Background There are limited injury data for Rugby-7s, and even less data analysed by participation level or days return-to-sport after injury. Objective To describe injury incidence, severity, and injury burden for three levels of Rugby-7s competition. Design Prospective descriptive epidemiology study. Setting U.S. Rugby-7s tournaments/series and championships (n=57; 2010-2014) over 72 tournament days; L1 elite, L2 sub elite, and L3 under-19/college/senior games (exposure=14,591 player-hours). Participants 24,538 U.S. players (men=17,770; women=6,768; age 13-54 years). Assessment of Risk Factors Intrinsic and extrinsic risk in match injuries. Main measurement outcome Incidence (per/1000 player-hour (ph)) and mechanism of injury were captured using Rugby Injury Survey & Evaluation (RISE) report methodology. Time-loss injuries, injury severity (days=d) from training/competition (including post tournament) were documented, and injury burden were calculated. Results Injury incidence (n=491) was not significantly different between levels (L3:30.74/1000ph, CI:27.26-34.54; L2:36.24/1000ph, CI:30.84-42.31; L1:41.78/1000ph, CI:30.8-55.39). Mean injury burden was significantly lower for L3 than L1 and L2 (L3-vs-L2, P<0.001; L3 vs L1, P<0.001). Greater risk of lower limb injuries was noted in L3-vs-L1 (RR:0.59, CI:0.38-0.95, P=0.024). The cohort sustained high head/neck injury rates (22.6%; 13.3/1000ph). Backs had more injuries among levels than forwards (L1 backs 51.8/1000ph, forwards 26.4/1000ph, P=0.034; L2 backs 37.7/1000ph, forwards 29.6/1000ph, P=0.152; L3, backs 32.76/1000ph, forwards 24.8/1000ph, P=0.029; total cohort backs 35.74/1000ph, forwards 26.39/1000ph, RR:1.35; CI:1.12-1.65, P=0.002). Average days absent post injury=44.0d (37.8-50.1d) in 68.4% with follow-up data. A significant difference (P=0.018) in mean severity days absent from sport was between the L3 (57.1d) and L2 (27.9d) forwards. Conclusions Competition level and playing position had significant effects on injury burden and nature of injury. The L1 and L2 had higher injury burden than the lower L3. The L1-vs-L3 cohort had a high proportion of head/neck injury risk compared with other injury locations. Backs sustained greater injury incidence rates among all three levels as compared to forwards.
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