Trends and Epidemiologic Factors Contributing to Soccer-Related Fractures That Presented to Emergency Departments in the United States

Epidemiology of rugby-related fractures in high school- and college-aged players in the United States: an analysis of the 1999-2018 NEISS database

OBJECTIVES

Rugby is a high-impact collision sport with identical competition rules by sex. The aim of this study was to analyze the trend of rugby-related fractures by body site, sex, and age in amateur athletes from 1999 to 2018.

METHODS

The National Electronic Injury Surveillance System (NEISS) database was queried to characterize rugby-related injuries from 1999 to 2018 in patients aged 14-23 years old. National injury estimates were calculated using sample weights. Chi-square analysis and one-way ANOVA were performed to compare categorical variables.

RESULTS

Out of a total of 43,722 weighted cases of rugby-related fractures over the 19-year period, 70.9% were among high school- and college-aged males and females between the ages of 14-23 years (N = 30,996). Males constituted 79.3% of cases whereas females composed 20.7% of the cases. The proportion of upper extremity fractures was similar in both males and females, yet facial fractures were significantly more common among males than females (27.9% vs. 14.6%, P < 0.001). Among facial fractures, nasal fractures represented 74.4% of the sample, yet facial fractures only resulted in hospital admittance in 1.3% of cases. Lower extremity fractures were more likely to be severe, with 11.3% of LE cases being admitted to the hospital.

CONCLUSION

Rugby players in the US diagnosed in the ED with fractures consisted largely of male, high school- and college-aged athletes. Males and females experienced upper and lower-extremity fractures at comparable rates, yet lower extremity injuries were more likely to be admitted to a hospital. Men were significantly more likely to experience a facial fracture in which a majority were nasal fractures.

Fractures in soccer: The current evidence, and how this can guide practice

This article reviews the current evidence on traumatic fractures in soccer, and assesses how this can guide practice. The incidence of traumatic soccer-related fractures was found to be 0.64 to 0.71/1000 in the general population. Demographics vary between the general population and professional soccer players, with 68% of traumatic soccer fractures occurring in the upper extremity in the general population, and only 23% of traumatic soccer fractures occurring in the upper extremity in professional players. Within the general population, around 80% of traumatic soccer-related fractures are managed non-operatively, with 20% managed operatively. The optimal treatment method is determined by fracture location and configuration. There is an increasing role for primary operative treatment in unstable, non-displaced fracture types, to facilitate an accelerated return to soccer. Around 86% of soccer players return to sport post-fracture. Return times vary by fracture locations and playing level, with elite players having quicker return times than the general population. Regarding injury prevention, shin guards appear to confer substantial benefit against tibial diaphyseal fractures. However, further research is required to determine the optimal preventative measures against fractures in soccer.

Lessons in Linkage: combining administrative data using deterministic linkage for surveillance of sports and recreation injuries in Florida, United States

Objectives

Previous and ongoing epidemiological surveillance of sports and recreation injuries (SRI) has been cross-sectional in nature, utilised a subset of injuries based on athletic trainer availability, or focused on elite and professional athletes. In the United States, surveillance is often prohibitively expensive and not well funded by national organisations or agencies, except for the case of some professional and elite sports. This paper details the methodology, barriers, and successes of using deterministic linkage to combine emergency department and hospitalisation data with a single identifier for use in surveilling sports injuries for persons aged 5 to 18 years.

Design

Data linkage of a population cohort.

Methods

We performed deterministic linkage of administrative emergency department and hospitalisation data from the state of Florida in the US. Data was acquired from the Florida Agency for Health Care Administration. With limited identifiers available due to privacy, we combined data across multiple years using a near universal identifier. We identified sport and recreation injuries using a modified External Cause of Injury Morbidity Matrix and ICD codes across all possible diagnoses. Finally, we obtained descriptive statistics of records that were successfully linked and those that were not to assess similarities between the groups.

Results

We found 384,731 visits for SRI over a seven-year period. We were able to link approximately 70% of the records using a single identifier. There were statistically significant differences by age, sex, payer, and race/ethnicity for the records that were linked compared to the records that were not linked.

Conclusions

This study is significant because while similar methods have been used to examine other conditions (e.g. asthma), few have linked multiple types of administrative data especially with nearly no identifiers to examine sports and recreation injuries. This method was found useful to identify injuries over time for the same individuals seeking care in emergency departments, or in hospital inpatient settings, though future work will need to address the limitations of this method. If we expect to move health surveillance forward as budgets for it become even more limited, we must develop and improve methods to do it with fewer resources, including using data that has great limitations.

Injuries in Recreational Footballers and the Severe Consequences of Player-to-Player Contact: A Prospective Observational Study

Introduction

Football is the most popular sport in the world with its wide audience and important economic effects. This game is mainly played by professional football players, it is also an activity that is frequently played by non-professionals. Although members of the public mostly engage in this sport as a hobby and to develop a healthy lifestyle, vital injuries, such as head and thorax trauma can also occur during these recreational activities. In this study, our aim was to identify these severe traumas, investigate their causes and mechanisms, and make suggestions to reduce trauma among recreational football players.

Methods

This prospectively designed study included players aged over 14 years who presented to the emergency department with an injury incurred during a recreational football match activity. The demographic characteristics of the patients, warm-up status, match conditions, field conditions, and injury mechanisms, as well as post-injury outcomes, were recorded and analyzed with appropriate statistical methods.

Results

There were 167 patients included in the study and 140 of these patients were eligible for the study. We identified 45 cases with poor outcomes such as pneumocephalus, rib fractures, pneumothorax, Achilles tendon rupture, and bone fractures. (32.1%). Factors that could have an effect on poor outcomes were determined as a pre-match warm-up, pre-match sleep duration, and suitability of equipment. Player-to-player contact was determined as a mechanism of head and thorax trauma.

Conclusions

It may be beneficial to inform recreational football players about how player-to-player contact can cause head and thoracic trauma and establish a database of sports injuries in hospitals.

Hand, Wrist, and Forearm Injuries in Male Professional Soccer Players: A Prospective Cohort Study of 558 Team-Seasons From 2001-2002 to 2018-2019

Background

The literature on upper extremity injuries in professional soccer players is scarce, and further insight into the onset and cause of these injuries as well as potential differences between goalkeepers and outfield players is important.

Purpose

To investigate the epidemiology of hand, wrist, and forearm injuries in male professional soccer players between 2001 and 2019.

Study Design

Descriptive epidemiology study.

Methods

Between the 2001-2002 and 2018-2019 seasons, 120 European male soccer teams were followed prospectively for a varying number of seasons (558 team-seasons in total). Time-loss injuries and player-exposures to training sessions and matches were recorded on an individual basis in 6754 unique players. Injury incidence was reported as the number of injuries per 1000 player-hours, and between-group differences were analyzed using Z statistics and rate ratios (RRs) with 95% CIs. Between-group differences in layoff time were analyzed.

Results

In total, 25,462 injuries were recorded, with 238 (0.9%) of these affecting the hand (71.4%; n = 170), wrist (16.8%; n = 40), and forearm (11.8%; n = 28), producing an incidence of 0.065 injuries per 1000 hours. A majority of the injuries were traumatic with an acute onset (98.7%; n = 235). Fractures were the most common injuries recorded (58.8%; n = 140), often involving the metacarpal bones (25.2%; n = 60) and phalanges (10.1%; n = 24). The injury incidence was significantly higher for goalkeepers (115 injuries; 0.265 per 1000 hours) compared with outfield players (123 injuries; 0.038 per 1000 hours) (RR, 7.0 [95% CI, 5.4-9.0]). Goalkeepers also had a significantly longer mean layoff time than outfield players (23 ± 27 vs 15 ± 27 days; P = .016).

Conclusion

Injuries to the hand, wrist, and forearm constituted less than 1% of all time-loss injuries in male professional soccer players. Fractures were most common and constituted more than half of all injuries. Goalkeepers had a 7-fold higher incidence and an over 1-week longer mean layoff time compared with outfield players.

Prospective analysis of craniofacial soccer incidents during FIFA competitions: an observational study

The aim of this prospective epidemiological study was to evaluate the occurrence of incidents involving the craniofacial region of soccer players during three official FIFA competitions. The craniofacial incidents were identified by video analysis of all 144 matches of two FIFA World Cups (2014/2018) and the 2017 FIFA Confederations Cup. Data collection included incident type, incident severity, site affected, incident cause and referee decision. The multivariate Poisson regression model was performed to analyze the associations between covariates. A total of 238 incidents were observed in the craniofacial region (1.6 incidents/match), representing a rate of 48.5 incidents per 1000 hours. At least 80.6% of the matches presented at least one incident, and, in more than 60%, the referee's decision was no foul. According to severity, 26.8% of the incidents were classified as having mild or high severity. Incidents involving lacerations or fracture presented higher severity compared with hits (IRR 3.45[95%CI: 1.89-6.30]). Head-to-head impacts showed an incidence of severe incidents twice as high as those involving upper extremities (IRR 2.01[95%CI:1.07-3.76]). A high number of craniofacial incidents were observed in the last FIFA competitions. Head-to-head impacts and lacerations or fractures were associated with higher incident severity.