Sharp increase in number of women taken to emergency department with rugby-related injuries

The findings showed that there was a 242.9% increase in attendances with women’s rugby injuries. There were increases in high impact injuries: dislocations, 0% versus 2.8%, wounds, 4.8% vs 6.3%, and concussions 2.4% vs 10.4%.

It was also found that CT scans are utilised more, 2.4% versus 6.9%. Follow up has changed with increased specialist opinion with team physicians, 0% vs 7.7%, hand clinics, 4.8% vs 9.0%, and concussion clinics, 0.0% vs 6.9%.

Study co-author Stephen Gilmartin, from the Emergency Department of St Vincent’s University Hospital, said that women’s rugby injury presentations are increasing.

We have seen a rise in significant injuries. Patients now require first level diagnostics and specialist follow up care.

“Women’s rugby is a rapidly growing sport. Following multiple initiatives launched by the Irish Rugby Football Union (IRFU), participation levels in Ireland have grown in line with worldwide rate of growth. Current reports note that over 50% of clubs now have a women’s section. This is in keeping with an overall increase in the number of women participating in sport in Ireland.”

The growing popularity of women’s rugby in Ireland was demonstrated by the successful hosting of the 2017 women’s world cup. Following this the IRFU has released their ‘women in rugby’ action plan.

St Vincent’s University Hospital is located on the south side of Co Dublin. There are 12 women’s rugby clubs in the hospital’s immediate catchment area. The last review of rugby injuries presenting to the ED in 1992 reported only one presentation secondary to women’s rugby participation.

The aim of the study, published in the Irish Medical Journal, was to describe the change in injury patterns, diagnostics used and treatments provided to women’s rugby players in our emergency department between two seasons ten years apart.

Mr Gilmartin continued: “This reported 1,341 adult players nationally with 2,500 active youth players. The IRFU is planning to increase participation and coaching numbers by 20% over the next five years. Despite the rapid expansion in playing numbers the sport continues to lag behind its men’s counterpart in terms of medical research.

There is a dearth of published data studying women’s rugby injuries and injury epidemiology with only one reporting on the role emergency departments play in their care.

In terms of the injuries sustained, soft tissue injuries and fractures were found to be the most common injuries in both study groups 52.4% (22) versus 40.3% (58), and 30.0% (13) vs 29.9% (43) respectively. In the first study period, 4.8% (2) patients had wounds, one patient had a concussion, and 4.8% of injuries were classified as ‘other’. No patient attended with a dislocation.

During the second study, period wounds accounted for 6.3% (9) of injuries, concussion 10.4% (15), dislocations 2.8% (4) and 6.3% of patients were classified as ‘other’. No final diagnosis was available for 4.8% (2) of patients in the first study period and 4.9% (7) of the second.

“We hypothesised that there would be an overall increased in presentations to the emergency department secondary to women’s rugby injuries. Our results have shown a 242.9% increase in women’s rugby-related injuries between the two study periods.

"This increase is due to a rise in presentations from tag rugby (32.1%), rugby union (650%) and sevens rugby. The increase in rugby union presentations has seen an expectant rise in high impact injuries including dislocations (0% verses 2.8%), wounds (4.8% vs 6.3%) and concussions (2.4% vs 10.4%).

“There has been a five-fold increase in patients being diagnosed by concussion. These figures are likely influenced by increased research and interest surrounding concussion over the last ten years. There has been an exponential rise among patients presenting with a head injury (0% versus 4.7%).

"The rise in concussion diagnosis adds to the growing concerns for player safety in both women’s and men's rugby. Locally in our emergency department, the increase in concussion presentations has seen the introduction of a consultant delivered concussion clinic,” added Mr Gilmartin.

This will be a growing problem going forward as women’s rugby continues to develop in Ireland. Patients require first level diagnostics and specialist follow up care. It is important that all emergency departments are prepared to care for the increasing level of attendances secondary to high impact female sports injuries.

The study team aims to monitor presentations on a yearly basis to examine if the increasing trends continue. They also aim to perform a study comparing presentation from women’s rugby to their male counterparts. Differences are seen in the type of injuries suffered. Concussion is the most frequent injury in the men’s game and anterior talo-fibuar ligament is the most frequent in the women’s game.

The IRFU in conjunction with the University of Limerick are pioneering women’s rugby injury research with the development of the Irish Rugby Injury Surveillance (IRIS) study. The IRIS study aims to measure the long term injury incidence and trends in both men’s and women’s amateur rugby union in Ireland.

The study is surveillance in nature and does not record medical treatment received.