Symptom presentation and evolution in the first 48 hours after injury are associated with return to play after concussion in elite Rugby Union.

Background: 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.

Methods: A retrospective cohort study was conducted in 380 concussed rugby players from elite men's rugby over 3 consecutive seasons.