Intended for healthcare professionals

Rapid response to:


The unknown risks of youth rugby

BMJ 2015; 350 doi: (Published 08 January 2015) Cite this as: BMJ 2015;350:h26

Rapid Response:

Re: The unknown risks of youth rugby: reply to response from Drs Trewartha and Stokes

The response to my editorial has been extensive and very illuminating. A large portion of it from parents of rugby injured children. Trewartha and Stokes' communication deserves special attention as much of it relates to work sponsored by the sports regulatory body in England. I absolutely agree that there has been a noticeable boom in injury prevention initiatives and injury surveys over the past couple of years.

Appropriately too in my view as observations by myself, other parents and increasingly some authors, suggest that injury is more of a problem than is generally accepted. I make no apology for supporting this assertion. The stakes are after all, very high. The reasons for this are becoming clear. A great deal of research in the UK involves restricted study groups both in terms of size and composition. This is true even for contemporary initiatives such as the RFUs CRISP project. We thus remain far from consensus informed by a comprehensive national data set. The value of such has clearly been demonstrated by the smart rugby initiative in New Zealand, where meticulous injury data are collected by the national accident injury compensation scheme. These have contributed to initiatives that have demonstrably reduced injury incidence in that nation. The other issue is that so many contemporary surveys depend on self reporting of injury by players, clubs and schools. The potential for under reporting in these situations is obvious.

Another point I'd like to make is that the machinery for prospectively acquiring a national data set already exists. All clinical activity by emergency departments and GPs is coded and there are several redundant ICD codes that could potentially be deployed to allow large scale surveillance of all rugby ( and other sporting) injuries. This would require a national public health initiative of sorts as ICD codes are generally not deployed unless associated with a tariff. This is something my department is already working on with NHS England.

Trewartha and Stokes also imply that the children's game is comprehensively supported by a wrap around interest from RFU sponsored bodies, particularly when it comes to injury. Having observed school and club rugby over a decade in this region, I think the reality is that such involvement is actually very patchy. Despite the fact that Bristol Paediatric Neurosurgery is an internationally recognised, research intense department and the RFUs injury surveillance service is based only twelve miles from here in Bath, we have not in ten years had any approach regarding injured players we've seen, return to play schedules or development of research collaborations. Given the number of paediatric rugby injuries we treat, this seems to be a bit of a missed opportunity. And indicative of the relative inertia, that until very recently, has bedevilled progress in this field.

Competing interests: No competing interests

25 February 2015
Michael Carter
Consultant paediatric neurosurgeon
Bristol Royal Hospital for Children
Upper Maudlin Street, Bristol BS2 8BJ