Rugby union is an extremely physical sport comprised of crunching tackles, rucks, scrums, mauls and line outs contested by enormous athletes.
In 2018, these high impact events made concussions the most reported match injury in the English professional game for the sixth season in a row.
The growing evidence of the long-term damage of sports-related brain injuries led World Rugby, the game’s global governing body, to search for a way to better identify and treat concussions.
The result was the Head Injury Assessment (HIA), a series of checks to determine whether a player has had a concussion and needs further treatment. The three stage assessment begins when match officials or doctors spot a suspected head impact on the pitch.
If the doctor recognises the symptoms of a concussion, the player is immediately removed from the game. If the signs are unclear but suspicious, the player is subbed off for a 10 minutes assessment that determines whether they’re fit to reenter the field.
Shortly after the game, every player undergoes another evaluation involving a check of their systems and a comparison of their memory and balance against their baseline measurements.
If this reveals signs of concussion that were previously not observed, they enter a third stage of assessment that takes place following two nights of sleep.
This system was tested during the 2015 Rugby World Cup in England, using cloud-based technology developed by CSx, which collects neuro-cognitive information that medical staff can review to determine if a player has had a concussion.
They then transferred the data on the players, incidents and assessments to the data analytics platform Domo via an API, where the various datasets can be joined up for analysis.
The project was led by Marc Douglas, research, turf and equipment manager at World Rugby.
"I'm not a coder. I'm a mechanical engineer and accountant by background and I've barely done any coding in my life,” he admits. “I tried to use the ETL, but they just weren't specific enough for what I was looking to do, so I started looking at the SQL workflows in Domo.
“I’ve got to say it was very easy for me to pick up enough to do what I needed to do. So my first advice is you don't need to be a coder to work with SQL workloads.
"What you do need is a computer, two hands if you have them, and Domo University. That's it. That's all I did to learn enough SQL to do what I needed to do.”
Drilling into the data
Douglas recommends reviewing the data in a format you understand, which in his case was an Excel spreadsheet.
"You can properly drill down into the data and give it a good grilling, and find those little nuggets that you need to improve the process," he told Computerworld UK, "but I would always encourage people to build it back into Domo."
It was imperative for World Rugby to have a single source of data, so that everyone would be looking at the same thing. They then sought feedback from medical experts, without letting them guide the analysis.
"Do not ask a doctor what they want,” Douglas suggests. “Show them something, and let them use human nature to tell you what you're doing wrong. Doctors love to tell you what you're doing wrong.”
This approach allowed World Rugby to create numerous iterations of the visualisations they use in Domo.
It also provided them with the flexibility to create and adjust calculations on the fly and develop KPIs to measure the impact they were having.
They started with four KPIs, which has now grown to seven, as they’ve learnt about additional factors they should track, but the key factor remains getting concussed players off the field.
“In 2012, before we launched the PSCA [pitch side concussion assessment], the figure was 56 percent. That meant if you were a rugby player concussed, you were more likely to continue and finish the game than you were to be removed from the game, which is a serious problem. And that stat there is the reason we started all of this,” says Douglas.
“Over the process of all of this work, we’ve cut that down to seven percent, which is a massive job. Over six years, you're going from 56 per cent, [meaning] you’re more likely than not to stay on the field, to a one in 14 chance that if you have concussion you’re not going to be removed from the field of play. It shows that our process works.”
Changing the game
The system needed the support of the players to make it effective however, a problem when they rarely want to leave the game.
Douglas has seen American football players pretending to have hurt an ankle after receiving a blow to the head in order to stay in the game. He says rugby players are more open to the process, as long as it works and extends their careers, rather than forcing them off the pitch when they were still fit to play.
The chance of them being removed from the game without suffering from a concussion have gone up from one in 33 to one in 20, but he views that as a positive sign of cautious assessments.
“I’m fairly comfortable with one in 20,” he says. “If that went to one in 10, I’m not so sure that the players would be comfortable with that.”
Domo also allows World Rugby to check if the doctors are doing the right thing. Douglas has set up an alert to check when a doctor’s actions don’t match the guidelines.
“I’m happy to say that I haven’t had an alert in three months,” he says. “So either my alerts aren’t working, or the doctors have started doing something right.”
Tackles are the source of 50 per cent of concussions in rugby, which made it at a natural starting point for turning the analysis into a set of rules.
The tackler is three times more likely to get a concussion than the ball carrier, and standing during the tackle rather than bending at the waist quadruples the risk.
World Rugby used this data to create the High Tackle Warning, which was trialled in last year’s under-20 championships in France. Under the new rule, tacklers who exceed the height boundary are given two warnings before they receive a suspension.
World Rugby plans continue using Domo in their investigations into concussion management.
”It is not the number one injury in rugby, but it’s the injury that affects players the most,” says Douglas. “You can recover from calf strains. You can recover from ACL tears. You don’t necessarily recover from concussions, especially if you continue to get them.”