CSx is an online programme created in conjunction with World Rugby to deliver the HIA protocol to rugby players around the world.

The HIA process has evolved since 2012 when the PSCA was first used. The CSx programme continues to evolve too.

This section outlines how the CSx module operates and should be used.

It is best to complete this module when you are ready to use the programme, and after each section in the module, complete the instructions for yourself within the programme.

For best viewing make sure to toggle to full screen for each video.

Getting Started

To complete this module you will need:

  • A tablet
  • A reliable wifi connection
  • An “invite code” from your Chief Medical Officer (or designated person) so that you can register

Navigating the App

Teams, Competitions and Unions may upload all of their players to the app.

Once players are uploaded baselines are added for comparison the the event of a HIA assessment

Menu Tabs

  • Player tab – this allows selection of players wither via team or competition.
  • Schedule tab – allows review or creation of team schedules- this prepopulates event details for a HIA.
  • Open cases tab - selecting a player with an open profile allows you to continue with their HIA process. It is not recommended to “close” a case unless the HIA process is completed.
  • Assessment tab – This opens all available assessment types – you may select the assessment you wish to use here
  • More tab – this allows ”Team Select”, and “Settings” which allows access to “clear of offline data” it is not recommended to access this.
  • The “help” section allows access to the online CSx help centre.

Using CSx offline

  • CSx may be used off-line.
  • To work properly however, the app and tablet must be “synced” before the game or when leaving internet access.
  • We recommend that the app is synced the afternoon of a game in good wifi coverage before all games to offset any potential coverage issues during the game.

Creating a Baseline

  • A players initial Baseline assessment may be started by finding “baselines” in the side menu.
  • Select “Create” for a new baseline assessment or “re-do” to replace the current baseline with a new one.
  • View brings you to the players assessment history

Completing an Assessment

  • Orientation testing is a component of the SCAT5 test
  • The correct answers are auto-populated by the app

  • The off-field HIA1 screen is a modified SCAT5. the instructions for all of the assessments are in the app.
  • For each assessment the instructions for the assessor can be read. And instructions for the player can be read out loud.

  • Changes to SCAT5 mean that the player is now handed the tablet to complete the symptom assessment themselves.They need to read the questions aloud and answer them.They should score the severity from 0-6.They may view a summary by hitting the “summary” tab in the right upper corner.Clicking on any individual symptoms brings them back to that symptom.The player then hands the tablet back.

  • Make sure the player cannot see the tablet screen for the immediate recall, delayed recall, orientation and digits backwards.
  • For immediate memory the words are read out at 1/second.
  • If the sound does not work, read the words as they appear to ensure correct cadence and order.

  • For digits backwards if a string is answered incorrectly another attempt is automatically created for the same length.
  • A 5 minute delayed recall lockout starts when immediate recall starts.

  • Months in reverse must be completed correctly in full

  • Neck pain is a commonly reported baseline symptom in rugby players.
  • Persistent neck pain may cause headache or may mimic some of the symptoms of concussion or post-concussion syndrome.
  • The neck examination is also part of the neurological examination,

  • The balance section has a description of the task required for the assessor, there is also a a graphic you may show the player.
  • Delayed recall may only be started after 5 minutes.
  • Assessments are only visible in player files when “synced”
  • Tandem gait is part of the neurological examination

  • Balance testing is the mBESS – Double leg stance, single leg stance, tandem stance

  • To score all tests score the number of errors outlined below
  • The graphic may also be used to remind the player of the stance

  • The finger to nose task is part of the neurological screen

  • The first three phases of the neurological screen are already completed and will be auto-populated by the app:Passive cervical spine movementFinger to nose taskTandem gait

New Injury Assessment Setup

  • The assessment button allows access to the assessment picker.
  • Each new “event” must be populated with game data.
  • When schedules have been uploaded by your union or competition event data will auto-fill.
  • If a player is visible in “open cases” do not create a new event

Off-field HIA1 Assessment

  • First identify if a Criteria 1 event has occurred.
  • Provide details of any signs seen
  • If there are no Criteria 1 signs select “Pitch side Head Injury Assessment”
  • Identify the reasons for this assessment.

Comparing to Baseline Assessment

  • The most recent player baseline scores will be available for comparison.
  • Where no baseline is available normative reference limits derived from 13,479 baseline SCAT tests from 7,565 elite adult rugby players are used.

Outcome logic

  • Some sections automatically select the outcome based on the answers given.
  • An abnormal section in HIA1 will select an “abnormal HIA1 screen”.
  • In certain situations this may be overruled by clinical judgement but this must be documented in the dialogue box and will saved in the assessment notes.

Assessment Notes

  • Assessment notes may be added at the end of any assessment

Post-injury Assessments

  • HIA2 & HIA3 may be commenced via the assessment tab
  • Selecting either test will show all players with an open case will be shown.
  • Select the player you wish to test from this.
  • If this is a new event or if the player has not had a HIA1 (or HIA2) press ”No, select another player”
  • You will need to create anew event similar to the HIA1

Dynamic Answers

  • The app uses dynamic answers to direct further questions wo you are directed to the correct options for further questions

Summary Button

  • At any stage during the assessment a live comparison with player baseline data may be viewed by selecting the summary button.
  • The answer may be changed by selecting the question and changing the entry.