Epidemiology of Injuries Sustained as a Result of Intentional Player Contact in High School Football, Ice Hockey, and Lacrosse: 2005-2006 Through 2015-2016

Descriptive Epidemiology of High School Swimming and Diving Injuries

OBJECTIVE

Using data from a longitudinal national sports injury surveillance program, this study aimed to calculate injury rates and describe injury patterns across high school swimmers and divers.

DESIGN

Descriptive Epidemiological Study. Athletic trainers (ATs) from participating high schools reported injuries from swimming and diving programs for the High School Reporting Information Online system.

SETTING

Convenience sample of high school boys and girls' swimming and diving injuries during the 2008 to 2019 school years.

PATIENTS OR OTHER PARTICIPANTS

High school boy and girl swimmers and divers (aged ∼14-18 years).

INDEPENDENT VARIABLES

Exposure data on gender, location of injury (practice vs competition), mechanism of injury, and sport (swimming vs diving).

MAIN OUTCOME MEASURES

Injury rates, rate ratios (RRs) with 95% confidence intervals, and other descriptive statistics were performed.

RESULTS

563 swimming and diving injuries occurred during 2 171 260 athlete exposures (0.26 per 1000 athlete exposures). Girls had higher injury rates than boys overall (RR 1.57, P < 0.05), in practice (RR 1.53, P < 0.05), and competition (RR 1.81, P < 0.05). In swimmers, most injuries were to the shoulder (48.6%), associated with the freestyle (67.3%), and classified as overuse/chronic (58.0%). Among divers, most injuries were to the head/face (36.6%) and from contact with the playing surface (68.3%).

CONCLUSIONS

Girls had statistically significantly higher injury rates than boys. The shoulder and head/face were the most injured body parts in swimmers and divers, respectively. Swimming injuries were most frequently of an overuse etiology, whereas diving injuries were more likely traumatic. Coaches and ATs should be aware of these findings to develop targeted strategies for injury prevention.

Associations between preference and participation in team sports: Physical activity promotion among adolescents

Background

The level of physical activity (PA) in adolescents is highly dependent on their PA preferences. PA preferences among adolescents are dominated by team PA, mostly team sports (TS). The aim of this study is to identify (a) the status and trends in the preferences of TS among Czech and Polish boys and girls in different educational and sports environments, and (b) the impact of the agreement between the preferred and simultaneously pursued TS on the structure of weekly PA and on the meeting of PA recommendations.

Methods

The research was carried out between 2009 and 2022 in the Czech Republic and Poland and included 2,939 boys and 4,427 girls aged 15-19 years. Preferences and participation in TS were identified using a PA preference questionnaire and weekly PA using the International Physical Activity Questionnaire-Long Form. Trends in TS preferences were analyzed over 27-year periods. The participants were divided into groups by agreement and disagreement between the preferred and pursued TS, and by agreement and disagreement between the preferences of TS and participation in organized TS.

Results

Throughout the 14-year study period, boys in both countries preferred soccer, whereas girls favored volleyball. Agreement between preferences and participation in TS increased vigorous PA in Czech and Polish boys and girls. The agreement between the preferences for TS and participation in organized TS had the most significant effect on increasing vigorous PA in Czech and Polish boys and girls and on total PA in boys in both countries. Those who preferred and participated in TS were more likely to meet PA recommendations.

Conclusion

Respecting the status and trends of TS preferences in supporting participation in TS increases adolescents' PA and their achievement of PA recommendations. Increasing active participation in organized TS among boys and girls may support regular PA and help eliminate the negative effects of the pandemic on adolescents' PA.

Epidemiology of Sports-Related Clavicle Fractures in the United States: Injuries From 2015 to 2019

Background

Clavicle fractures are common orthopaedic injuries that frequently occur during sports and recreational activity.

Purpose

To (1) determine the incidence rate of sports-related clavicle fractures among patients evaluated in emergency departments in the United States over a 5-year period, (2) determine the most common sports and risks associated with clavicle fractures, and (3) update the literature by comparing past and present injury trends.

Study Design

Descriptive epidemiology study.

Methods

The National Electronic Injury Surveillance System (NEISS) database was queried for patients evaluated with clavicle fractures in US emergency departments from 2015 to 2019. The authors evaluated the data by age, sex, race, and sport/recreational activity. Injuries were characterized based on sports-specific mechanism of injury. Using the NEISS weighted multiplier, the authors estimated annual incidence rates based on US Census data. Contingency table comparisons of categorical variables (ie, age groups vs sex distributions) were analyzed using either chi-square or Fisher exact tests as appropriate for the population size, while continuous variable comparisons were performed using 1-way analysis of variance statistical testing.

Results

A total of 2386 athletic-related clavicle fractures were evaluated at participating emergency departments, translating to 304,211 clavicle fractures, with an annual per-year injury rate of 18.72 clavicle fractures per 100,000 persons at risk (95% CI, 15.28-23.67). Male athletes had disproportionately higher injury rates than female athletes (P < .001) for every year of the study and demonstrated a higher incidence of fractures compared with female athletes (injury proportion ratio, 5.54). Patients aged 10 to 19 years accounted for the highest overall incidence of injury (64.5%). The annual incidence rate of athletic-related clavicle fractures was not significantly different during the study period (P = .24). The most common mechanisms of injury were participation in football (26.87%), soccer (15.76%), snowboarding (5.03%), bicycling (3.77%), wrestling (3.65%), and snow skiing (3.52%).

Conclusion

Study findings indicated that clavicle fractures sustained during sports and recreational activity disproportionately affect male athletes. Adolescent populations (10-19 years of age) had the highest overall incidence of injury, and the most common activities associated with clavicle fractures were football and soccer.

Targeting Rule Implementation Decreases Concussions in High School Football: A National Concussion Surveillance Study

Background:

Concussions occur at higher rates in high school football as compared with all other high school sports. In 2014, the National Federation of State High School Associations implemented rules defining illegal contact against a defenseless player above the shoulders to reduce concussions in football players in the United States. To the best of our knowledge, rates of emergency department (ED)—diagnosed concussions of high school football players before and after the 2014 rule implementation have not been compared.

Hypothesis:

It was hypothesized that (1) there would be lower rates of helmet-to-helmet and helmet-to-body-part concussions after rule implementation and (2) alternative mechanisms of concussion would not differ, as these would be less influenced by rule implementation.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Data from the National Electronic Injury Surveillance System (NEISS) were analyzed for high school football players 14 to 18 years old sustaining a concussion from January 1, 2009, to December 31, 2019. Data were collected on mechanism of injury, setting, and loss of consciousness. Raw data were used to calculate national estimates based on the assigned statistical sample weight of each hospital by the NEISS.

Results:

A total of 4983 (national estimate = 154,221) high school football concussions were diagnosed in US EDs; 58.8% of concussions occurred during competition and 41.2% during practice. Between 2009 and 2013 the rate of concussions diagnosed in EDs rose 10.7% as compared with a 6.2% decrease between 2015 and 2019 (P = .04). Between 2009 and 2013, the rate of helmet-to-helmet concussions rose 17.6% as compared with a 5.6% decrease between 2015 and 2019 (P = .03). There were no significant changes between other mechanisms of concussion before and after the 2014 rule implementation.

Conclusion:

We identified a decreased trend in overall and helmet-to-helmet high school football concussions diagnosed in the ED after implementation of the targeting rule. This study adds to the growing literature regarding the importance and efficacy of rule implementation in reducing sports-related concussions.

Adult Maxillofacial Trauma Patterns in American Football

INTRODUCTION

The authors aimed to identify and categorize adult maxillofacial trauma patterns in the setting of American football.

METHODS

The National Electronic Injury Surveillance System was accessed to identify adult patients presenting with football-related head and facial injuries from 2009 to 2018. Data surrounding each event were collected including age, injury type, injury location, and disposition of the patient. Chi-squared testing was performed to compare categorical variables, with a Bonferroni correction applied.

RESULTS

During the study period, 1784 total patients (national estimate = 65,052) were identified. The average age for this cohort was 27.26 (SD ± 8.49), with young adults (86.1%) and males (87.9%) sustaining the majority of injuries. Lacerations were the most common injury type (43.1%). Maxillofacial fractures comprised 15.8% of the sample, with nasal bone (52.8%) being the most common subtype. Female patients were significantly more likely to present with head injuries than men (46.8% versus 29.0%, P < 0.001). Young and middle-aged adults combined were more likely to be discharged from the emergency department, whereas the elderly were significantly less likely (P = 0.002). Patients with fractures were significantly more likely to be admitted to the hospital compared to all other types of injuries (P < 0.001).

CONCLUSIONS

An understanding of maxillofacial injuries while participating in American football is important in developing safety initiatives. To address these, it is crucial that providers understand the patterns of craniofacial injuries as they relate to American football trauma.

Rule Modifications to Reduce Checking-Related Injuries in High School Boys' Lacrosse

CONTEXT

The National Federation of State High School Associations previously implemented 2 lacrosse rule modifications: Rule 5.4 in the 2012-2013 academic year to heighten the penalty for a head or neck hit to the head, face, or neck (HFN) and Rule 5.3.5 in the 2013-2014 academic year to minimize body checking.

OBJECTIVE

To determine if the rates of overall injury, HFN injuries, and concussions due to intentional contact (checking) differed for boys' high school lacrosse players after Rule 5.4 and 5.3.5 modifications were enacted.

DESIGN

Descriptive epidemiology study.

SETTING

Web-based online surveillance system.

PATIENTS OR OTHER PARTICIPANTS

Boys' high school lacrosse players during the 2008-2009 to 2016-2017 seasons whose teams involved athletic trainers participating in the High School Reporting Information Online sports injury-surveillance system.

INTERVENTION(S)

Rule 5.4 in the 2012-2013 academic year increased the penalty for any intentional hits to the HFN, and Rule 5.3.5 in the 2013-2014 year eliminated body checking to a player in a defenseless position.

MAIN OUTCOME MEASURE(S)

Overall, HFN, and concussion injury rate ratios (IRRs) by checking mechanism; overall and checking-related injury ratios by competitions and practices.

RESULTS

A decrease was shown in checking-related HFN injuries (IRR = 0.29, 95% CI = 0.13, 0.65) and checking-related concussions (IRR = 0.29, 95% CI = 0.12, 0.70) during practices in the seasons after both rule modifications were imposed, but no decreases occurred in any checking-related injuries during competitions. By injury mechanism, no decreases were evident after the Rule 5.4 modification. When both rule modifications (Rules 5.4 and 5.3.5) were enacted together, concussion rates due to delivering body checks (IRR = 0.51, 95% CI = 0.29, 0.91) and overall injury risk due to being body checked (IRR = 0.72, 95% CI = 0.53, 0.97) decreased.

CONCLUSIONS

When both Rule 5.4 and 5.3.5 modifications were in effect, concussion and overall injury risks decreased for the body checker and the player being body checked, respectively.

Data-Driven Risk Classification of Concussion Rates: A Systematic Review and Meta-Analysis

BACKGROUND

Concussion is a growing public health concern and generating concussion prevention programs depends on identifying high-risk sports and characteristics. Identifying the roles of sport, sex, and participation level (e.g., high school versus collegiate athletics) in concussion risk would facilitate more informed decision-making regarding sports participation and generate better targeted prevention strategies.

OBJECTIVES

The current study's objectives were to: (1) determine the magnitude and hierarchy of sports-related concussion (SRC) risk across an array of events and (2) evaluate the modifying roles of sex, participation level, and session type on SRC rates.

METHODS

A literature search was conducted on PubMed, searching concussion studies published between 2001 and December 2019. Inclusion criteria for studies required: (1) concussion occurred during sport, (2) that the SRC was clinically diagnosed, and (3) athlete exposures and concussions could be extracted or estimated. A study was excluded if it: (1) was not an original research article, (2) was not written in English language, (3) was an animal study, (4) did not have enough data to calculate SRC rates, (5) included professional or youth sample, and/or (6) contained data collected prior to 2001. The meta-analysis and meta-regression analyses were fit using a random effects model.

RESULTS

Search results returned 2695 unique research articles, with 83 studies included in analyses. Sport, sex, participation level, and session type all significantly influenced SRC rates. Overall, rugby had the highest concussion rate and was classified as the highest risk sport (28.25 concussions per 10,000 athlete exposures). Overall, females had a higher concussion rate than males. Only lacrosse demonstrated a higher concussion rate for males compared to females. Collegiate athletes had higher concussion rates than high school athletes. Games were associated with 2.01 more concussions per 10,000 AEs than practices.

CONCLUSIONS

This meta-analysis demonstrated rugby has the highest concussion risk, followed by American Football, ice hockey, and wrestling. Concussion risk was influenced by sport, sex, participation, and session. Identifying the factors and environments that influence concussion risk can facilitate risk reduction and prevention strategies.

Laryngeal fractures in professional and semiprofessional ice hockey players

OBJECTIVE

Injuries in professional ice hockey players are common, however significant laryngeal trauma is rare. Here, we present a case series of professional and semiprofessional ice hockey players to demonstrate the mechanism and nature of laryngeal injuries they sustain during play, and to recommend best practices for treatment, prevention, and return to the ice.

METHODS

A retrospective case review was done of hockey-related laryngeal injuries between 2016 and 2019 at a tertiary laryngology practice. Only semiprofessional and professional hockey players were included.

RESULTS

In total, four cases were included. All cases involved trauma from a hockey puck to the neck. No cases were the result of punching, fighting, high sticks or routine checking. Notably, 1 of 4 presented with severe airway compromise, requiring urgent intubation, whereas most presented with pain or a significant voice complaint. Two patients required operative intervention with open reduction and internal fixation of significantly displaced fractures. One patient experienced significant mucosal disruption with cartilaginous exposure at the posterior vocal complex requiring microflap. The average return to ice was 6 weeks for those who required operative intervention and 4 weeks for those who were managed conservatively. One patient had persistent mild dysphonia and all others had a return to baseline phonation. None were wearing neck guards or other protective equipment at the time of injury.

CONCLUSION

Though voice and airway injuries are rarely sustained by ice hockey players, they may require urgent intervention. We recommend that protective equipment be worn and improved to prevent laryngeal trauma.

LEVEL OF EVIDENCE

4.

Epidemiology of Injuries Sustained in Boys' High School Contact and Collision Sports, 2008-2009 Through 2012-2013

Background:

Injury epidemiology for boys’ high school contact and collision sport has been described in several overlapping but fragmented studies. Comprehensive comparisons of injuries sustained in boys’ soccer, wrestling, football, ice hockey, and lacrosse are lacking.

Purpose:

To describe patterns of injury by severity, body site, and diagnosis among high school boys’ contact and collision sports in the United States.

Study Design:

Descriptive epidemiology study.

Methods:

Injury rates and rate ratios (RRs) were calculated for injuries sustained in boys’ high school soccer, wrestling, football, ice hockey, and lacrosse through use of the High School RIO (Reporting Information Online) surveillance data from 2008-2009 through 2012-2013. Injury patterns were described by site, diagnosis, time loss, and severity. Severe injury was defined as an injury that resulted in 21 days or more of time loss from sport participation. Risk of sustaining a concussion was compared between sports.

Results:

The risk of sustaining an injury was higher in competition compared with practice overall (RR, 4.01; 95% CI, 3.90-4.12); the same pattern was true for severe injuries (RR, 4.61; 95% CI, 4.34-4.90). Football players experienced the highest injury rate (3.87 per 1000 athlete-exposures [AEs]) and the highest severe injury rate (0.80 per 1000 AEs). Overall, the most commonly injured body site was the head/face (22.5%), and the most prevalent injury diagnosis was ligament sprain not requiring surgery (23.5%). The most frequently injured body site from severe injury was the knee (24.6%), and fracture or avulsion was the most prevalent severe injury diagnosis (37.0%). Football players had a significantly higher risk of sustaining a concussion compared with other contact or collision sport athletes (P < .05).

Conclusion:

Injuries rates were higher in competition than those in practice for boys’ high school contact and collision athletes. Football players sustained the highest injury rate, the highest severe injury rate, and the highest concussion rate among the sports included in this analysis. Understanding these patterns of injury can generate policy and rule changes to make sports safer and maintain high levels of participation.

Epidemiology of Clavicle Fractures Among US High School Athletes, 2008-2009 Through 2016-2017

Background

Little is known about the epidemiology of clavicle fractures in United States (US) high school athletes. Sports participation among high school students has increased steadily, placing increased numbers at risk of sports-related injury.

Purpose

To describe the epidemiology of clavicle fractures among high school athletes, including injury rates by sex, sport, and type of play and trends in operative versus nonoperative treatment.

Study Design

Descriptive epidemiology study.

Methods

The study data set included all athlete-exposure (AE) and clavicle fracture data collected from 2008-2009 through 2016-2017 from a large sample of US high schools as part of the National High School Sports-Related Injury Surveillance Study for students participating in boys' football, boys'/girls' soccer, boys'/girls' basketball, boys'/girls' volleyball, boys' wrestling, boys' baseball, girls' softball, girls' field hockey, boys' ice hockey, boys'/girls' lacrosse, boys'/girls' swimming and diving, boys'/girls' track and field, girls' gymnastics, girls' cheerleading, boys'/girls' tennis, and boys'/girls' cross-country.

Results

Overall, 567 clavicle fractures were reported during 31,520,765 AEs, an injury rate of 1.80 per 100,000 AEs. Injury rates varied by sport, with the highest rates in the boys' full-contact sports of ice hockey (5.27), lacrosse (5.26), football (4.98), and wrestling (2.21). Among girls' sports, the highest rates were in soccer (0.92), lacrosse (0.26), and basketball (0.25). In sex-comparable sports, injury rates were still significantly higher among boys (1.03) than girls (0.35) (rate ratio, 2.91; 95% CI, 1.97-4.30). Injury rates were significantly higher in competition (4.58) as compared with practice (0.87) (rate ratio, 5.27; 95% CI, 4.44-6.26). Most injuries were treated conservatively (82.7%) rather than operatively (17.3%). Time to return to sports varied, with a greater proportion of medical disqualifications among those treated operatively (40.0%) as compared with those treated conservatively (22.6%) (injury proportion ratio, 1.77; 95% CI, 1.31-2.39).

Conclusion

Although clavicle fracture rates are relatively low, they vary by sport, sex, and activity. Understanding such differences should drive more effective, targeted injury prevention efforts. Increased time loss from sports with surgical versus conservative treatment may have been influenced by factors including injury severity and its timing relative to the season's progress.