Baseline Symptom Collection in Elite Rugby Union Players—Limited Clinical Utility? An Investigation of Assessments Across 5879 men and Women Athletes

In World Rugby's Head Injury Assessment (HIA) protocol, a modified Sports Concussion Assessment Tool (SCAT) is completed during the pre-season (baseline) and when a player has a suspected head injury. The symptom component of the SCAT, which involves comparing current to baseline symptoms, has been shown to be the most predictive component for concussion diagnosis. Because the clinical comparison of symptom report to baseline is a key determinant of concussion diagnosis, this study aims to explore the relationship between symptoms endorsement at baseline and during HIA. Mean and standard deviation (SD) or median and interquartile ranges (IQR) are presented along with relevant bivariate analyses. Logistic regressions compared proportions of symptom endorsement profiles between men and women. At baseline, 'Trouble sleeping' and 'Fatigue or low energy' were commonly reported symptoms for men and women. At baseline, women (mean + SD) reported more symptoms than men (mean + SD) on average. During the HIA, women players were nearly 3 times (Relative risk: 2.98 95% CIs: 2.47-3.60) more likely than men to report fewer symptoms immediately after the match than at baseline (47% women vs. 16% men). While this study highlights the importance of collecting baseline assessment as a medical overview of players, it de-emphasises the relevance of baseline symptoms when using the SCAT as a clinical assessment tool in professional rugby players. This study also highlights important differences in men and women's rugby players in symptom reporting, and recommends de-coupling baseline symptom reporting from the diagnostic part of the HIA.