Jam J. Khojasteh1, David K. Brennan2, Eric Sherburn2,

1Oklahoma State University, Tulsa, Oklahoma, 2University of Oklahoma Center for Concussion, Tulsa, Oklahoma

There are estimated 170,000 concussion each year in Australia, 75% are Sports Related Concussions (SRC). Many concussions go unreported, mostly due to the “culture of concussion” and a player reluctance for removal from play. Team physicians and other providers must establish a sideline evaluation protocol that is reliable, and considers the safety of the player against premature Return to Play (RTP). Loss of Consciousness (LOC) is common in SRC but not necessary for a positive diagnosis. PURPOSE: This study examines the RTP predictive value of LOC and game day RTP. The relationship between Number of Symptoms (NOS) and game day RTP was also examined. Both variables are included in the New South Wales Rugby League (NSWRL) Head Injury Assessment (HIA) protocol used in the assessment and determination of player RTP status after sustaining a head impact. METHODS: Sports physicians from 14 professional Rugby League teams (18-20 year age group) completed a standardized 18 item Head Injury Assessment (HIA (n = 107) for all players sustaining a head impact over the course of a 22 game 2019 season. The form has four sections 1) General information, 2) Structural head/neck injury management, 3) Removal from play criteria and 4) RTP status. A Chi Square (2x2) analyses for LOC status and RTP outcome status was performed. Predictive values, specificity and sensitivity were calculated. An independent t-test assessed the differences between NOS and RTP status. RESULTS: For LOC and RTP status, the positive predicted value (PPV) was moderate at 69.6% and the negative predictive value (NPV) was very low at 8.3%. Sensitivity for LOC status and removal from play was high at 0.83 while specificity was low 0.04 There was a weak non-significant relationship between LOC and RTP status, χ2 (1) = 2.541, p = .111 ES = .027. Mean differences in NOS for those returning to play compared to those removed from play were very small and non-significant, (M = -.609 SE± .371) t(89) = -1.642, p = .104, g = - 0.382. CONCLUSION: LOC status had high sensitivity but very poor specificity with regard to determining RTP status. NOS did not significantly influence game day RTP status. For game day RTP, the clinician must consider a broad spectrum of factors that represent the true impairment of the athlete. No single variable should determine the RTP trajectory.

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