Video and clinical screening of national rugby league players suspected of sustaining concussion

Primary Objective: This study reviewed the available sideline Sport Concussion Assessment Tool-Third Edition (SCAT3) performance of players who were removed from play using the 'concussion interchange rule' (CIR), the available video footage of these incidences, and associated return to play and concussion diagnosis decisions. Research Design: Descriptive, observational case series. Methods and Procedures: Data were collected from all NRL players who used the CIR during the 2014 season. Main Outcomes and Results: Complete SCAT3 and video analysis data were available for 38 (23%) of 167 uses of the concussion interchange rule, of which 20 (52.6%) players were medically diagnosed with concussion. Those with video evidence of unresponsiveness performed more poorly on the modified Balance Error Scoring System (M-BESS; p =.04; Cohen's d =.69) and reported greater symptoms (p =.03; d =.51). Similarly, players with a vacant stare reported greater symptoms (p =.05; d =.78). Those who demonstrated three signs (unresponsiveness, vacant stare and gait ataxia) performed more poorly on the M-BESS (p =.03; d = 1.4) and reported greater symptoms than those with no observable signs (p =.03; d = 1.4). Conclusions: The SCAT3 is sensitive to the acute effects of concussion in professional athletes; however, a minority of injured athletes might go undetected by this test.