Video Review
Goal of Video Review
To determine the most appropriate action in the event of a head injury.
- Criteria 1 – remove, view, discuss.
- Criteria 2 – remove, assess, discuss.
- Request TD to undertake an on-field assessment.
- Discuss with TD to clarify the case.
Criteria 1 - Clinical Indicators
Twelve indications for permanent and immediate removal
- Convulsion
- Tonic posturing
- Suspected LOC
- Confirmed LOC
- Clearly dazed
- Ataxia
- Oculomotor signs
- Player not orientated in TPP
- Definite confusion
- Definite behaviour change
- On-field identification of sign or symptom of concussion
- Under-19 Recognise and Remove
Only the first six indicators in the above list can be identified using video signs
Criteria 1 - Video Signs
- Convulsion
- Tonic posturing
- Rigid extended upper limb(s)
- LOC – suspected /confirmed
- Lying motionless for > 5 secs
- Falling no protection
- Failure to protect themselves on ground
- Cervical hypotonia
- Unusual postural reaction
- Clearly dazed
- Vacant or blank stare
- Ataxia
- Unsteady on rising
- Unsteady on feet
- Unusual postural reaction
Criteria 1 - Video Signs Comments
- Criteria 1 video signs are not always clear cut.
- Clinical suspicion of a Criteria 1 sign → look at multiple angles.
- Player and team mate reaction is often telling.
- Review using the 5-point in time process.
- Return to feet and return to play must be viewed.
- If there is a suspicion of Criteria 1 event – the player MUST be removed from play and a review of the video undertaken with the TD. As a minimum the off-field HIA1 assessment must be completed and a second video review completed.
Criteria 2 - Clinical Indicators
Five indications for off-field assessment
- Head impact where diagnosis not immediately apparent
- Possible behaviour change
- Possible confusion
- Event witnessed with potential to cause a concussion
- Sub-threshold Criteria 1 sign e.g. possible balance disturbance, possible LOC
Criteria 2 are clinical indicators of suspected concussion NOT video signs
Criteria 2 - Video Signs
- Head impact where diagnosis not immediately apparent
- Sub-threshold ataxia
- Hands to balance on rising, crawling
- Player collapses on impact
- Sub-threshold LOC
- Motionless 3-5 seconds
- Referee / player concern
- Sub-threshold blank stare
- Multiple signs that don’t confirm a Criteria 1
Post probable head injury event
- On ground for more than 30 seconds
- Receives medical attention for > 1 minute
- Returns to ground after head impact
- Second medical review
- Slow to respond or slow to rise
- Avoids further game participation
- Poor performance on return to play
Criteria 2 - Video Signs Comments
- A Criteria 2 should be applied when there is a suspicion of a Criteria 1 event, but views are unclear, or an event does not reach the ‘threshold for a Criteria 1 video sign.
- An off-field HIA1 assessment is indicated if there is suspicion of an event, but you cannot be sure on available views.
- Where there are a number of individually “less serious” events or signs in a row.
- When you have not seen the event, or cannot see an incident on video but a player is behaving strangely or under-performing.
- When the player receives prolonged or repeated medical attention after a head injury event.
5-Step Approach to Video Review
World Rugby has developed a 5 step approach to video review which aims to improve consistency and accuracy of video interpretation.
The 5 steps are Look at the head impact, watch for the immediate response 0-2 seconds, note the delayed response 3-7 seconds, watch the return to stand and watch the return to play.
This 5 step approach supports a more accurate review of a head injury video
Video Review Process - 5 Steps
- Look at the head impact event – identify a direct blow or whiplash, force of impact.
- Direct head contact, the head will move away from the point of contact.
- Whiplash the head will move towards the contact.
- Beware of head contact with ground after an initial contact.
- Beware contact from a second player AFTER the event.
- Immediate response (0-2 second) – identify inappropriate postural response.
- Player falling to the ground without head or neck control.
- Player falling stiffly – displaying tonic posturing.
- Player not protecting himself as he falls to ground.
- Player not protecting himself on the ground from other players (boots etc.).
- Delayed response (3-7 seconds plus) – identify inappropriate postural or functional response.
- Evidence of convulsion or tonic posturing.
- The time the player remains motionless > 5 seconds is significant.
- Purposeful movements within the first 5 seconds.
- Return to feet (if they have fallen) – identify inappropriate functional response.
- Unsteady when attempting to stand
- Player using hands to get up- or crawling
- Player falling back to the ground
- Player with a vacant look?
- Player who is unsteady after getting to their feet – returning to kneel
- Player resting in ”tripod” position to avoid unsteadiness
- Return to play – identify inappropriate game actions/reactions.
- Player clearly confused and not functioning properly- eg. missed tackle
- Player not moving immediately to the correct position on the field of play
- Player not trying to participate or avoid returning to the game
Video Review - Speed Tips
Always start with a normal speed view before viewing slower vision
- Head impact – determining the mechanism of injury or point of impact may require very slow speeds (<25%) or even frame by frame review.
- Immediate response - if the point of primary interest is the initial impact or assessment as they fall to the ground then viewing the video at 50% or 25% speed may assist.
- Delayed response - looking a potential loss of consciousness whilst on the ground - 100% speed is best.
- Return to feet and return to play - Reduced playback speeds may be misleading.