Return to play (RTP) in elite rugby is managed using a 6-stage graduated RTP protocol, which can result in clearance to play within 1 week of injury. We aimed to explore how symptom, cognitive, and balance presentation and evolution during concussion screens 2 h (head injury assessment (HIA) 2) and 48 h (HIA3) after injury were associated with time to RTP) to identify whether a more conservative graduated RTP may be appropriate. A retrospective cohort study was conducted in 380 concussed rugby players from elite men's rugby over 3 consecutive seasons Players were classified as shorter or longer returns, depending on whether RTP occurred within 7 days (allowing them to be considered to play the match 1 week after injury) or longer than 8 days, respectively. Symptom, cognitive, and balance performance during screens was assessed relative to baseline (normal or abnormal) and to the preceding screen (improving or worsening). Associations between sub-test abnormalities and RTP time were explored using odds ratios (OR, longer . shorter). Median day absence was compared between players with abnormal or worsening results and those whose results were normal or improving. Abnormal symptom results during screens 2 h and 48 h after concussion were associated with longer return time (HIA2: OR = 2.21, 95% confidence interval (95%CI): 1.39–3.50; HIA3: OR = 3.30, 95%CI: 1.89–5.75). Worsening symptom number or severity from the time of injury to 2 h and 48 h post-injury was associated with longer return (HIA2: OR = 2.49, 95%CI: 1.36–4.58; HIA3: OR = 3.34, 95%CI: 1.10–10.15. Median days absence was greater in players with abnormal symptom results at both HIA2 and HIA3. Cognitive and balance performance were not associated with longer return and did not affect median days absence. Symptom presentation and evolution within 48 h of concussion were associated with longer RTP times. This may guide a more conservative approach to RTP, while still adhering to individualized concussion management principles.

中文翻译：

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精英橄榄球联盟中受伤后 48 小时内的症状表现和演变与脑震荡后重返比赛相关

精英橄榄球赛的重返比赛 (​​RTP) 采用 6 阶段分级 RTP 协议进行管理，可在受伤后 1 周内恢复比赛。我们的目的是探索脑震荡筛查期间的症状、认知和平衡表现及演变如何与受伤后 2 小时（头部受伤评估 (HIA) 2）和 48 小时 (HIA3) 与 RTP 时间相关，以确定是否更保守的毕业RTP 可能是合适的。一项回顾性队列研究对连续 3 个赛季的 380 名来自精英男子橄榄球队的脑震荡橄榄球运动员进行了一项回顾性队列研究。根据 RTP 是否发生在 7 天内（允许他们在受伤后 1 周内被考虑参加比赛），将球员分为较短或较长的回归) 或分别超过 8 天。相对于基线（正常或异常）和之前的筛查（改善或恶化），评估筛查期间的症状、认知和平衡表现。使用比值比（OR，更长。更短）探索子测试异常与 RTP 时间之间的关联。对成绩异常或恶化的球员与成绩正常或有所改善的球员之间的中位缺勤天数进行了比较。脑震荡后 2 小时和 48 小时筛查期间的异常症状结果与较长的返回时间相关（HIA2：OR = 2.21，95% 置信区间 (95%CI)：1.39–3.50；HIA3：OR = 3.30，95%CI：1.89 –5.75）。从受伤时到受伤后 2 小时和 48 小时，症状数量或严重程度的恶化与更长的恢复时间相关（HIA2：OR = 2.49，95%CI：1.36–4.58；HIA3：OR = 3.34，95%CI：1.10 –10.15. HIA2 和 HIA3 症状结果异常的球员的中位缺席天数与更长的回归无关，并且不影响脑震荡 48 小时内的中位缺席天数。更长的 RTP 时间。这可能会指导更保守的 RTP 方法，同时仍然坚持个性化脑震荡管理原则。