BackgroundThe use of video to assist professional sporting bodies with the diagnosis of sport-related concussion (SRC) has been well established; however, there has been little consistency across sporting codes with regards to which video signs should be used, and the definitions of each of these signs.AimThe aims of this study were to develop a consensus for the video signs considered to be most useful in the identification of a possible SRC and to develop a consensus definition for each of these video signs across the sporting codes.MethodsA brief questionnaire was used to assess which video signs were considered to be most useful in the identification of a possible concussion. Consensus was defined as >90% agreement by respondents. Existing definitions of these video signs from individual sports were collated, and individual components of the definitions were assessed and ranked. A modified Delphi approach was then used to create a consensus definition for each of the video signs.ResultsRespondents representing seven sporting bodies (Australian Football League, Cricket Australia, Major League Baseball, NFL, NHL, National Rugby League, World Rugby) reached consensus on eight video signs of concussion. Thirteen representatives from the seven professional sports ranked the definition components. Consolidation and refinement of the video signs and their definitions resulted in consensus definitions for six video signs of possible concussion: lying motionless, motor incoordination, impact seizure, tonic posturing, no protective action—floppy and blank/vacant look.ConclusionsThese video signs and definitions have reached international consensus, are indicated for use by professional sporting bodies and will form the basis for further collaborative research.

Background:Concussion in sport is a topic of growing interest in Australia and worldwide. To date, relatively few studies have examined the true incidence of concussion in cricket.Hypothesis:Concussion in cricket is more common than current literature suggests.Study Design:Descriptive epidemiology study.Level of Evidence:Level 4.Methods:This is a prospective registry and subsequent analysis of head impacts and concussions in elite-level male and female cricketers in Australia over 2 seasons (2015-2016 and 2016-2017). A total of 172 male and 106 female domestic and international players in 2015-2016 and 179 males and 98 females in 2016-2017 were included.Results:There were 92 head impacts (29 concussions) in men’s matches and 15 head impacts (8 concussions) in women’s matches. Match incidence rates per 1000 player days were 7.2 head impacts (2.3 concussions) in elite male cricket and 3.7 head impacts (2.0 concussions) in elite female cricket. This equates to a head impact every 2000 balls and concussion every 9000 balls in male domestic cricket. Concussion rates per 1000 player-match hours were 0.4 for elite males and 0.5 for elite females; 53% of head impacts in females were diagnosed as concussions compared with 32% in males, and 83% of concussions resulted in missing no more than 1 game.Conclusion:The rate of concussion in cricket is higher than previously appreciated; however, the majority of patients recovered quickly, and players generally did not miss much playing time as a result. The institution of concussion policies after head impact, including player substitution, appears to have had an effect on increasing reporting of symptoms, resulting in an increase in diagnosis of concussion.Clinical Relevance:Concussion in cricket is not as infrequent as previously assumed. Ongoing review of the rules and regulations is required to ensure that protection of player welfare lies in parallel with other sporting codes.

BackgroundVideo review has become an important tool in professional sporting codes to help sideline identification and management of players with a potential concussion.AimTo assess current practices related to video review of concussion in professional sports internationally, and compare protocols and diagnostic criteria used to identify and manage potential concussions.MethodsCurrent concussion management guidelines from professional national and international sporting codes were reviewed. Specific criteria and definitions of video signs associated with concussion were compared between codes. Rules and regulations adopted across the codes for processes around video review were also assessed.ResultsSix sports with specific diagnostic criteria and definitions for signs of concussion identified on video review participated in this study (Australian football, American football, world rugby, cricket, rugby league and ice hockey). Video signs common to all sports include lying motionless/loss of responsiveness and motor incoordination. The video signs considered by the majority of sports as most predictive of a diagnosis of concussion include motor incoordination, impact seizure, tonic posturing and lying motionless. Regulatory requirements, sideline availability of video, medical expertise of video reviewers and use of spotters differ across sports and geographical boundaries. By and large, these differences reflect a pragmatic approach from each sport, with limited underlying research and development of the video review process in some instances.ConclusionsThe use of video analysis in assisting medical staff with the diagnosis or identification of potential concussion is well established across different sports internationally. The diagnostic criteria used and the expertise of the video review personnel are not clearly established, and research efforts would benefit from a collaborative harmonisation across sporting codes.

Video analysis of situational factors associated with head impacts and concussion has been completed in several sports, however has yet to be completed in cricket. This study aimed to identify situational factors associated with concussion in elite Australian male and female cricket. Match video of head impacts were coded for player position, impacting object, source of ball, location of impact, and where the ball went after impact. Head impacts were then categorised as either concussion or no concussion based on clinical diagnosis. Data for 197 head impacts included 35 (18%) which were diagnosed as concussion. Head impacts typically occurred to an on-strike batter facing a pace bowler (84%). If the ball stopped or rebounded towards the source, 21% were diagnosed as concussion (13% if the ball deflected away from the source). If impact was to an unprotected head, 38% were diagnosed as concussion (16% if impact was to a helmet). If impact was to the back of the helmet or head, 40% were diagnosed as concussion (11–21% for other areas of the head or helmet). The combination of situational factors most consistent with concussion were impact from ball that hit the back of helmet or head and stopped or rebounded towards the source (PPV 80%, p = 0.002). Consideration of the situational factors of a head impact may improve the speed and accuracy of clinical decision making on whether to remove a player from the field for further assessment, particularly if clinical signs are unclear. Video may be used as a tool to support this process. Improved impact attenuation of cricket helmets, particularly at the back, may reduce the risk of concussion.

Objectives:To compare the safety policies and practices reported to be adopted during training and competition by community sports clubs in northern Sydney, Australia.Methods:This cross sectional study involved face to face interviews, using an 81 item extensively validated questionnaire, with representatives of 163 community netball, rugby league, rugby union, and soccer clubs (response rate 85%). The study was undertaken during the winter sports season of 2000. Two separate 14 item scales were developed to analyse the level of safety policy adoption and safety practice implementation during training and competition. The statistical analysis comprised descriptive and inferential analysis stratified by sport.Results:The reliability of the scales was good: Cronbach’s α  =  0.70 (competition scale) to 0.81 (training scale). Significant differences were found between the safety scores for training and competition for all clubs (mean difference 11.2; 95% confidence interval (CI) 10.0 to 12.5) and for each of the four sports: netball (mean difference 14.9; 95% CI 12.6 to 17.2); rugby league (mean difference 10.3; 95% CI 7.1 to 13.6); rugby union (mean difference 9.4; 95% CI 7.1 to 11.7); and soccer (mean difference 8.4; 95% CI 6.5 to 10.3).Conclusions:The differences in the mean competition and training safety scores were significant for all sports. This indicates that safety policies were less often adopted and practices less often implemented during training than during competition. As injuries do occur at training, and sports participants often spend considerably more time training than competing, sporting bodies should consider whether the safety policies and practices adopted and implemented at training are adequate.