evaluating real-life removal-from-play outcomes and determining the theoretical diagnostic accuracy of the HIA01 tool, and individual sub-tests, if player-specific baseline or normative sub-test thresholds were strictly applied. The reference standard was clinically diagnosed concussion determined by serial medical assessments. Results: One thousand one hundred eighteen head impacts events requiring off-field assessments were identified, resulting in 448 concussions. Real-life removal-from-play decisions demonstrated a sensitivity of 76.8% (95% CI 72.6–80.6) and a specificity of 86.6% (95% CI 83.7–89.1) for concussion (AUROC 0.82, 95% CI 0.79–0.84). Theoretical HIA01 tool performance worsened if pre-season baseline values (sensitivity 89.6%, specificity 33.9%, AUROC 0.62, p < 0.01) or normative thresholds (sensitivity 80.4%, specificity 69.0%, AUROC 0.75, p < 0.01) were strictly applied. Symptoms and clinical signs were the HIA01 screening tool sub-tests most predictive for concussion; with immediate memory and tandem gait providing little additional diagnostic value. Conclusions: These findings support expert recommendations that clinical judgement should be used in the assessment of athletes following head impact events. Substitution of the tandem gait and 5-word immediate memory sub-tests with alternative modes could potentially improve screening tool performance.en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.articleid2en
dc.identifier.citationFuller, G., Tucker, R., Starling, L., Falvey, É, Douglas, M.and Raftery, M. (2020) 'The performance of the World Rugby Head Injury Assessment Screening Tool: a diagnostic accuracy study', Sports Medicine - Open, 6, 2 (12pp). doi: 10.1186/s40798-019-0231-yen
dc.identifier.doi10.1186/s40798-019-0231-yen
dc.identifier.eissn2198-9761
dc.identifier.endpage12en
dc.identifier.issn2199-1170
dc.identifier.journaltitleSports Medicine - Openen
dc.identifier.startpage1en
dc.identifier.urihttps://hdl.handle.net/10468/10495
dc.identifier.volume6en
dc.language.isoenen
dc.publisherBioMed Central Ltden
dc.rights© 2020, the Authors. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.en
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/en
dc.subjectConcussionen
dc.subjectDiagnostic accuracyen
dc.subjectRugbyen
dc.subjectScreeningen
dc.titleThe performance of the World Rugby Head Injury Assessment Screening Tool: a diagnostic accuracy studyen
dc.typeArticle (peer-reviewed)en
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