Observed but overlooked (possible) concussions in slap fighting - a video analysis study.

BACKGROUND

Existing literature on slap fighting is restricted to frequency and the distribution of visible signs of possible concussion. This study examines possible concussions and their assessments in male slap fighting.

METHODS

All male slap fights conducted between January 2023 and August 2025 were reviewed using video analysis and coded independently by two investigators with a focus on visible signs of possible concussion, referee and ringside physician assessments.

RESULTS

A total of 231 possible concussions were identified across 164 fights and 766 slaps (a mean of 1.4/fight and 0.3/slap). Overall, 558 visible signs were observed i.e. most commonly being motor incoordination (n = 224, 40.1%). Of the 231 possible concussions, 223 were assessed by the referee; 124 (55.6%) resulted in continuation of the fight, of which 113 (91.1%) presented with one or two visible signs. Eleven possible concussions were assessed by the ringside physician and 45.5% resulted in the fight's continuation. Both referee and ringside physician assessments were brief (16.9 ± 11.1 and 15.8 ± 11.2 seconds, respectively).

CONCLUSION

Findings underscore the need for referees and ringside physicians to receive structured training in identifying visible concussion signs-particularly motor incoordination-and to ensure that all suspected cases are referred for medical assessment and withheld from continuing competition.