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“Recognize and Remove”: A Universal Principle for the Management of Sports Injuries

Objective: To identify the locations and types of injury that result in players not being immediately removed from the field of play when injured and to quantify the magnitude of the situation. Design: Prospective cohort epidemiological study with definitions and procedures compliant with the international consensus statement for studies in rugby. Setting: Sevens World Series (SWS) (2008-2016) and Rugby World Cup (RWC) (2007, 2011, 2015). Participants: Players from 17 countries taking part in the SWS and 22 countries taking part in the RWC. Main Outcome Measures: Location, type, and mean severity of injury, period of match when the injury occurred and whether players were removed from the field of play when injured. Results: Injured players (51.5%) in the SWS and 33.1% of injured players in the RWC were immediately removed from the field of play at the time of injury. The percentages of players immediately removed varied from 16.7% for hand fractures (severity: 71 days) to 96.7% for shoulder dislocations/subluxations (severity: 105 days) during the SWS and from 4.5% for shoulder ligament sprains (severity: 25 days) to 65.9% for concussions (severity: 9 days) during the RWC. The percentage of players immediately removed from play when injured was not related to the severity of the injury sustained. Conclusions: A high proportion of players continue to play (in the same game) after sustaining an injury although the likelihood of being removed from play is not dependent on injury severity.