Background: Sport-related concussion (SRC) in rugby union is common and carries a high injury burden, especially among children. Computed tomography (CT) imaging is commonly used to assess rugby-related head injuries, including SRC, subjecting children to ionising radiation. In addition, there is concern about the relationship between SRC, repetitive head impacts and neurodegeneration. Objective: To review and correlate the imaging findings of head injuries in school-level rugby players from a public tertiary referral centre and a private multi-centre radiology service. Design: Descriptive, retrospective cross-sectional correlational study for the 2014-2023 period. Methods: Anonymised data were collected from the radiological information systems of a tertiary referral centre and a private radiology provider. Data included participant age, imaging modality, study type, date, findings and SRC status. The public and private datasets were analysed using descriptive and comparative statistics. Results: A total of 369 cases were identified (public n = 132, 36%). Mean participant age was 15 (± 2.5) years, with 78% (n = 289) clinically deemed to have an SRC. CT was performed in 347 (94%) cases, with abnormal findings reported in 50 studies (public n = 32). The most common findings were craniofacial fractures (n = 28) and intracranial injuries (n = 19). The sensitivity of CT for detecting SRC was 14%. Public sector participants were more likely to have an SRC (odds ratio: 8.39; 95% CI 8.37-8.41, p < 0.001). Conclusions: CT demonstrates limited utility in the context of SRC beyond detecting craniofacial fractures or surgical emergencies, reinforcing clinical assessment as the diagnostic cornerstone. Protocol optimisation should prioritise radiation risk mitigation through strict adherence to paediatric low-dose guidelines. Key Points The commonest CT-evident rugby-related head injuries included craniofacial fractures, cerebral haemorrhage, contusions and oedema. Despite its frequent use in the assessment of rugby-related head injuries, CT imaging has low sensitivity and negative predictive value. Future longitudinal studies should investigate the correlation between advanced imaging, biomarkers and metrics of head impact load to aid in the development of assessment methodologies that are more sensitive to the changes of sport-related concussion.
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