Background Rugby is increasing in popularity across the world and has seen an increase in the number of injuries since the introduction of professionalism. Consequently parents and health professionals are questioning the safety of rugby in schools.

Methods A systematic review of the epidemiology of rugby injuries among young rugby players. Inclusion criteria were all primary research studies of rugby injury in children and adolescents, under the age of 21. Where match injury incidence was given per 1000 player-hours, we calculated probabilities of injury over a typical season for a typical player, and a pooled estimate of match injury incidence where studies were sufficiently similar.

Results We identified 32 studies from 1978 to 2013. The incidence of match injury ranged from 7.0 per 1000 player-hours (where the player was prevented from playing for at least seven days) to 129.8 per 1000 player-hours (where any physical complaint caused by rugby was counted); the probability of a typical child or adolescent rugby player being injured during a typical school rugby season was between 12% and 90%. The pooled estimate of injury incidence of 26.7 (95% CI 13.2 to 54.1) per 1000 player-hours for injuries irrespective of need for medical attention or time-loss from matches or training and of 10.3 (6.0 to 17.7) per 1000 player-hours for injuries requiring at least seven days absence from games, is the equivalent of a 37.4% (20.6% to 61.2%) and 16.5% (9.9% to 26.6%) respective risk of a typical player being injured over a typical season. The nature of injury varied as follows; concussion ranged from 2.2% to 24.6% of all injuries recorded while sprains and strains combined ranged from 15.7% to 46.7% and fractures from 3.0% to 27.0%. Being tackled was the phase of play where most injuries occurred, between 19.4% and 65% of all injuries, followed by active tackling (18.5% to 40%), ruck and maul (8.3% to 31.5%) and scrums (2% to 36%). Severe injuries (requiring absence from playing for more than 28 days) ranged from 5.8% to 32%. Injury rates were similar for forward and back positions.

Discussion Study heterogeneity particularly in injury definitions contributed to a wide variation in injury incidence. Although injury surveillance systems have been implemented in many countries, there are no formal public reporting systems in the UK. The high number of injuries observed also raises the question whether rugby should be a mandatory part of the school curriculum.