Incidence of and return to play from head injury assessments in female, semi-elite, Rugby league players

Objective To determine the incidence of Head Injury Assessments (HIA) in female, semi-elite rugby league players and to explore age- and sex-related differences in HIA rates and return to play periods. Design Retrospective cohort study. Methods HIA data from all matches (n = 258) and training sessions undertaken by Under 17 (U17), Under 19 (U19), and Open-age (Open) group players during the 2023 and 2024 Queensland Rugby League competitions were analysed. HIAs were conducted by medical practitioners with incidence rates and ratios, and return to play times following positive HIAs (diagnosed concussion) calculated and compared between groups. Results Across 2023 and 2024, younger female players (U17 and/or U19) demonstrated significantly higher observed positive HIA rates than Open females, a pattern also observed in male competitions in 2024. Significant age differences were found in incidence rate ratios [95% confidence intervals] for observed positive HIAs (2023 female U19 > Open, 2.88 [1.34–6.87], p = 0.003; 2024 female U17 and U19 > Open, 2.66 [1.32–5.51], p = 0.0045 & 1.96 [1.00–3.97], p = 0.037); and 2024 male U17 > Open 2.18, [1.30–3.57], p = 0.002). Significant sex-related differences were found for the U19 female incidence rate ratios for observed positive and total HIAs in 2023 compared to males (2.13 [1.17–3.98], p = 0.008 and 2.13]1.17–3.98], p = 0.008). Return to play from observed positive HIAs was comparable across age groups and sexes in 2023 while in the 2024 timeframes were significantly longer for younger compared to Open age groups. Conclusions Younger players demonstrated greater observed positive HIA incidence rates/ratios than their older counterparts, with policy changes between 2023 and 2024 likely contributing to the extended return to play timeframes for younger age groups.