Andrew J Gardner1,2. 1. Priority Research Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia. 2. Hunter New England Local Health District Sports Concussion Program, Waratah, NSW, Australia.
Abstract
BACKGROUND: Consensus on the definition of extant video signs of concussion have recently been proposed by representatives of international sporting codes for global consistency across professional leagues. OBJECTIVE: To review the reliability of the proposed international consensus video signs of concussion in National Rugby League (NRL) head impact events (HIEs). METHODS: The video signs of concussion were coded for every HIE during the 2019 NRL season. Coding was conducted blinded to the concussion status. Frequency, sensitivity, specificity, and a receiver operating characteristic curve were calculated. RESULTS: There were 943 HIEs identified over the 2019 NRL season, of which 106 resulted in a diagnosed concussion. The most frequently observed video sign in concussed athletes was blank/vacant look (54%), which was also the most sensitive video sign (0.54, CI: 0.44-0.63), while the most specific was tonic posturing (0.99, CI: 0.99-1.00). In 43.4% of diagnosed concussions none of the 6 video signs were present. The 6 video signs demonstrated a "fair" ability to discriminate between concussion and nonconcussion HIEs (area under the curve = 0.76). CONCLUSION: International consensus agreement between collision sports for extant video signs of concussion and the definition of those extant video signs are clinically important. The selection of signs requires rigorous assessment to examine their predictive value across all sports and within individual sports, and to determine further video signs to compliment and improve the identification of possible concussion events within various sports. The current study demonstrated that, for NRL-related HIEs, the diagnostic accuracy of video signs varies.
BACKGROUND: Consensus on the definition of extant video signs of concussion have recently been proposed by representatives of international sporting codes for global consistency across professional leagues. OBJECTIVE: To review the reliability of the proposed international consensus video signs of concussion in National Rugby League (NRL) head impact events (HIEs). METHODS: The video signs of concussion were coded for every HIE during the 2019 NRL season. Coding was conducted blinded to the concussion status. Frequency, sensitivity, specificity, and a receiver operating characteristic curve were calculated. RESULTS: There were 943 HIEs identified over the 2019 NRL season, of which 106 resulted in a diagnosed concussion. The most frequently observed video sign in concussed athletes was blank/vacant look (54%), which was also the most sensitive video sign (0.54, CI: 0.44-0.63), while the most specific was tonic posturing (0.99, CI: 0.99-1.00). In 43.4% of diagnosed concussions none of the 6 video signs were present. The 6 video signs demonstrated a "fair" ability to discriminate between concussion and nonconcussion HIEs (area under the curve = 0.76). CONCLUSION: International consensus agreement between collision sports for extant video signs of concussion and the definition of those extant video signs are clinically important. The selection of signs requires rigorous assessment to examine their predictive value across all sports and within individual sports, and to determine further video signs to compliment and improve the identification of possible concussion events within various sports. The current study demonstrated that, for NRL-related HIEs, the diagnostic accuracy of video signs varies.