Sports injuries among children in six European union countries

Injuries in male youth football: a one season prospective cohort study of 223 Danish elite players

Objectives

This study prospectively investigated injury prevalence, incidence, and burden in male elite under-17 football players (N = 223) during a full season.

Methods

The players weekly completed a standardized web-based injury survey (OSTRC-H2) and a physical exposure report throughout the study.

Results

Average weekly response rate was 89.5%. Football exposure accounted for 52.4% of total physical exposure. On average (±SD), the players participated in individual football, strength, and rehabilitation practices for 1.2 ± 1.5, 3.0 ± .2.1, and 1.9 ± 3.4 h/week, respectively. In total, 742 health problems were reported. Mean weekly prevalence of health problems, injuries and illnesses were 20.1%, 16.5% and 3.8%, respectively. The injury incidence per 1,000 h of football exposure, match play and team practice were 8.28 (95% CI: 7.54-9.08), 16.77 (95% CI: 13.65-20.4), and 7.24 (95% CI: 6.5-8.04), respectively. Sudden-onset and gradual-onset injuries accounted for 36.7% and 43.4% of the total proportion of health problems. Hip/groin injuries had the highest incidence (1.58/1,000 h), whereas knee injuries had the highest burden (20.86 days lost/1,000 h). On average, the players experienced 3.33 health problems (average duration: 7.8 days). On average pr. player, 2.7 (95% CI: 2.2-3.3) wks of football exposure were lost.

Conclusion

Sudden and gradual-onset injuries influenced player availability during the season. Health problem prevalence fluctuated markedly, and injury incidence was higher during match play than training. The players had substantial volumes of training beyond football-specific training and matches. Our findings could assist medical and sports science practitioneers in enhancing training and recovery processes to maximize player availability.

The "SHRed Injuries Basketball" Neuromuscular Training Warm-up Program Reduces Ankle and Knee Injury Rates by 36% in Youth Basketball

OBJECTIVE

To evaluate the effectiveness of a neuromuscular training warm-up prevention program, Surveillance in High school and community sport to Reduce (SHRed) Injuries Basketball, for reducing all-complaint ankle and knee injuries in youth basketball players.

DESIGN

Quasi-experimental study.

METHODS

High school/club basketball teams (male and female players aged 11-18 years) in Calgary, Canada participated in 2016-2017 (control; season 1) and 2017-2018 (intervention; season 2). The control season included a standard-of-practice warm-up. In season 2, a SHRed Injuries Basketball coach workshop was completed by participating team coaches. Teams were randomized by school/club to an unsupervised or a supervised (weekly supervision by study personnel) implementation of the coach-delivered SHRed Injuries Basketball program. The 10-minute SHRed Injuries Basketball program included 13 exercises (ie, aerobic, agility, strength, balance). All-complaint ankle and knee injuries were collected weekly using validated injury surveillance. Multilevel, multivariable Poisson regression analyses (considering important covariates, clustering by team and individual, and offset by exposure hours) estimated incidence rate ratios (IRRs) by intervention group (season 1 versus season 2) and secondarily considered the control versus completion of the SHRed Injuries Basketball program, unsupervised and supervised.

RESULTS

Sixty-three teams (n = 502 players) participated in season 1 and 31 teams (n = 307 players: 143 unsupervised, 164 supervised) participated in season 2. The SHRed Injuries Basketball program was protective against all-complaint knee and ankle injuries (IRR = 0.64; 95% confidence interval [CI]: 0.51, 0.79). Unsupervised (IRR = 0.62; 95% CI: 0.47, 0.83) and supervised (IRR = 0.64; 95% CI: 0.49, 0.85) implementations of the SHRed Injuries Basketball program had similar protective effects.

CONCLUSION

The SHRed Injuries Basketball program was associated with a 36% lower rate of ankle and knee injuries. Neuromuscular training warm-ups are recommended as the minimal standard of practice for injury prevention in youth basketball. J Orthop Sports Phys Ther 2022;52(1):40-48. doi:10.2519/jospt.2022.10959.

Translation and transcultural validation of the Dutch hospital for special surgery paediatric functional activity brief scale (HSS Pedi-FABS)

Background

There is a need for a validated simple Dutch paediatric activity scale. The purpose was to translate and transculturally validate the Dutch Hospital for Special Surgery Paediatric Functional Activity Brief Scale (HSS Pedi-FABS) questionnaire in healthy children and adolescents.

Methods

The original HSS Pedi-FABS was translated forward and backward and was transculturally adapted after performing a pilot study among children and professionals. The final version of the Dutch HSS Pedi-FABS was validated in healthy children and adolescents aged 10 to 18 years old. Children who had any condition or injury limiting their normal physical activity were excluded. The interval between the first questionnaire T0 (HSS Pedi-FABS, Physical Activity Questionnaire for children or adolescents (PAQ-C/A) and Tegner activity scale) and the second questionnaire T1 (HSS Pedi-FABS) was 2 weeks. Construct validity, interpretability and reliability were evaluated. Content validity was evaluated through cognitive interviews among a smaller group of children and through a questionnaire among professionals.

Results

To evaluate content validity, 9 children and adolescents were interviewed, and 30 professionals were consulted. Content validity among professionals showed a relevance of less than 85% for most items on construct. However, content validity among children was good with a 92% score for item relevance. Readability was scored at a reading level of 11- to 12-year-olds. The validation group consisted of 110 healthy children and adolescents (mean age of 13.9 years ±2.6). Construct validity was considered good as 8 out of 10 hypotheses were confirmed. The Dutch HSS Pedi-FABS showed no floor or ceiling effect. Analysis of the internal consistency in the validation group resulted in a Cronbach’s alpha of 0.82. Test-retest reliability was evaluated among 69 children and adolescents and revealed an Intraclass Correlation Coefficient (ICC) of 0.76.

Conclusion

The Dutch HSS Pedi-FABS showed good psychometric properties in a healthy Dutch paediatric and adolescent population. Limitations of the current Dutch HSS Pedi-FABS are content validity on construct of items reported by professionals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04729-0.

Injuries on the Youth Soccer (Football) Field: Do Additional Referees Reduce Risk? Randomized Crossover Trial

OBJECTIVE

Youth soccer injury can be prevented through various means, but few studies consider the role of referees. Following previous research suggesting children take fewer risks when supervised intensely, this randomized crossover trial evaluated whether risky play and injuries decrease under supervision from three referees instead of one referee.

METHODS

Youth soccer clubs serving a metropolitan U.S. area participated. Boys' and girls' clubs at under age 10 (U10) and under age 11 (U11) levels were randomly assigned such that when the same clubs played each other twice in the same season, they played once with one referee and once with three referees. A total of 98 games were videotaped and subsequently coded to obtain four outcomes: collisions between players, aggressive fouls (involving physical player-to-player contact) called by the referee(s) on the field, aggressive fouls judged by trained coders, and injuries requiring adult attention or play stoppage.

RESULTS

Poisson mixed model results suggest players in the 98 games committed fewer aggressive fouls, as identified independently by referees (rate ratio [RR] 0.58; 95% confidence interval [CI] 0.35-0.96) and by researchers (RR 0.67; 95% CI 0.50-0.90), when there were three referees versus one referee. Collisions (RR 0.98; 95% CI 0.86-1.12) and injury rates (RR 1.15; 95% CI 0.60-2.19) were similar across conditions.

CONCLUSION

When the same youth soccer clubs played with three referees rather than one, they committed fewer aggressive fouls. More intense supervision created better rule adherence. Injury rates were unchanged with increased supervision. Results raise questions concerning whether financial investment in additional referees on youth soccer fields yields safety benefits.

Blunt nasal trauma in children: a frequent diagnostic challenge

OBJECTIVE

The clinical challenge in blunt nasal trauma in children, is to identify cases requiring specialized care among frequently encountered banalities, whilst trying to minimize the exposure to diagnostic procedures. We aim to evaluate the related diagnostic and therapeutic pathways and its outcome during follow-up.

METHODS

This retrospective cohort study includes children up to 16 years presenting at the emergency department with blunt nasal trauma of our tertiary reference center.

RESULTS

The incidence of blunt nasal injuries was estimated 1750 cases in 7 years. A total of 459 consecutive cases with suspected complications were enrolled. Univariate comparison between age groups revealed a statistically significant diminution of downfall related injuries with growing up, whereas blows (including violence) significantly increased with age (p < 0.001 each). The logistic regression model identified male sex as an independent risk factor for soft tissue lesions (OR 1.699, p = 0.017) and for frontobasal fractures (OR 2.415, p = 0.050). Age was not identified to play a significant role regarding localization of injuries. Delayed septorhinoplasties became necessary in 2 cases only (0.4%). The logistic regression model identified nasal bone fracture (OR 17.038, p < 0.001) and mandibular fracture (OR 4.753, p = 0.004) as independent risk factor for a surgical intervention.

CONCLUSIONS

Blunt trauma to the nose is frequent in children. Trauma mechanisms differ significantly between age groups, whereas localization and concomitant injuries do not. Male sex was identified as an independent risk factor for soft tissue lesions and frontobasal fractures. In our experience, initial triage by the pediatric department with consecutive involvement of the ENT specialists in case of suspected complications is safe and effective and may help to reduce unnecessary diagnostic procedures/irradiation to the young patients.

Comparison of the '11+ Kids' injury prevention programme and a regular warmup in children's football (soccer): a cost effectiveness analysis

OBJECTIVE

To evaluate a potential reduction in injury related healthcare costs when using the '11+ Kids' injury prevention programme compared with a usual warmup in children's football.

METHODS

This cost effectiveness analysis was based on data collected in a cluster randomised controlled trial over one season from football teams (under-9 to under-13 age groups) in Switzerland. The intervention group (INT) replaced their usual warmup with '11+ Kids', while the control group (CON) warmed up as usual. Injuries, healthcare resource use and football exposure (in hours) were collected prospectively. We calculated the mean injury related costs in Swiss Francs (CHF) per 1000 hours of football. We calculated the cost effectiveness (the direct net healthcare costs divided by the net health effects of the '11+ Kids' intervention) based on the actual data in our study (trial based) and for a countrywide implementation scenario (model based).

RESULTS

Costs per 1000 hours of exposure were CHF228.34 (95% CI 137.45, 335.77) in the INT group and CHF469.00 (95% CI 273.30, 691.11) in the CON group. The cost difference per 1000 hours of exposure was CHF-240.66 (95%CI -406.89, -74.32). A countrywide implementation would reduce healthcare costs in Switzerland by CHF1.48 million per year. 1002 players with a mean age of 10.9 (SD 1.2) years participated. During 76 373 hours of football, 99 injuries occurred.

CONCLUSION

The '11+ Kids' programme reduced the healthcare costs by 51% and was dominant (ie, the INT group had lower costs and a lower injury risk) compared with a usual warmup. This provides a compelling case for widespread implementation.

Neuromuscular Adaptations to Multimodal Injury Prevention Programs in Youth Sports: A Systematic Review with Meta-Analysis of Randomized Controlled Trials

Objective: Neuromuscular injury prevention programs (IPP) can reduce injury rate by about 40% in youth sport. Multimodal IPP include, for instance, balance, strength, power, and agility exercises. Our systematic review and meta-analysis aimed to evaluate the effects of multimodal IPP on neuromuscular performance in youth sports.

Methods: We conducted a systematic literature search including selected search terms related to youth sports, injury prevention, and neuromuscular performance. Inclusion criteria were: (i) the study was a (cluster-)randomized controlled trial (RCT), and (ii) investigated healthy participants, up to 20 years of age and involved in organized sport, (iii) an intervention arm performing a multimodal IPP was compared to a control arm following a common training regime, and (iv) neuromuscular performance parameters (e.g., balance, power, strength, sprint) were assessed. Furthermore, we evaluated IPP effects on sport-specific skills.

Results: Fourteen RCTs (comprising 704 participants) were analyzed. Eight studies included only males, and five only females. Seventy-one percent of all studies investigated soccer players with basketball, field hockey, futsal, Gaelic football, and hurling being the remaining sports. The average age of the participants ranged from 10 years up to 19 years and the level of play from recreational to professional. Intervention durations ranged from 4 weeks to 4.5 months with a total of 12 to 57 training sessions. We observed a small overall effect in favor of IPP for balance/stability (Hedges' g = 0.37; 95%CI 0.17, 0.58), leg power (g = 0.22; 95%CI 0.07, 0.38), and isokinetic hamstring and quadriceps strength as well as hamstrings-to-quadriceps ratio (g = 0.38; 95%CI 0.21, 0.55). We found a large overall effect for sprint abilities (g = 0.80; 95%CI 0.50, 1.09) and sport-specific skills (g = 0.83; 95%CI 0.34, 1.32). Subgroup analyses revealed larger effects in high-level (g = 0.34–1.18) compared to low-level athletes (g = 0.22–0.75), in boys (g = 0.27–1.02) compared to girls (g = 0.09–0.38), in older (g = 0.32–1.16) compared to younger athletes (g = 0.18–0.51), and in studies with high (g = 0.35–1.16) compared to low (g = 0.12–0.38) overall number of training sessions.

Conclusion: Multimodal IPP beneficially affect neuromuscular performance. These improvements may substantiate the preventative efficacy of IPP and may support the wide-spread implementation and dissemination of IPP. The study has been a priori registered in PROSPERO (CRD42016053407).

Perceived Injury Risk among Junior Cricketers: A Cross Sectional Survey

Understanding how junior athletes perceive injury risks when participating in sport and the environment they play in is an important component of injury prevention. This study investigates how Sri Lankan junior cricketers (n = 365, aged 11–14 years, boys) perceive injury risks associated with playing cricket. The study used a Sri Lankan modification of an Australian junior cricket injury risk perception survey that considered playing cricket versus other sports, different cricket playing positions and roles, and different ground conditions. The risk of playing cricket was considered to be greater than that for cycling, but lower than that for rugby and soccer. Fast-bowlers, batters facing fast-bowlers, fielding close in the field, and wicket-keeping without a helmet were perceived to pose greater risks of injury than other scenarios. Playing on hard, bumpy and/or wet ground conditions were perceived to have a high risk opposed to playing on a grass field. Fielding in the outfield and wicket-keeping to fast-bowlers whilst wearing a helmet were perceived as low risk actions. The risk perceptions of junior cricketers identified in this study, do not necessarily reflect the true injury risk in some instances. This information will inform the development of injury prevention education interventions to address these risk perceptions in junior cricketers.

A 20-Year Comparison of Football-Related Injuries in American and Canadian Youth Aged 6 to 17 Years: A Replication Study

Introduction Little is known about Canadian youth football injuries. The objectives of this study were (a) to contrast the injuries in Canadian and American football players aged 6 to 17 years and (b) compare the injuries sustained during organized football with those in nonorganized football. Methods Using a retrospective cohort design based on data from the Canadian Hospitals Injury Reporting and Prevention Program and the National Electronic Injury Surveillance System a comparison of injuries was made. Results Trends in injuries were comparable. Proportions and odds of injuries were similar, except for a few exceptions. In Canada, more girls were injured and fractures were more prevalent. Compared with nonorganized football, organized football players were older, involved more males, and suffered more traumatic brain injuries and injuries to their lower extremities. Conclusion Canadian and American youth football injuries were similar. The type of football, be it organized or nonorganized, has an impact on injuries.

A Comparison of Women's Collegiate and Girls' High School Volleyball Injury Data Collected Prospectively Over a 4-Year Period

BACKGROUND

There is a relative paucity of research examining the sport-specific injury epidemiology of high school and collegiate volleyball athletes. Moreover, differences in study methodology frequently limit our ability to compare and contrast injury data collected from selected populations.

HYPOTHESIS

There are differences between the injury patterns characteristic of high school and collegiate female volleyball athletes.

STUDY DESIGN

Retrospective clinical review.

LEVEL OF EVIDENCE

Level 3.

METHODS

We statistically analyzed injury incidence and outcome data collected over a 4-year interval (2005-2006 to 2008-2009) by 2 similar injury surveillance systems, the National Collegiate Athletic Association's Injury Surveillance System (NCAA ISS) and the High School Reporting Injuries Online (HS RIO). We compared diagnoses, anatomic distribution of injuries, mechanisms of injury, and time lost from training or competition between high school and collegiate volleyball athletes.

RESULTS

The overall volleyball-related injury rate was significantly greater among collegiate athletes than among high school athletes during both competition (injury rate ratio, 2.9; 95% CI, 2.5-3.4) and practice (injury rate ratio, 3.5; 95% CI, 3.1-3.9). Collegiate athletes had a higher rate of ankle sprain, knee injury, and shoulder injury. Concussions represented a relatively high percentage of injuries in both populations (5.0% of total NCAA ISS injuries vs 4.8% of total HS RIO injuries, respectively).

CONCLUSION

The data suggest that although similar, there were distinct differences between the injury patterns of the 2 populations. Compared with high school volleyball players, collegiate athletes have a higher rate of acute time loss injury as well as overuse time loss injury (particularly patellar tendinosis). Concussions represented a significant and worrisome component of the injury pattern for both study populations.

CLINICAL RELEVANCE

The injury data suggest that important differences exist in the injury patterns of female high school compared with collegiate volleyball athletes. Consideration of the specific injury patterns may be helpful in future prevention efforts.

Exercise-based injury prevention in child and adolescent sport: a systematic review and meta-analysis

BACKGROUND

The promotion of sport and physical activity (PA) for children is widely recommended to support a healthy lifestyle, but being engaged in sport bears the risk of sustaining injuries. Injuries, in turn, can lead to a reduction in current and future involvement in PA and, therefore, may negatively affect future health as well as quality of life. Thus, sports injury prevention is of particular importance in youth.

OBJECTIVE

The aim of this systematic review was to quantify the effectiveness of exercise-based injury prevention programs in child and adolescent sport in general, and with respect to different characteristics of the target group, injury prevention program, and outcome variables.

DATA SOURCES

An Internet-based literature search was conducted in six databases (CINAHL, Cochrane, EMBASE, ISI Web of Science, PubMed, SPORTDiscus) using the following search terms with Boolean conjunction: (sport injur* OR athletic injur* OR sport accident*) AND (prevent* OR prophylaxis OR avoidance) AND (child* OR adolescent OR youth).

STUDY SELECTION

Randomized controlled trials and controlled intervention studies in organized sport, published in English in a peer-reviewed journal, analyzing the effects of an exercise-based injury prevention program in athletes younger than 19 years of age.

DATA EXTRACTION

Two reviewers evaluated eligibility and methodological quality. Main outcome extracted was the rate ratio (RR). Statistical analyses were conducted using the inverse-variance random effects model.

RESULTS

Twenty-one trials, conducted on a total of 27,561 athletes (median age 16.7 years [range 10.7-17.8]), were included. The overall RR was 0.54 (95% CI 0.45-0.67) [p < 0.001]. Girls profited more from injury prevention than boys (p = 0.05). Both prevention programs with a focus on specific injuries (RR 0.48 [95% CI 0.37-0.63]) and those aiming at all injuries (RR 0.62 [95% CI 0.48-0.81]) showed significant reduction effects. Pre-season and in-season interventions were similarly beneficial (p = 0.93). Studies on programs that include jumping/plyometric exercises showed a significant better (p = 0.002) injury preventive effect (RR 0.45 [95% CI 0.35-0.57], Z = 6.35, p < 0.001) than studies without such exercises (RR 0.74 [95% CI 0.61-0.90], Z = 3.03, p = 0.002).

CONCLUSIONS

The results provide good evidence and clearly demonstrate beneficial effects of exercise-based injury prevention programs in youth sports as they can result in statistically significant and practically relevant injury reduction. In particular, multimodal programs including jumping/plyometric exercises can be recommended. However, there is a considerable lack of data for children (under 14 years of age) and for individual sports in general. Future research should include these groups and focus on the effect of specific exercises and compliance.

What is the Relationship between Risky Outdoor Play and Health in Children? A Systematic Review

Risky outdoor play has been associated with promoting children’s health and development, but also with injury and death. Risky outdoor play has diminished over time, concurrent with increasing concerns regarding child safety and emphasis on injury prevention. We sought to conduct a systematic review to examine the relationship between risky outdoor play and health in children, in order to inform the debate regarding its benefits and harms. We identified and evaluated 21 relevant papers for quality using the GRADE framework. Included articles addressed the effect on health indicators and behaviours from three types of risky play, as well as risky play supportive environments. The systematic review revealed overall positive effects of risky outdoor play on a variety of health indicators and behaviours, most commonly physical activity, but also social health and behaviours, injuries, and aggression. The review indicated the need for additional “good quality” studies; however, we note that even in the face of the generally exclusionary systematic review process, our findings support the promotion of risky outdoor play for healthy child development. These positive results with the marked reduction in risky outdoor play opportunities in recent generations indicate the need to encourage action to support children’s risky outdoor play opportunities. Policy and practice precedents and recommendations for action are discussed.

Position Statement on Active Outdoor Play

A diverse, cross-sectorial group of partners, stakeholders and researchers, collaborated to develop an evidence-informed Position Statement on active outdoor play for children aged 3–12 years. The Position Statement was created in response to practitioner, academic, legal, insurance and public debate, dialogue and disagreement on the relative benefits and harms of active (including risky) outdoor play. The Position Statement development process was informed by two systematic reviews, a critical appraisal of the current literature and existing position statements, engagement of research experts (N = 9) and cross-sectorial individuals/organizations (N = 17), and an extensive stakeholder consultation process (N = 1908). More than 95% of the stakeholders consulted strongly agreed or somewhat agreed with the Position Statement; 14/17 participating individuals/organizations endorsed it; and over 1000 additional individuals and organizations requested their name be listed as a supporter. The final Position Statement on Active Outdoor Play states: “Access to active play in nature and outdoors—with its risks— is essential for healthy child development. We recommend increasing children’s opportunities for self-directed play outdoors in all settings—at home, at school, in child care, the community and nature.” The full Position Statement provides context for the statement, evidence supporting it, and a series of recommendations to increase active outdoor play opportunities to promote healthy child development.

Linking emergency medical department and road traffic police casualty data: a tool in assessing the burden of injuries in less resourced countries

OBJECTIVE

The study aimed to (1) assess the magnitude of road traffic injuries in a country missing a formal linkage system of police with hospital data, (2) quantify the underreporting, and (3) produce a convenient algorithm exploring its constituent components.

METHODS

Linkage of disaggregate (individual) data collected by the road traffic police (RTP) with those by the Emergency Department Injury Surveillance System (EDISS) on the Greek island of Corfu and coded with different classification systems was carried out. The applied four-step methodology, also comprising the calculation of underreporting coefficients of the variation by basic demographic variables, mode of transport, and injury outcome, led to the identification of the overall underreporting from either registry.

RESULTS

RTP data captured 96.6% (coefficient: 1.035), whereas EDISS captured only 54.4% of total fatalities (overall concordance: 51.1%). On the contrary, EDISS captured 94.6% of nonfatal injuries, whereas RTP only captured 16% (coefficient: 6.238), resulting in a low overall concordance (10.6%). Considering severity of injury assessed by EDISS, by using the ISS as the gold standard, RTP data misclassified 20.3% of severe injuries as less severe, and a statistically significant difference in the underreporting by gender was also noted.

CONCLUSION

Relatively simple methodologies can provide essential coefficients to assess the actual numbers, severity, and components of road casualties by complementing routinely collected RTP with sentinel emergency department reporting systems.

National survey on sports injuries in the Netherlands: target populations for sports injury prevention programs

OBJECTIVE

To define target populations for sports injury prevention programs.

DESIGN

A computer-assisted telephone survey on sports injuries and sports participation during 2000-2005 using a 3-month recall period.

SETTING

Data obtained from a representative sample of Dutch citizens.

PARTICIPANTS

Fifty-eight thousand four hundred five Dutch citizens aged older than 3 years.

ASSESSMENT OF RISK FACTORS

Age, gender, and type of sports were used to distinguish subgroups with a substantial contribution to sports injuries.

MAIN OUTCOME MEASURES

The absolute number of sports injuries, the incidence of sports injuries per 10,000 hours, the severity, and costs of sports injuries.

RESULTS

Sports participation was associated with 1.5 million injuries per year and 10 injuries per 10,000 hours; of these, 50% had to be treated medically. Two-thirds of all medically treated sports injuries were associated with 9 sports (representing 18 subpopulations, all younger than 55 years): outdoor soccer (males 4-54 years and females 4-17 years), indoor soccer (males 18-34 years), tennis (males/females 35-54 years), volleyball (females 18-54 years), field hockey (males 18-34 years and females 4-17 years), running/jogging (males/females 35-54 years), gymnastics (males/females 4-17 years), skiing/snowboarding (males 4-17 years and females 18-34 years), and equestrian sports (females 18-34 years). These groups showed more than average injury rates and covered two-thirds of all direct and indirect costs (euro 400 million).

CONCLUSIONS

The survey identified the most important (sports-, age-, and gender-specific) target populations for injury prevention programs in the Netherlands. Sports participants aged older than 55 years were excluded from these target groups because of their limited contribution to the total sports injury problem.

The perception of causes of accidents in mountain sports: a study based on the experiences of victims

Each year, accidents involving mountain sports have many repercussions, including alarming public opinion and society. This study outlines the results of a qualitative study on the responses of 135 survivors of accidents that took place while mountaineering, climbing, downhill skiing and ski mountaineering, hiking, cross-country biking, and mountain racing. A content analysis was performed on the textual data obtained from the responses to an online survey. The identified causes were: environmental events, equipment, medical events, behavioral events, and time pressure, but they appear combined in different ways for the analyzed disciplines. Results show that for downhill skiing, direct causes of accidents were mainly behavioral: excessive speed, skiing errors, and fatigue. For ski mountaineering, direct causes were errors in decision-making and skiing. In mountaineering, precursors were unfavorable conditions, fatigue, lack of preparation, and skill errors. In climbing, difficulty is an omnipresent feature, but the precursors are mainly errors. Our results highlight the multi-causal nature of accidents that take place when practicing mountain sports. Finally, we examine the need to promote a mountain sports culture that highlights safety and injury prevention.

Injuries, risk factors and prevention initiatives in youth sport

BACKGROUND

Sports injuries in young athletes are a public health issue which deserves special attention. Effective prevention can be achieved with training programmes originating from the field of physical therapy and medicine.

SOURCES OF DATA

A systematic literature search on injury prevention in youth sport was performed in the MEDLINE database.

AREAS OF AGREEMENT

For prevention programmes to reduce sports injuries, critical factors must be considered, such as training content, duration and frequency, as well as athlete compliance.

AREAS OF CONTROVERSY

Home-based programmes could be inferior to supervised training, but are efficient if compliance is high. So far prevention programmes have focused on team sports and their efficiency in individual sports remains to be proven.

GROWING POINTS

Active prevention programmes focusing specifically on the upper extremity are scarce. Initiatives enhancing the awareness of trainers, athletes and therapists about risk factors and systematic prevention measures should be encouraged.

The effect of concentrating periods of physical activity on the risk of injury in organized sports in a pediatric population

BACKGROUND

The trend in pediatric sport organizations is to regroup activities into tournaments. Sports-related injuries in children are a public concern.

OBJECTIVE

To evaluate the association between sport injuries and consolidation of physical activity in children.

DESIGN

A case-crossover study.

SETTING

The emergency department of a tertiary care hospital for approximately 1 year in 2006.

PARTICIPANTS

Eligible participants had to be between 8 to 16 years of age, presenting to the emergency department for an acute injury that occurred during a timed organized sport event.

ASSESSMENT OF RISK FACTORS

A standardized questionnaire was used to evaluate the number of hours of organized physical activity, which was defined as a supervised exercise leading to competitions. The number of hours of activity was compared between case periods (48 hours and 7 days) and control periods of same length.

MAIN OUTCOME MEASUREMENTS

An injury was defined as any acute problem with organic tissue that occurred during a sport.

RESULTS

On average, participants performed 136 minutes of organized sport activity in the 48 hours preceding the injury for a mean difference of 8 +/- 18 min. They also performed 356 minutes of organized sports in the 7 days prior the injury. This represented an increase of 40 +/- 31 minutes compared to the control periods.

CONCLUSIONS

More injuries were observed if the athletes had increased the concentration of activity in the 7 days prior. Although small, this difference reflected a minor clinical effect. In our study, we failed to disclose an association for the period of 48 hours.

Determinants of school injury proneness in adolescents: a prospective study

OBJECTIVE

Injury proneness is common in adolescents, but the role of individual factors has received little attention. This study assessed the relationships of a number of individual characteristics with frequency of school injuries.

METHODS

This prospective study was conducted on 2396 students from middle schools and high schools in an urban area in France over one school year. A questionnaire was completed by each student at the beginning of the school year, and an injury questionnaire was completed for all injuries that occurred at school during the year. Data were analysed using the chi2 independence test and logistic models.

RESULTS

Over the study year, 10.6% of the students had a single injury. Frequent injuries (two or more) were common (2.3%) and were strongly related to younger age [adjusted odds ratio (aOR) 1.52, 95% confidence interval (95%CI) 1.28-1.79], frequent use of psychotropic drugs (aOR 2.03, 95%CI 1.06-3.86) and a poorer average school mark (<10/20, aOR 2.58, 95%CI 1.30-5.12). The occurrence of a single injury was less strongly related to younger age (aOR 1.20, 95%CI 1.11-1.30) and frequent use of psychotropic drugs (aOR 1.43, 95%CI 1.04-1.96), and was also associated with parental absence (aOR 1.33, 95%CI 1.00-1.77), not being calm (aOR 1.41, 95%CI 1.03-1.89) and not being easily irritated (aOR 1.56, 95%CI 1.14-2.13).

CONCLUSIONS

This study identified a number of factors associated with injury frequency. This information could be useful for injury prevention. Physicians could help students, parents, teachers and school staff to be more aware of the risks and to find remedial measures.

School injury and gender differentials: a prospective cohort study

This study assessed the role of certain individual characteristics in school injury among male and female adolescents. The sample included 2,398 subjects attending middle schools and high schools. Respondents completed a self-administered questionnaire at the beginning of the school year. School nurse completed a questionnaire on injury for each school injury occurred during the school year. The data was analyzed with the adjusted odds ratios (ORa) computed via the logistic models. The school injury was common (13% for both sexes). Sports/physical training injury was more frequent among girls (8.8% vs. 6.6%, P < 0.05) contrarily to the other types of injury (4.6% vs. 8.8%, P = 0.001). Sports/physical training injury was strongly associated with age <15 years (ORa 3.42) and presence of previous injury (2.63) among boys, and with age <15 years (2.02), presence of previous injury (2.94), not easily irritated (1.89), and irresponsible (1.59) among girls. The other types of injury were highly related to age <15 years (ORa 4.18), frequent use of psychotropic drugs (1.76), not living with both parents (1.65), being not calm (2.03), and presence of previous injury (1.82) among boys, and to age <15 years (2.59), obesity (3.24), and being not calm (1.84) among girls. The present study identified a number of potential risk factors for school injury among male and female adolescents. Preventive measures should be taken to make adolescents, their parents and teachers more aware of the risks and to find remedial measures.

From sports injury prevention to safety promotion in sports

Every fifth unintentional injury treated at a healthcare facility in the industrialised part of the world is associated with sports or physical exercise. This article reviews the literature regarding the theoretical and practical underpinnings for community-based sports safety promotion, including both professional and recreational sports. While injury prevention entails the implementation of specific interventions in terms of structural or educational measures, sports safety promotion includes also the antecedent and wider campaigns that are required to succeed with these measures. Comprehensive sports safety promotion programmes thus require that the perspective on the sports injury problem is made broader than consideration of the individual athlete. The results display that involvement in sports safety issues from the sports federations that formulate policies and allocate resources is necessary for coordinated implementation of programme actions. The authorities responsible for sports facilities and legislations in the civil society also need to be included, because of the fact that they control many of the central safety determinants in the sporting environment. It is concluded that the sports injury problem needs to be addressed in liaison with the leaders of socially defined sports communities and the governments representing geographically defined civic communities, and that the safety-supporting environment in professional sports is underdeveloped compared with other areas of working life.

Impact of social standing on sports injury prevention in a WHO safe community: intervention outcome by household employment contract and type of sport

OBJECTIVES

As physical activity is promoted as part of a healthy lifestyle, sports injuries are becoming an important public health concern in many countries. The objective of this study is to investigate rates of sports injuries before and after implementation of a WHO Safe Community program.

METHODS

Sports injury data were collected pre- and post-implementation from all individuals below 65 years of age during 1 year in the targeted municipality (population 41,000) and in a control municipality (population 26,000). A quasi-experimental design was used and individuals were divided into three categories based on household relationship to the labour market.

RESULTS

There were no differences between socio-economic categories regarding pre-intervention injury rates. No statistically significant post-intervention changes in injury rate were observed in the control area or among any females in either area. In the intervention area, a statistically significant (p = 0.011) decrease in injury rate was observed among male members of households in which the vocationally important member was employed. A statistically significant decrease was observed in injuries sustained in team sports among male members of households in which the vocationally important member was employed (p = 0.001) and among members of households in which the vocationally important member was self employed (p<0.05).

CONCLUSIONS

The study indicates areas for improvement in the civic network based WHO Safe Community model. The results show that females, participants in individual sports, and members of non-vocationally active households were less affected by the interventions. These facts have to be addressed in planning future community based sports injury prevention programmes and their evaluations.

Acute Injury of the Articular Cartilage and Subchondral Bone:A Common but Unrecognized Lesion in the Immature Knee

OBJECTIVE

We studied the prevalence of injuries of the articular cartilage and subchondral bone after acute trauma in skeletally immature knees using high-resolution MRI.

MATERIALS AND METHODS

We reviewed knee MRIs of 126 young children and adolescents suspected to have internal knee derangement, including 82 with open physes and a control group of 44 who were skeletally mature. High-resolution proton density and T2-weighted pulse sequences were used in all patients. The prevalence of common injuries in the two groups was compared using chi-square analysis. Levels of interobserver agreement for evaluation of chondral lesions in the skeletally immature group were determined using the kappa statistic.

RESULTS

In the skeletally immature group, chondral lesions were the most prevalent injuries (prevalence = 0.34, p = 0.009) followed by meniscal and anterior cruciate ligament injuries (prevalence = 0.23 and 0.24, respectively). No significant difference in the prevalence of chondral injury before and after physeal closure was seen (p = 0.45). There was no significant difference in the prevalence of anterior cruciate ligament injuries between the two groups, but meniscal injuries were more prevalent in the skeletally mature patients (prevalence = 0.41, p = 0.037). Interobserver agreement for chondral injuries in the group with open physes was good (weighted kappa = 0.45-0.51).

CONCLUSION

The most common injuries occurring as a result of acute trauma to the immature knee were chondral. In patients with open physes, chondral injuries were significantly more prevalent than anterior cruciate ligament and meniscal injuries.

Sports and recreation related injury episodes in the US population, 1997-99

OBJECTIVE

To characterize sports and recreation related (SR) injury episodes in the US population. SR activities are growing in popularity suggesting the need for increased awareness of SR injuries as a public health concern for physically active persons of all ages in the US population.

SETTING

The National Health Interview Survey (NHIS) is a face-to-face household survey conducted yearly by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention. Demographic and health data are collected from a nationally representative sample of the civilian, non-institutionalized population residing in the US.

METHODS

Medically attended injury events reported in the 1997-99 Injury Section of the NHIS were categorized according to the associated sport or recreational activity using a classification scheme based on the International Classification of External Causes of Injury system. Episodes where the injured person received any type of medical attention (that is, medical advice or treatment) from any health care provider were used to report the incidence, severity, and nature of SR injuries sustained by US citizens.

RESULTS

Annually, an estimated seven million Americans received medical attention for SR injuries (25.9 injury episodes per 1000 population). For 5-24 year olds, this national estimate was about 42% higher than estimates based on SR injuries seen only in emergency departments over a similar time frame. The highest average annual SR injury episode rates were for children ages 5-14 years (59.3 per 1000 persons) and persons aged 15-24 years (56.4 per 1000 persons). The SR injury episode rate for males was more than twice the rate for females. The age adjusted injury rate for whites was 1.5 times higher than for blacks (28.8 v 19.0 per 1000 population). Basketball was the most frequently mentioned SR activity when the injury episode occurred, with a rate of about four injury events per 1000 population. Strains and sprains accounted for 31% of injury episodes. An estimated 1.1 million SR episode related injuries involve the head or neck region, of which 17% were internal head injuries. The most common mechanisms of injury were struck by/against (34%), fall (28%), and overexertion (13%).

CONCLUSION

As physical activity continues to be promoted as part of a healthy lifestyle, SR injuries are becoming an important public health concern for both children and adults. Prevention efforts aimed at reducing SR injuries through targeting high risk activities, places of occurrence, activity, risk behaviors, and use of protective devices need to go beyond focusing on children and also consider physically active adults.