INTRODUCTION

American football is renowned for being one of the most contact-intensive sports, frequently resulting in head injuries, with over 40% of retired National Football League (NFL) players showing evidence of long-term sequelae. Contrastingly, epidemiological data on head injuries in rugby, a sport with shared origins and similarities to American football, is lagging. Rugby has grown significantly in the United States over the past few decades. Despite the level of contact rivaling that of football, players wear little to no protective gear. Given the rising popularity of rugby in American sports, it is crucial to examine the rates and mechanisms of injury to better protect these high-performance athletes.

METHODS

The National Electronic Injury Surveillance System (NEISS) was queried for injuries related to playing rugby while using body part codes for head injuries between 2004-2023. NEISS offers estimates of national injuries reported to emergency departments across the United States. Narratives were screened for relevance, specific diagnosis, and mechanisms of injury. Non-cranial head injuries were excluded from the narratives, and nonspecific narratives only indicating a ‘head injury’ or ‘head trauma’ were only included if a loss of consciousness was noted. Weighted survey analysis determined incidence rates and 95% confidence intervals. Weighted binomial regression was used to analyze relationships between age and other binary variables.

RESULTS

A total of 910 narratives produced a national estimate of 29,250 emergency department (ED) visits for traumatic brain injuries (TBI) in the United States from playing rugby between 2004-2023. Of all the estimated cases of TBI, 63.3% were concussions (Figure 1), of which 17.6% were accompanied by a loss of consciousness. The majority of those who sustained a TBI were male (70%), and the average age was 20 years (Figure 2). Male rugby players with TBI were older on average than females (P = 0.04). A total of 565 narratives (national estimate: 17,781) indicated the mechanism of injury, with tackles (27.4%) resulting in more injuries than any other observed mechanism.

The prevalence of head injuries among rugby players is a pressing issue, compounded by the lack of comprehensive research on injury frequency and on-field signs like motor incoordination. These injuries pose immediate and long-term risks, particularly for younger, inexperienced athletes who may have poorer tackling form. Addressing these challenges requires ongoing research, education, and improved injury prevention strategies, such as tailored protective equipment and training in safe play practices. Investing in these measures enhances player safety and supports the long-term health and performance of young athletes, highlighting the need for further studies into rugby players' neurologic health.