Rugby is a full contact sport with minimal protective gears unlike American football and ice hockey. Sports-related Concussion with Structural Brain Injury (SRCSBI) is rarely reported. However, the outcome and sequelae can be devastating.
A 25-year-old gentleman was tackled and thrown on the ground. He hit his head on the ground and rolled over multiple times. He lost consciousness and developed tonic posturing for four minutes. At the medical tent, he became more alert without signs of neurological deficit. He had no external injury but complained of headaches with few episodes of vomiting. He was then referred to a tertiary centre.
CT scan of the brain revealed a left temporal bone fracture with minimal EDH. He was admitted for observation and discharged for home care two days later.
Nearly 18 months after the incident, he returned to playing full contact rugby with no symptoms. Between 1.6 to 3.8 million athletes diagnosed with Sports-related Concussion (SRC) in the United States every year. Only 9% of the patients had positive findings on MRI and CT scan. Systemic review by Zuckerman SL et al in 2012, showed only 40 articles containing SRCSBI, of which 28 are case reports, 10 case series, 1 observational cohort design and 1 case-control study. EDH has been previously reported in other sports such as basketball, golf, skiing, and skateboarding. The outcome of these patient depends on clinical and radiological predictors. There is no consensus on return to play in SCRBSI as the incidence is rare. Ultimately, it depends on the clinical assessment of the physicians. However, if there is surgical intervention the athlete should not be allowed to return to contact sports. It is crucial for emergency physicians to be present in high impact or contact sports events to ensure the welfare and safety of the athletes.
EDH, Rugby, Sports injury, Concussion, Traumatic brain injury