If England's hopes are not to stall from the outset, they will have to rediscover their true character in Rome on Sunday. The RBS Six Nations Championship - and before it the Five Nations Championship - has not started so poorly for them for 25 years, the last time that England were at Twickenham on the opening weekend and lost.

Change there will have to be, given the casualty list stemming from Saturday's 26-19 defeat by Wales. Mike Tindall, the Gloucester centre, was kept in Hammersmith Hospital over the weekend after bruising his liver and is unlikely to play again in the championship. That could mean a prompt return for Mathew Tait.

Lewis Moody, David Strettle and Tom Rees have been discounted from the encounter with Italy, for which the team is due to be named on Wednesday. Moody has damaged his right Achilles tendon, Rees the collateral medial ligaments of his left knee and Strettle the fifth metatarsal of his left foot, a recurrence of the injury that kept him out of the World Cup.

The removal of the Harlequins wing surely means a first start for Lesley Vainikolo but the departure of the two flankers comes at a bad time, given that Joe Worsley, Nick Easter, Dan Ward-Smith and Tom Croft were all out of contention a week ago. Michael Lipman, the Bath open-side, must hope for a first appearance in the Six Nations, ahead of Andrew Hazell and the younger contender, Ben Woods.

But the number of wounded means that Brian Ashton, the head coach, will not contemplate further change - at this stage. “You don't throw all your toys out of the pram because you've lost a game,” he said, although that is more or less what he did last season after the 43-13 defeat by Ireland in Dublin. That game, however, was midway through the championship, when England had won their first two games.

But if England cannot make headway against Italy, to whom they have never lost, then Ashton faces some serious decisions, not least around his half backs. His options are limited at scrum half, given that the next two behind Andy Gomarsall are the uncapped pairing of Richard Wigglesworth and Lee Dickson, even though Gomarsall was implicated in the bizarre decision-making that let Wales back in the second half.

The head coach has choices aplenty at fly half, where Jonny Wilkinson, who had an anonymous game for Newcastle Falcons against Leicester a week earlier, was inaccurate in his play just when England needed a steadying hand. Wilkinson, who took over the captaincy when Phil Vickery was replaced, is not in danger, but will be even more aware of the queue behind - Toby Flood, his club colleague, Danny Cipriani, the tyro from London Wasps, and Shane Geraghty, of London Irish, who played so well for England Saxons last Friday.

There is a chance, too, that Wilkinson will be cited for foul play for the stiff-arm tackle that ended Jonathan Thomas's game. John West, the match commissioner, has until this evening to decide whether Thomas's head injury was the result of the tackle or the Wales flanker's head hitting the ground. Either way, Thomas and his colleague, Alun-Wyn Jones (ankle) are likely to miss the game in Cardiff against Scotland on Saturday. Scotland, too, face the possibility of a citation after Andrew Henderson appeared to head-butt Damien Traille in yesterday's game at Murrayfield.

Damaged ankle ligaments may keep Rory Lamont out of the championship but Ireland, resigned to losing Gordon D'Arcy with a broken right forearm sustained against Italy, may have Paul O'Connell available at lock for the game with Scotland on February 23.

Italy made two changes yesterday to the squad to play England in Rome on Sunday. Carlos Nieto, the Gloucester prop, returns in place of Lorenzo Cittadini, and Enrico Patrizio, of Padova, replaces Pablo Canavosio at centre.

The weekend's results: England 19 Wales 26 (at Twickenham); Ireland 16 Italy 11 (at Croke Park, Dublin); Scotland 6 France 27 (at Murrayfield).

Fixtures: Saturday: Wales v Scotland (2.0); France v Ireland (4.0). Sunday: Italy v England (2.30). Feb 23: Wales v Italy (3.0); Ireland v Scotland (5.0); France v England (8.0). Mar 8: Ireland v Wales (1.15); Scotland v England (3.15). Mar 9: France v Italy (3.0). Mar 15: Italy v Scotland (1.0); England v Ireland (3.0); Wales v France (5.0).