World Rugby defends head-injury protocols in wake of Johnny Sexton’s selection

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World Rugby has warned against “irresponsible” remote head-injury diagnosis in defending its Head Injury Assessment (HIA) protocols.

Safety campaign group Progressive Rugby has claimed HIA checks are “being exposed” in the wake of Johnny Sexton’s selection for Ireland’s second Test against New Zealand.

Talismanic fly-half Sexton failed HIA1 – an on-field assessment – in Ireland’s 42-19 defeat by the All Blacks in Auckland last weekend.

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Andy Farrell file photo
Ireland boss Andy Farrell, pictured, has selected Johnny Sexton to start at fly-half (Niall Carson/PA)

Progressive Rugby has called into question Sexton’s subsequent selection for Saturday’s second Test in Dunedin, raising fears over the HIA process.

But World Rugby has stressed that failing the HIA1 on-field assessment does not automatically mean a player has sustained concussion.

“It is the duty of any individual or organisation commenting on the Head Injury Assessment process to do so using the facts,” a World Rugby spokesperson told the PA news agency.

“Attempting to diagnose a serious medical condition like concussion from afar, without all the relevant information including a player’s medical history, is irresponsible and no substitute for the world-leading medical care received by elite rugby players.

“Doctors are supported by the Head Injury Assessment and recently updated return-to-play protocols put in place by World Rugby.

“These protocols are developed using scientific evidence and independent expert opinion which are kept under constant review, as we never stand still on player welfare.”

Sexton was withdrawn after slipping and colliding with Sam Kane in Saturday’s first Test defeat, with the 36-year-old not returning after his HIA1 check.

The full HIA process involves three steps, and Sexton later passed both HIA2 and HIA3 before being cleared to return to play this coming weekend.

Progressive Rugby has questioned Sexton’s return, but World Rugby has moved to defend the head-injury check process.

“Concussion in elite rugby is formally diagnosed by qualified doctors via the HIA2 and HIA3 assessments as part of the Head Injury Assessment protocol, with the exception of any player displaying obvious symptoms who will be immediately removed from play,” said a World Rugby spokesperson.

“The in-game HIA1 off-field assessment combines video review and clinical observation to determine suspected concussion and informs the need to remove a player as a precaution.

“Any player who had not displayed obvious concussion symptoms and who compares to a pre-recorded baseline on HIA2 and HIA3 assessments, which take place two and 36 hours after an incident respectively, is deemed by medical professionals to be clear of concussion.

“There is an open and frank discussion about head injury in rugby which is to be welcomed.

“Everyone wants the game to be the safest it can possibly be, and to encourage new players to benefit from all the good that rugby does.

“It should be reiterated that the Head Injury Assessment process only applies to elite rugby where there is an extremely high level of constant medical care.

“Such an environment is not possible at the community level and anyone who suspects a concussion should seek medical advice immediately as per World Rugby guidelines.”

Safety group Progressive Rugby insists, however, that any failure of HIA1 should lead medics to treat the player’s future participation with “extreme caution”.

“Elite players who fail an in-game HIA1 have, by definition, displayed cognitive dysfunction requiring their removal,” said a Progressive Rugby spokesperson.

“In our view, this is sufficient evidence, regardless of subsequent testing, to exercise extreme caution for the good of both their short and long-term health.

“This caution must be further amplified in players with a history of brain injury, as evidence is they are at higher risk of sustaining further concussions and other injuries.

“Regrettably, the HIA is being exposed. Last week the process again failed to diagnose a clear and obvious brain injury (Jeremy Loughman), while three days later we are told it has identified a phantom one (Sexton).

“The fact is there remains no examination by any expert that can demonstrate a brain has healed and is not at risk of further damage. As such, if player welfare is truly the game’s number one priority, the only option must be to err on the side of caution – otherwise the new elite protocols are failing in their key purpose.”