Baseball-Related Craniofacial Injury Among the Youth: A National Electronic Injury Surveillance System Database Study

Facial trauma in the major league baseball

OBJECTIVE

The objectives of this study were to identify and describe significant facial trauma present in Major League Baseball (MLB) that resulted in players missing games or being placed in the injury reserve list.

STUDY DESIGN

This was a retrospective cohort study. The predictor variables were the player's age, height, weight, body mass index, position, team conference, and if played games took place in playoffs season. The outcome variables were injury location (upper, middle, and lower facial third) and type of injury (soft tissue, fracture). Chi-square and logistic regression were computed to determine associations between predictor and outcome variables.

RESULTS

A total of 109 players missed games due to facial injuries, and a total of 115 injuries were identified. Of the 115 injuries, none occurred in the upper facial third, 96 (83%) were in the middle third, and 19 (17%) in the lower third. Most fractures occurred in fielders (45%), and most soft tissue injuries in basemen (40%).

CONCLUSIONS

Significant facial trauma in the MLB has risen in recent years. The player's height, conference, and playoff season were the most associated factors. Most injuries occurred in the periorbital area. A recommendation for the use of protection goggles can be made to prevent them.

Assessing the COVID-19 pandemic's impact on pediatric baseball and basketball-related craniofacial and neck injuries treated in United States emergency departments, 2003-2022

BACKGROUND

A large proportion of United States (U.S.) youth play basketball, baseball, softball, or T-ball. Each of the activities poses a documented risk of craniofacial and neck injuries. However, few studies have assessed the national prevalence of pediatric craniofacial and neck injuries in this population, particularly following the COVID-19 pandemic.

METHODS

The National Electronic Injury Surveillance System (NEISS) dataset was used to identify pediatric craniofacial and neck injuries associated with basketball, baseball, softball, or T-ball from 2003-2022 in a cross-sectional study. The annual number of injuries before and after the onset of the COVID-19 pandemic with 95% confidence intervals were calculated. Interrupted time series analysis (ITSA) was used to estimate the pandemic's impact on the monthly number of injuries incurred nationally.

RESULTS

Both overall and stratified by sport involvement, the annual number and rate of injuries identified in NEISS decreased significantly after the COVID-19 pandemic. ITSA demonstrated that the monthly number of injuries decreased -4094.4 (95% CI = -5100, -3088.7) immediately after the beginning of the pandemic. The number of injuries began increasing towards pre-pandemic levels at a rate of 110.6 (95% CI = 64, 157.2) injuries per month after the initial plunge.

CONCLUSION

Prior to the-pandemic, there was a steady decline in craniofacial and neck injuries due to basketball, baseball, softball and T-ball among children, aged <18 years. The shutdown during the initial months of the COVID-19 pandemic resulted in a precipitous drop in such injuries. Current rates are approaching pre-pandemic levels and may exceed them. Continued efforts are needed to keep the pre-pandemic progress.

Baseball Injury Prevention Through a Community Outreach Initiative

Sports-related craniofacial injuries account for 10% to 42% of facial fractures in the US pediatric population, with the incidence of injury peaking at ages 6 to 7 and 12 to 14. The National Survey of Children's Health reported ~5.6 million children between the ages of 6 and 17 participated in baseball in 2021. National Electronic Injury Surveillance System reported 861,456 injuries resulting from baseball and 511,117 injuries resulting from softball in 2021, with ~500,000 of those injuries being to the face/head/neck. While participation in baseball and other youth sports has tremendous physical and mental health benefits, facial and other athletic injuries are concerning beyond the pain and disability caused by the incident itself. Severe injury can result in lost time from school as well as other social activities. Players and their families often experience financial strain as a result of physical trauma as well. The use of protective equipment has decreased the incidence of emergency department visits due to baseball-related trauma, especially mouthguards. However, adherence to using mouthguards is relatively low in baseball, with over 80% of players reporting not being told by a coach to wear mouthpieces. Youth from low-income areas often lack financial means to provide protective equipment and health insurance in the case of injury. The authors, along with the University of Miami Miller School of Medicine Division of Plastic and Reconstructive Surgery and Miami Marlins RBI Program, created an outreach program by which over 400 mouthguards were given to players and caretakers at inner-city baseball and softball programs. Two community outreach events took place in South Florida. One event was held at a University of Miami Men's Baseball Game, and another was held on the opening day of the Miami Marlins RBI Program youth baseball league. In addition to handing out protective equipment and informational pamphlets, a question and answers session was held to discuss injury prevention. In conclusion, our community safety initiative created an interactive dialogue and message to hundreds of youth baseball players about the importance of protective gear to prevent injuries.