This  study  aimed  to determine the association of a range of off-field symptoms reported by athletes retrospectively with on-field concussion signs and in-office symptoms among rugby union players.

Cross-sectional study. We consecutively enrolled 92 adult rugby union players, within the first 72 h after sport concussion. Ten symptoms assessed using a retrospective symptoms interview were examined for their association with observed concussion signs and post-concussion symptoms using the Post-Concussion Symptoms Scale (PCSS).

Odds ratios revealed that athletes who was overtly symptomatic based on retrospective concussion interview at the time of the concussion were over 2.6 times more likely (p=0.047) to have exhibited post-traumatic amnesia when compared with athletes who was asymptomatic. There were no differences between groups in terms of on-field loss of consciousness or confusion. Off-field symptoms reported by athlete were associated with symptoms reporting on the Beck Depression Inventory (OR2.8; 95%CI 1.14–6.88), headache (O4.9; 95%CI 1.92–12.79), memory concerns (OR3.15; 95%CI 1.06–9.34), pressure in head (OR2.8; 95%CI 1.03–8.08), and visual disturbances (OR3.9; 95%CI 1.05–14.50) within the first 72 h after concussion.

Symptomatic concussed rugby athletes have increased odds for sustaining on-field concussion signs that can be observed by others and persistent symptoms within the first 72 h after concussion. Information from the on-field and off-field assessment is essential in understanding the severity of sports concussion.