0 players (95% CI 0 to 1.10) between 2008 and 2011.

The Senior age group accounted for 79% (n=11 of 14) of the *permanent* scrum injuries and 88% (n=7 of 8) of the *permanent* tackle injuries. Of all the scrum injuries, scrum engagement and a collapsed scrum contributed to 56% and 39% of cases, respectively (n=10 and 7 of 18, respectively; n=1 case was attributed to *popping out*, and information was not provided for n=1 case). The tackle events were evenly split between the tackler and ball-carrier (n=8 for each).

For further analyses, only n=40 cases were considered because four cases occurred in positional groupings that are not the conventional 15-a-side rugby (n=3 'seven-a-side', n=1 Mini-rugby) and the event responsible was 'unclear' for one case.

The hooker and loose-forward positional groupings were associated with 38% (n=15 of 40) and 25% (n=10 of 40) of all ASCIs ([figure 2](#BMJOPEN2012002475F2){ref-type="fig"}A). Eighty per cent of all ASCIs to the hooker position were permanent injury outcomes (n=12 of 15). Together, the hooker, prop and lock positional groupings (tight five) accounted for all the scrum injuries. The tackle injuries were shared between all positional groupings except prop and scrumhalf.

When examining *permanent* ASCIs in isolation ([figure 2](#BMJOPEN2012002475F2){ref-type="fig"}B), only the forward positional groupings were represented (prop, hooker, lock and loose-forward). Of these permanent outcomes, the hooker alone accounted for 46% (n=12 of 26) of all injuries, 83% of which (n=10 of 12) were as a result of the scrum. The loose-forward positional grouping accounted for 31% (n=8 of 26) of all permanent outcomes, 63% (n=5 of 8) of which came from the tackle.

Discussion {#s4}
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In South Africa, we found that the average annual incidence of all rugby-related catastrophic outcomes (excluding cardiac events) was 2.00 per 100 000 players (95% CI 0.91 to 3.08) between 2008 and 2011. This is comparable to the rate reported for Argentina (1.90 per 100 000 players)[@R2