Objectives To describe tackle characteristics associated with increased risk of Head Injury Assessment (HIA) removals in elite women`s Rugby Union. Design Case-control study Methods 145 instances of player removal for head injury assessments with video footage were identified in elite women`s rugby. 114 cases occurred during tackles, which were analysed to describe the influence of foul play, tackle type, tackle height, head contact location, and body position on injury risk. The relative proportion of tackles resulting in head injury removals was compared to the proportion of each tackle characteristic in a control cohort of 1763 tackles that did not result in head injuries to assess risk of each characteristic. Results Proximity of the tackler`s head with the ball carrier`s head and shoulder occurred in 72.1% of HIA1-inducing tackles, compared to 25.0% of non-HIA1 tackles. Head and shoulder contact was 9.79 (95% CI 5.95 - 16.90) times more likely to cause HIA1 removals than head-to-torso contact and proximity. Upright tackles and active shoulder tackles had increased HIA1 risk for both players. Illegal tackles were 21.42 (95% CI 11.49 - 39.93) more likely to cause HIA1s than legal tackles. Conclusions Risk factors for head injury removals from tackles are similar in women as has been described in men, with higher contact, upright tacklers, dominant tackles and foul play increasing head injury risk. Strategies to lower tackle height and reduce the prevalence of head to head and shoulder contact should be explored to reduce head injury incidence in the elite women`s game.
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