A comparison of clinical assessment with common diagnostic tools for monitoring concussion recovery in adolescent rugby union players

Objectives: To characterise the incidence, severity and recovery of sport-related concussion (SRC) in schoolboy rugby players and explore whether the Sports Concussion Assessment Tool (SCAT), Cogstate Brief Battery (CBB) and the King-Devick test (K-D test) can be used to monitor concussion status through to full recovery. Design: Prospective cohort study. Setting: Rugby union has a high rate of SRC; however, there is little research investigating how concussion affects adolescent rugby players. Participants: Schoolboy rugby players. Main outcome measures: Participants completed baseline tests in the preseason. Participants diagnosed with SRC during the season attended for post-concussion testing on a weekly basis until recovered. Results: 135 schoolboy rugby players (16.7 +/- 0.82y) participated in the study. There were 18 SRCs in 16 participants. Concussion incidence was 9/1000 player hours. CBB and K-D tests were poorly associated with clinical assessment and produced high false negative rates (0.58 and 0.52 respectively). Conclusions: This study reports a relatively high match SRC incidence for an adolescent population. Analysis of clinical recovery with CBB and K-D test revealed a relatively poor ability to accurately monitor concussion status compared to clinical assessment suggesting that these tools should not be used in isolation for monitoring SRC recovery in adolescents.