An epidemiologic comparison of high school sports injuries sustained in practice and competition

CONTEXT: More than 7 million US high school students play sports. OBJECTIVE: To compare practice and competition injury rates and patterns in 5 boys' sports (football, soccer, basketball, wrestling, and baseball) and 4 girls' sports (soccer, volleyball, basketball, and softball) during the 2005-2006 school year. DESIGN: Prospective injury surveillance study. SETTING: Injury data were collected from 100 nationally representative United States high schools via High School RIO (Reporting Information Online). PATIENTS OR OTHER PARTICIPANTS: Athletes from participating high schools injured while participating in a school-sanctioned practice or competition in one of the above sports. MAIN OUTCOME MEASURE(S): Practice and competition injury rates, body site, diagnosis, and severity. RESULTS: High school athletes participating in these 9 sports at participating schools sustained 4350 injuries during the 2005-2006 school year, which corresponds to an estimated 1 442 533 injuries nationally. The rate of injury per 1000 athlete-exposures was higher in competition (4.63) than in practice (1.69) (rate ratio [RR] = 2.73, 95% confidence interval [CI] = 2.58, 2.90). Of all sports, football had the highest competition (12.09) and practice (2.54) injury rates per 1000 athlete-exposures. Compared with injuries sustained during practice, higher proportions of competition injuries were head/face/neck injuries (proportion ratio [PR] = 1.61, 95% CI = 1.34, 1.94), particularly in boys' soccer (PR = 7.74, 95% CI = 2.53, 23.65) and girls' basketball (PR = 6.03, 95% CI = 2.39, 15.22). Competition injuries were more likely to be concussions (PR = 2.02, 95% CI = 1.56, 2.62), especially in boys' soccer (PR = 6.94, 95% CI = 2.01, 23.95) and girls' basketball (PR = 5.83, 95% CI = 2.06, 16.49). Higher proportions of competition injuries caused the athlete to miss more than 3 weeks of play (PR = 1.28, 95% CI = 1.08, 1.52), particularly in baseball (PR = 3.47, 95% CI = 1.48, 8.11) and volleyball (PR = 2.88, 95% CI = 1.01, 8.24). CONCLUSIONS: Rates and patterns of high school sport injuries differed between practice and competition. Providing athletic trainers with this information is a crucial step in developing the targeted, evidence-based interventions required to effectively reduce injury rates among the millions of high school student-athletes.     

Analysis of Injury Rates and Treatment Patterns for Time-Loss and Non-Time-Loss Injuries Among Collegiate Student-Athletes

OBJECTIVE: To compare the injury rates for time-loss and non-time-loss injuries among selected intercollegiate athletic programs and to describe the number of treatments associated with these injuries. DESIGN AND SETTING: A volunteer, cross-sectional cohort study of 50 collegiate athletic programs representing the 3 National Collegiate Athletic Association divisions, the National Association of Intercollegiate Athletics, and the National Junior College Athletic Association during the 2000-2002 academic years. SUBJECTS: Individuals listed on the team rosters for the participating institutions and representing the sports associated with the institution's athletic programs. MEASUREMENTS: The athletic training staff and students recorded the injury and treatment data for the participating institutions. The data included information for time-loss and non- time-loss injuries, daily treatments, and daily athlete-exposures. RESULTS: Non-time-loss injury rates were 3.5 (confidence interval = 3.4, 3.6) times the time-loss rate for men and 5.1 (confidence interval = 4.9, 5.2) times the time-loss rate for women. Non-time-loss injuries required more treatments over the course of the year than did time-loss injuries. For men's sports, 22% of the injuries resulted in loss of participation time, with 47% of the treatments associated with these injuries. For women's sports, 16% of the injuries and 34% of the treatments were associated with time-loss injuries. CONCLUSIONS: Throughout the sports medicine year, athletic training staff and students spent more time delivering treatments to athletes who were not missing participation time than to athletes who were missing time. A noteworthy difference in the workforce available to provide health care among the various levels of intercollegiate athletics may contribute to the frequency of injury and treatments reported.     

Subsequent injury patterns in girls' high school sports

CONTEXT: Girls' participation in high school sports has increased 79.5% since 1975-1976. The incidence of injury among boys in high school sports has been well documented, but information regarding the incidence, severity, and type of injury among girls in high school sports is limited. OBJECTIVE: To examine the effects of subsequent injuries among high school girls in 5 sports. DESIGN: Observational cohort.Setting: Existing data from the 1995-1997 National Athletic Trainers' Association High School Injury Surveillance database. PATIENTS OR OTHER PARTICIPANTS: Girl athletes (n = 25 187 player-seasons) participating in 5 varsity high school sports: basketball, field hockey, soccer, softball, and volleyball. MAIN OUTCOME MEASURE(S): Injury status, body location, injury type, time lost from injury, and number of players at risk for injury as recorded by athletic trainers and submitted to the Sports Injury Monitoring System. RESULTS: Overall, 23.3% of the athletes had 2 or more injuries within a sport; basketball and soccer athletes were most vulnerable. Overall, the probability of an athlete sustaining 3 or more injuries was 38.6%, and the risk was highest for field hockey players (61.9%). The risk of subsequent injury at a new body location was almost 2 times higher than reinjury at the same body location (risk ratio = 1.7, 95% confidence interval = 1.6, 1.8) and was similar for all sports except volleyball. Only in softball was the proportion of reinjuries causing 8 or more days lost from participation greater than the proportion of new injuries causing similar time loss. Softball and volleyball had the highest proportion of reinjuries at the shoulder, especially rotator cuff strains. The proportion of knee reinjuries was significantly higher than new injuries for all sports except soccer. The proportion of anterior cruciate ligament injuries was significantly higher for volleyball players only. Overall, the proportion of reinjuries was significantly higher for stress fractures and musculoskeletal condition injuries. CONCLUSIONS: Patterns of subsequent injury risk appear to vary among these 5 sports. Almost one quarter of the athletes incurred 2 or more injuries over a 3-year period, so the effects of subsequent injuries deserve more consideration.     

Catastrophic Head Injuries in High School and Collegiate Sports

OBJECTIVE: To describe the incidence of catastrophic head injuries in a variety of high school and college sports. DESIGN AND SETTING: Data on catastrophic head injuries were compiled in a national surveillance system maintained by the National Center for Catastrophic Sports Injury Research. The data were compiled with the assistance of coaches, athletic trainers, athletic directors, executive officers of state and national athletic organizations, a national newspaper clipping service, professional associates of the researchers, and national sport organizations. SUBJECTS: Data included all high school and college athletic programs in the United States. MEASUREMENTS: Background information on the athlete (age, height, weight, experience, previous injury, etc), accident information, immediate and postaccident medical care, type of injury, and equipment involved. Autopsy reports were used when available. RESULTS: A football-related fatality has occurred every year from 1945 through 1999, except for 1990. Head-related deaths accounted for 69% of football fatalities, cervical spinal injuries for 16.3%, and other injuries for 14.7%. High school football produced the greatest number of football head-related deaths. From 1984 through 1999, 69 football head-related injuries resulted in permanent disability. Sixty-three of the injuries were associated with high school football and 6 with college football. Although football has received the most attention, other sports have also been associated with head-related deaths and permanent disability injuries. From 1982 through 1999, 20 deaths and 19 permanent disability injuries occurred in a variety of sports. Track and field, baseball, and cheerleading had the highest incidence of these catastrophic injuries. Three deaths and 3 injuries resulting in permanent disability have occurred in female participants. CONCLUSIONS/RECOMMENDATIONS: Reliable data collection systems and continual analysis of the data can help us to reduce the number of catastrophic head-related injuries. I include additional recommendations for injury prevention.     

Descriptive epidemiology of collegiate men's baseball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004

OBJECTIVE: To review 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for men's baseball and identify potential areas for injury prevention initiatives. BACKGROUND: Prevention and management of collegiate baseball injuries may be facilitated through injury research aimed at defining the nature of injuries inherent in the sport. Through the NCAA Injury Surveillance System, 16 years of collegiate baseball data were collected for the academic years 1988-1989 through 2003-2004. MAIN RESULTS: College baseball has a relatively low rate of injury compared with other NCAA sports, but 25% of injuries are severe and result in 10+ days of time loss from participation. The rate of injury was 3 times higher in a game situation than in practice (5.78 versus 1.85 injuries per 1000 athlete-exposures [A-Es], rate ratio = 3.1, 95% confidence interval = 3.0, 3.3, P < .01). Practice injury rates were almost twice as high in the preseason as in the regular season (2.97 versus 1.58 per 1000 A-Es, rate ratio = 1.9, 95% confidence interval = 1.8, 2.0, P < .01). A total of 10% of all game injuries occurred from impact with a batted ball, an injury rate of 0.56 injuries per 1000 game A-Es. Sliding was involved in 13% of game injuries. RECOMMENDATIONS: Proper preseason conditioning is important to reduce injuries. Athletic trainers covering practices and games should be prepared to deal with serious, life-threatening injuries from batted balls and other injury mechanisms. Further study of batted-ball injuries is warranted, and the use of breakaway bases to prevent sliding injuries should be supported in college baseball.     

Key Factors for Providing Appropriate Medical Care in Secondary School Athletics: Athletic Training Services and Budget

Context:

Research suggests that appropriate medical care for interscholastic athletes is frequently lacking. However, few investigators have examined factors related to care.

Objective:

To examine medical care provided by interscholastic athletics programs and to identify factors associated with variations in provision of care.

Design:

Cross-sectional study.

Setting:

Mailed and e-mailed survey.

Patients or Other Participants:

One hundred sixty-six South Carolina high schools.

Intervention(s):

The 132-item Appropriate Medical Care Assessment Tool (AMCAT) was developed and pilot tested. It included 119 items assessing medical care based on the Appropriate Medical Care for Secondary School-Age Athletes (AMCSSAA) Consensus Statement and Monograph (test-retest reliability: r  =  0.89). Also included were items assessing potential influences on medical care. Presence, source, and number of athletic trainers; school size; distance to nearest medical center; public or private status; sports medicine supply budget; and varsity football regional championships served as explanatory variables, whereas the school setting, region of state, and rate of free or reduced lunch qualifiers served as control variables.

Main Outcome Measure(s):

The Appropriate Care Index (ACI) score from the AMCAT provided a quantitative measure of medical care and served as the response variable. The ACI score was determined based on a school''s response to items relating to AMCSSAA guidelines.

Results:

Regression analysis revealed associations with ACI score for athletic training services and sports medicine supply budget (both P < .001) when controlling for the setting, region, and rate of free or reduced lunch qualifiers. These 2 variables accounted for 30% of the variance in ACI score (R²  =  0.302). Post hoc analysis showed differences between ACI score based on the source of the athletic trainer and the size of the sports medicine supply budget.

Conclusions:

The AMCAT offers an evaluation of medical care provided by interscholastic athletics programs. In South Carolina schools, athletic training services and the sports medicine supply budget were associated with higher levels of medical care. These results offer guidance for improving the medical care provided for interscholastic athletes.     

Laryngeal fracture in a high school football player

Laryngeal injuries are rare in the athletic setting, but such sports as football, basketball, and hockey often place the athlete in a position to receive blunt trauma to the throat area. Such an injury has the potential of developing into a life-threatening situation. A high school athlete sustained a fractured larynx during a football game. The injury required surgical repair. Unfortunately, because this type of injury is uncommon in sports, many athletic training books do not extensively address soft tissue and cartilaginous injuries to the structures of the anterior neck. Athletic trainers must be able to recognize the signs and symptoms of a laryngeal injury and refer the athlete for immediate medical attention.     

Descriptive epidemiology of collegiate women's basketball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004

OBJECTIVE: To review 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for women's basketball and to identify potential areas for injury prevention initiatives. BACKGROUND: The number of colleges participating in women's college basketball has grown over the past 25 years. The Injury Surveillance System (ISS) has enabled the NCAA to collect and report injury trends over an extended period of time. This has allowed certified athletic trainers and coaches to be more informed regarding injuries and to adjust training regimens to reduce the risk of injury. It also has encouraged administrators to make rule changes that attempt to reduce the risk of injury. MAIN RESULTS: From 1988-1989 through 2003-2004, 12.4% of schools across Divisions I, II, and III that sponsor varsity women's basketball programs participated in annual ISS data collection. Game and practice injury rates exhibited significant decreases over the study period. The rate of injury in a game situation was almost 2 times higher than in a practice (7.68 versus 3.99 injuries per 1000 athlete-exposures, rate ratio = 1.9, 95% confidence interval = 1.9, 2.0). Preseason-practice injury rates were more than twice as high as regular-season practice injury rates (6.75 versus 2.84 injuries per 1000 athlete-exposures, rate ratio = 2.4, 95% confidence interval = 2.2, 2.4). More than 60% of all game and practice injuries were to the lower extremity, with the most common game injuries being ankle ligament sprains, knee injuries (internal derangements and patellar conditions), and concussions. In practices, ankle ligament sprains, knee injuries (internal derangements and patellar conditions), upper leg muscle-tendon strains, and concussions were the most common injuries. RECOMMENDATIONS: Appropriate preseason conditioning and an emphasis on proper training may reduce the risk of injury and can optimize performance. As both player size and the speed of the women's game continue to increase, basketball's evolution from a finesse sport to a high-risk contact sport also will continue. The rates of concussions and other high-energy trauma injuries likely will increase. The NCAA ISS is an excellent tool for identifying new risk factors that may affect injury rates and for developing consistent injury definitions in order to improve the research and provide a source of clinically relevant data.     

Concussion in Rugby: The Hidden Epidemic

OBJECTIVE: To determine the incidence of concussion in high school rugby players and compare the findings with the relevant published literature. DESIGN AND SETTING: Prospective data collection in one US high school rugby program. SUBJECTS: Two teams followed for 3 years. MEASUREMENTS: Injury rate, injury severity, and time withheld from competition. RESULTS: Seventeen concussions were recorded, accounting for 25% of all reported injuries. The incidence rate for concussion was 3.8 per 1000 athlete-exposures (95% confidence interval, 2.0-5.7) or 11.3 per 100 player-seasons (95% confidence interval, 5.9-16.7). Of the 17 concussions, 14 were Cantu grade 1, 2 were grade 2, and 1 was grade 3. Concussions accounted for 25% of all days lost from rugby participation due to injury. CONCLUSIONS: The incidence of concussion in this study was higher than previously reported in other studies. Methodologic limitations and administrative rules that required suspension for injured players may have suppressed reporting in previous epidemiologic studies. The incidence of concussion in rugby is probably much higher than previously suggested.     

Sex Differences and the Incidence of Concussions Among Collegiate Athletes

OBJECTIVE: To compare sex differences regarding the incidence of concussions among collegiate athletes during the 1997-1998, 1998-1999, and 1999-2000 seasons. DESIGN AND SETTING: A cohort study of collegiate athletes using the National Collegiate Athletic Association (NCAA) Injury Surveillance System; certified athletic trainers recorded data during the 1997-2000 academic years. SUBJECTS: Collegiate athletes participating in men's and women's soccer, lacrosse, basketball, softball, baseball, and gymnastics. MEASUREMENTS: Certified athletic trainers from participating NCAA institutions recorded weekly injury and athlete-exposure data from the first day of preseason practice to the final postseason game. Injury rates and incidence density ratios were computed. Incidence density ratio is an estimate of the relative risk based on injury rates per 1000 athlete-exposures. RESULTS: Of 14 591 reported injuries, 5.9% were classified as concussions. During the 3-year study, female athletes sustained 167 (3.6%) concussions during practices and 304 (9.5%) concussions during games, compared with male athletes, who sustained 148 (5.2%) concussions during practices and 254 (6.4%) concussions during games. Chi-square analysis revealed significant differences between male and female soccer players (chi(2)(1) = 12.99, P =.05) and basketball players (chi(2)(1) = 5.14, P =.05). CONCLUSIONS: Female athletes sustained a higher percentage of concussions during games than male athletes. Of all the sports, women's soccer and men's lacrosse were found to have the highest injury rate of concussions. Incidence density ratio was greatest for male and female soccer players.     

Characteristics of Injuries Occurring During Cross-Country: A Report from the Athletic Training Practice-Based Research Network

ContextCross-country is a popular sport activity, particularly in adolescent populations. Although epidemiologic investigations have provided insight into patient and injury characteristics associated with running injuries, little is known about how these injuries are managed at the point of care.ObjectiveTo describe injury and treatment characteristics of injuries sustained during cross-country.DesignCross-sectional study.SettingHigh school athletic training clinics within the Athletic Training Practice-Based Research Network.Patients or Other ParticipantsPatient cases were included if the patient was diagnosed with an injury that occurred during interscholastic cross-country participation. All patients received usual care by an athletic trainer.Main Outcome Measure(s)We used summary statistics to describe injury (sex, age, participation level, time of injury, mechanism of injury, body part, injury type, diagnosis) and treatment (type, amount, duration, number of services) characteristics.ResultsMost cross-country injuries occurred to the lower extremity and were musculotendinous or ligamentous in nature. The most common injury types were sprain/strain (43.8%), tendinopathy (18.5%), and general pain (9.5%). Injured body parts and diagnoses were typically similar between sexes. The most frequently used treatment was therapeutic exercises or activities (28.7%), and patients received an average of 7.4 ± 17.4 total athletic training services during 5.5 ± 15.1 episodes of care over 27.8 ± 87.5 days.ConclusionsAdolescent cross-country student-athletes frequently sustained non–time-loss injuries that required up to 1 month of treatment and management. These findings will generate awareness surrounding the role of athletic trainers in providing care for cross-country athletes.     

Epidemiology of Rare Injuries and Conditions Among United States High School Athletes During the 2005–2006 and 2006–2007 School Years

Context:

Although more than 7 million athletes participate in high school sports in the United States, to date no nationally representative studies of rare injuries and conditions (RICs) exist. Rare injuries and conditions include eye injuries, dental injuries, neck and cervical injuries, and dehydration and heat illnesses.

Objective:

To describe the epidemiology of RICs sustained by high school athletes during the 2005–2006 and 2006–2007 school years.

Design:

Prospective cohort study.

Setting:

A nationally representative sample of 100 US high schools using an injury surveillance system, High School Reporting Information Online.

Patients or Other Participants:

Athletes participating in football, boys'' soccer, girls'' soccer, volleyball, boys'' basketball, girls'' basketball, wrestling, baseball, or softball at one of the 100 participating high schools.

Main Outcome Measure(s):

We reviewed all RICs to calculate injury rates and to identify potential risk factors and preventive measures.

Results:

A total of 321 RICs were sustained during 3 550 141 athlete-exposures (AEs), for an injury rate of 9.04 RICs per 100 000 AEs. This represents an estimated 84 223 RICs sustained nationally. The RICs accounted for 3.5% of all high school athletes'' injuries. The most common diagnoses were neck and cervical injuries (62.0%, n  =  199) and dehydration and heat illnesses (18.7%, n  =  60). Football had the highest RIC rate per 100 000 AEs (21.2), followed by wrestling (15.2) and baseball (7.60). The RICs occurred at a higher rate in boys (12.4) than in girls (2.51) (rate ratio  =  4.93; 95% confidence interval  =  3.39, 7.18). The majority of RICs (67.3%, n  =  216) permitted athletes to return to play within 1 week of diagnosis.

Conclusions:

The RIC injury rates varied by sport and sex and represented almost 100 000 potentially preventable injuries to high school athletes. Because of the potentially serious consequences, future researchers must develop and implement more effective preventive measures to aid certified athletic trainers in decreasing the RIC incidence among high school athletes.     

Incidence of injuries in high school softball and baseball players

Context:

Participation in high school sports has grown 16.1% over the last decade, but few studies have compared the overall injury risks in girls'' softball and boys'' baseball.

Objective:

To examine the incidence of injury in high school softball and baseball players.

Design:

Cohort study.

Setting:

Greenville, South Carolina, high schools.

Patients or Other Participants:

Softball and baseball players (n = 247) from 11 high schools.

Main Outcome Measure(s):

Injury rates, locations, types; initial or subsequent injury; practice or game setting; positions played; seasonal trends.

Results:

The overall incidence injury rate was 4.5/1000 athlete-exposures (AEs), with more injuries overall in softball players (5.6/1000 AEs) than in baseball players (4.0/1000 AEs). Baseball players had a higher initial injury rate (75.9/1000 AEs) than softball players (66.4/1000 AEs): rate ratio (RR) = 0.88, 95% confidence interval (CI) = 0.4, 1.7. The initial injury rate was higher than the subsequent injury rate for the overall sample (P < .0001) and for softball (P < .0001) and baseball (P < .001) players. For both sports, the injury rate during games (4.6/1000 AEs) was similar to that during practices (4.1/1000 AEs), RR = 1.22, 95% CI = 0.7, 2.2. Softball players were more likely to be injured in a game than were baseball players (RR = 1.92, 95% CI = 0.8, 4.3). Most injuries (77%) were mild (3.5/1000 AEs). The upper extremity accounted for the highest proportion of injuries (63.3%). The incidence of injury for pitchers was 37.3% and for position players was 15.3%. The rate of injury was highest during the first month of the season (7.96/1000 AEs).

Conclusions:

The incidence of injury was low for both softball and baseball. Most injuries were minor and affected the upper extremity. The injury rates were highest in the first month of the season, so prevention strategies should be focused on minimizing injuries and monitoring players early in the season.     

Descriptive epidemiology of collegiate men's soccer injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2002-2003

OBJECTIVE: To review 15 years of National Collegiate Athletic Association (NCAA) injury surveillance data for men's soccer and to identify potential areas for injury prevention initiatives. BACKGROUND: The NCAA sanctioned its first men's soccer championship in 1959. Since then, the sport has grown to include more than 18 000 annual participants across 3 NCAA divisions. During the 15 years from 1988-1989 to 2002-2003, the NCAA Injury Surveillance System accumulated game and practice injury data for men's soccer across all 3 NCAA divisions. MAIN RESULTS: The injury rate was 4 times higher in games compared with practices (18.75 versus 4.34 injuries per 1000 athlete-exposures, rate ratio = 4.3, 95% confidence interval = 4.2, 4.5), and preseason practices had a higher injury rate than in-season practices (7.98 versus 2.43 injuries per 1000 athlete-exposures, rate ratio = 3.3, 95% confidence interval = 3.1, 3.5). In both games and practices, more than two thirds of men's soccer injuries occurred to the lower extremities, followed by the head and neck in games and the trunk and back in practices. Although player-to-player contact was the primary cause of injury during games, most practice injuries occurred without direct contact to the injured body part. Ankle ligament sprains represented the most common injury during practices and games, whereas knee internal derangements were the most common type of severe injury (defined as 10+ days of time loss). RECOMMENDATIONS: Sprains, contusions, and strains of the lower extremities were the most common injuries in men's collegiate soccer, with player-to-player contact the primary injury mechanism during games. Preventive efforts should focus on the player-to-player contact that often leads to these injuries and greater enforcement of the rules that are in place to limit their frequency and severity. Emphasis also should be placed on addressing the high rate of first-time and recurrent ankle ligament sprains.