Traumatic Head and Neck Injuries in Elite Australian Cricket Players: Retrospective Analysis from 12 Seasons

Objectives

To describe traumatic head and neck injuries in elite Australian cricket players, for the purposes of understanding risk and the role of protective equipment and regulations.

Design

Retrospective cohort study.

Methods

This study reviewed twelve seasons of clinical data for elite male and female cricket players who sustained a traumatic head or neck injury (excluding isolated concussion) whilst participating in a cricket match or training.

Results

199 events of head and neck injuries were recorded over the 12 seasons, equating to an average incidence of 5.6 per 100 players per season. Since the introduction of helmet regulations in 2016, the average incidence was 7.3. Including concurrent injuries, 232 injuries revealed contusions were the most common type of injury (41%, 35-48%), and the face was the most common location (63%, 57-69%). Injuries resulted in the player being unavailable for cricket for one or more days in 15% (11-22%) of events. Since the introduction of cricket helmet regulations, the proportion of injuries sustained while batting decreased from 54% (43-65%) to 38% (30-47%) (p = 0.026), and the proportion of injuries sustained while wicket keeping decreased from 19% (11-29%) to 6% (3-11%) (p=0.004).

Conclusion

Traumatic head and neck injuries occur at an incidence of approximately 7.3 per 100 players per season in elite Australian male and female cricket players. Whilst most injuries cause a low burden with respect to days unavailable, the risk of potentially serious or catastrophic consequences warrants further risk reduction strategies including tightening of the existing industry standard for helmets and governing body regulations.

Graphical Abstract

Comparison of injury profiles between elite Australian male and female cricket players

OBJECTIVES

This study presents seven seasons of injury surveillance data for both elite Australian male and female cricket players, revealing injury statistics and allowing for comparison between sexes.

DESIGN

Retrospective cohort.

METHODS

Participants were elite Australian male and female cricket players who were contracted to play for a national and/or state/territory team and/or T20 franchise between 2015-16 and 2021-22 (7 seasons). Injury data was recorded in Cricket Australia's Athlete Management System database and combined with match data. The STROBE-SIIS statement was used as the relevant guideline for this study.

RESULTS

Data for 1345 male player seasons and 959 female player seasons revealed sex-related differences in the injury incidence rates and prevalence. Males had higher incidence (average 136 vs 101 injuries per 1000 match days) and prevalence of match time-loss injuries (average 10.4% vs 6.5% players unavailable). However, the overall incidence of all medical attention injuries were similar between sexes (Incidence Rate Ratio (IRR) 0.9, 95%CI 0.8-1.0). The most frequent match time-loss injuries for males were hamstring strains (7.4 new injuries per 100 players per season), side and abdominal strains (5.5), concussion (5.0), lumbar stress fractures (4.3), and wrist and hand fractures (3.9). The most frequent match time-loss injuries for females over the 7 seasons were hamstring strains (3.1), concussion (2.3), quadriceps strains (2.4) and shin/foot/ankle stress fractures (2.0). The IRR of medical attention injuries for males compared to females was higher for lumbosacral stress fractures (IRR 2.3), elbow and forearm injuries (1.5), and concussion (1.4), and lower for lower leg, foot, and ankle stress fractures (0.6), shoulder and upper arm injuries (0.7), and quadriceps strains (0.6).

CONCLUSIONS

Robust long-term injury surveillance enabled the injury profiles of elite Australian male and female cricket players to be understood and compared. Males had a higher incidence and prevalence of match time-loss injuries, likely reflecting a higher match exposure.

Association of Preexisting Mental Health Conditions With Increased Initial Symptom Count and Severity Score on SCAT5 When Assessing Concussion

Background:

Mental health conditions, such as depression, anxiety, and learning disabilities, are associated with symptoms that can overlap with those seen in persons with concussion. While concussion screening tools such as the Sport Concussion Assessment Tool–5th Edition (SCAT5) quantify the number of symptoms and symptom severity, it is not known whether these outcomes differ among individuals with concurrent mental health conditions compared with those without them.

Purpose:

To determine whether, during initial concussion assessment, individuals with a self-reported mental health condition have a significantly different number of self-reported concussion symptoms or symptom severity compared with those without a self-reported mental health condition (controls).

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A retrospective chart review was performed on consecutive patients aged ≥13 years who underwent post-concussion assessment at the Fowler Kennedy Sport Medicine Clinic between May 2018 and March 2020 (N = 765). Most participants did not self-report a mental health condition (n = 606; 79.2%). Participants with a self-reported mental health condition (n = 159) were classified as having a learning disability (n = 14; 8.8%), anxiety (n = 62; 39.0%), depression (n = 20; 12.6%), or multiple conditions (≥2 conditions: n = 63; 39.6%). Each participant with a mental health condition was matched with 2 control participants (overall pool, n = 318) based on age, sex, student status, and sport-related risk. Mann-Whitney U tests were used to determine the statistical significance of differences between each subgroup and their matched controls for the self-reported number of concussion symptoms and symptom severity as measured using the SCAT5.

Results:

The anxiety and multiple-conditions subgroups had a significantly greater number of reported symptoms than their corresponding control subgroups (median, 17 vs 15 [P = .004] and 18 vs 14.5 [P < .001], respectively). Additionally, the SCAT5 symptom severity score was significantly greater in the anxiety and multiple-conditions subgroups than their corresponding controls (median, 49 vs 34.5 [P = .018] and 62 vs 32 [P < .001], respectively).

Conclusion:

During initial concussion assessment, both the number of concussion-related symptoms and the symptom severity were greater in study participants with anxiety and multiple mental health conditions than participants without these conditions.