Childhood soccer injuries treated in U.S. emergency departments

Soccer-related injuries utilization of U.S. emergency departments for concussions, intracranial injuries, and other-injuries in a national representative probability sample: Nationwide Emergency Department Sample, 2010 to 2013

Soccer participation in the United States (U.S.) has increased over time, and injuries as well as interest to prevent injuries has become more common. This study described Emergency Department (ED) visits related to concussions, intracranial injuries (ICI), and all-other injuries attributed to soccer play; described healthcare cost and length of hospital stay of soccer-related injuries; and determined independent predictors of concussions, ICI, and all-other soccer injuries leading to ED visits. The study examined soccer-related weighted discharge data from the Nationwide Emergency Department Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Weighted tabular analysis of univariate and bivariate analyses and weighted and adjusted logistic regression models were conducted. A total of 480,580 of U.S. ED visits related to soccer injuries were available for analysis between 2010 to 2013. Generally, 98% of soccer-related ED visits resulted in routine (treat-and-release) visits. However, the odds of transfer to a short-term hospital following ED evaluation and treatment was more than 37-fold higher for soccer-injured youth and adults diagnosed with ICI when compared to all-other soccer injuries; additionally, these patients showed 28-fold higher odds of being admitted for inpatient care at the ED-affiliated hospital. For concussion, soccer-injured patients with concussion showed nearly 1.5-fold higher odds of being transferred to a short-term hospital than did those with any other soccer injury. Soccer-related ED visits cost more than 700 million in U.S. dollars from 2010 to 2013. Notable differences were noted between concussions, ICI, and all-other soccer injuries presenting to U.S. ED. Albeit underestimated given that this study excludes other forms of health care and treatment for injuries, such as outpatient clinics, over the counter medications and treatment, and rehabilitation, healthcare cost associated with soccer-related injuries presenting to ED is high, and remarkably costly in those with an ICI diagnosis.

Trends in Soccer-Related Ocular Injuries within the United States from 2010 through 2019

Purpose: Soccer participation within the United States continues to increase, necessitating consideration of the various injuries that may occur. The present study analyzes trends in the incidence of ocular injuries secondary to soccer trauma, the associated mechanism, and related visual sequelae, and quantifies age- and sex-specific differences in the distributions of these variables.Methods: The Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS) was queried for soccer-related ocular injuries from 2010 through 2019. Data exclusively focused on the globe were selected, and information regarding age, sex, specific diagnosis, mechanism of injury, and visual sequelae were acquired. Significance was calculated using the chi-squared test.Results: 628 NEISS entries were evaluated, extrapolating to a national average incidence of approximately 1580 soccer-related ocular injuries per year. There were a relatively static number of events during the ten-year time period of study. The most common diagnoses were contusions or abrasions (36.1%); among records with a reported mechanism of injury, the most common was contact with the soccer ball (80.9%). Visual sequelae were noted in a significant minority of patients (15.4%). Patients ≤18 and males comprised the majority of visits (68.2% and 70.2%, respectively). Significant sex- and age-specific differences were observed in the distributions of diagnoses.Conclusions: There are serious visual consequences associated with soccer-related ocular injury. Despite the existence of eye protection, there remain no regulations requiring its consistent use. Therefore, among all parties involved (e.g., players, families, and physicians), there remains a need to increase education regarding the potential ocular dangers associated with the sport.

Epidemiology of soccer-related head injury in children 5-14 years in Victoria, Australia

AIM

Our aim was to use epidemiological data to determine the incidence of soccer-related head injuries in children aged 5-14 years who presented at emergency departments (EDs) or were admitted in hospitals in Victoria, Australia.

METHODS

ED presentation and hospital admission de-identified aggregate data were from the Victorian Injury Surveillance Unit. Soccer participation data were compared with the soccer-related head injury data to determine the incidence of this injury among these children.

RESULTS

The incidence of ED presentations was 0.17% of children participating in soccer during the study period (financial years 2011-2012 to 2015-2016). The 10-14-years age group presented with more head injuries than the 5-9-years age group. For the admissions data, soccer had a significantly lower (P = 0.0379) incidence of head injury when compared with 'sport as a whole'.

CONCLUSIONS

The low incidence of soccer-related head injuries presenting to an ED or admission to hospital is consistent with international findings.

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

Background:

Understanding the risks and trends of soccer-related injuries may prove beneficial in creating preventative strategies against season-ending injuries.

Hypothesis:

Soccer-related fractures will have decreased over the past 7 years.

Study Design:

Descriptive epidemiology study.

Level of Evidence:

Level 3.

Methods:

The National Electronic Injury Surveillance System (NEISS) database was queried to identify soccer-related injuries from 2010 through 2016. The sum of the weighted values provided in the NEISS database was used to determine injury frequency and allowed us to estimate the incidence and annual trends of soccer-related fractures. The estimated annual number of hospital admissions resulting from each fracture location was calculated. Statistical analyses were performed, and a linear regression was used to analyze the annual injury trends, reported as the correlation coefficient.

Results:

Over the 6-year period, there were an estimated 1,590,365 soccer-related injuries. The estimated annual frequency of soccer-related injuries slightly increased from 225,910 in 2010 to 226,150 in 2016 (P = 0.477). The most common injuries were sprains/strains (32.4%), followed by fractures (20.4%). Fractures at the wrist were the most common (18%), while upper leg fractures were the most common soccer-related fractures to be admitted to the hospital (51.6%). The annual trends of the most common soccer-related fractures demonstrated increases in shoulder (r = 0.740; R² = 0.547; P = 0.057) and wrist (r = 0.308; R² = 0.095; P = 0.502) fractures. There were no significant changes in the trends of soccer-related fractures of the lower arm (r = 0.009; R² = 7.3 × 10⁻⁵; P = 0.986), finger (r = 0.679; R² = 0.460; P = 0.094), lower leg (r = 0.153; R² = 0.024; P = 0.743), ankle (r = 0.650; R² = 0.422; P = 0.114), toe (r = 0.417; R² = 0.174; P = 0.353), or foot (r = 0.485; R² = 0.235; P = 0.270).

Conclusion:

Despite the reported growing number of soccer players in the United States, the overall number of soccer-related injuries has remained relatively stable. Overall, 60% of reported fractures occurred in the upper extremity, with the wrist being the most common site, while lower extremity fractures were the most likely to lead to hospital admission.

Clinical Relevance:

This study offers an overview of the most common types of fractures that affect soccer players and may prove beneficial in creating preventative strategies against season-ending injuries.

Epidemiology of Upper Extremity Soccer Injuries Among High School- and College-Aged Players in the United States: An Analysis of the 1999-2016 NEISS Database

BACKGROUND:

Although lower extremity injuries are more common than upper extremity injuries in high school- and college-aged soccer players, upper extremity injuries may be equally severe. The epidemiology of upper extremity injuries is poorly characterized in this population.

HYPOTHESIS:

Upper extremity injuries are an important contributor to soccer-related morbidity among high school- and college-aged players.

STUDY DESIGN:

Descriptive epidemiology study.

LEVEL OF EVIDENCE:

Level 3.

METHODS:

The National Electronic Injury Surveillance System (NEISS) is a nationally representative sample of 100 hospital emergency departments (EDs). Each record contains demographic and injury information. Records from 1999 to 2016 were analyzed, including patients between the ages of 14 and 23 years with a soccer-related injury sustained at school or during an athletic event.

RESULTS:

A total of 1,299,008 high school- or college-aged patients presented to the ED for a soccer-related injury from 1999 to 2016, of which 20.4% were in the upper extremity. Patients were predominantly male (58.0%) and high school-aged (81.4%). Males constituted a greater proportion of upper extremity injuries when compared with other injury locations (63.5% male for upper extremity). Upper extremity injuries were more likely to be fractures (43.7% vs 13.9%) and dislocations (7.1% vs 3.4%) and less likely to be strains/sprains (27.8% vs 56.6%). Males suffered more shoulder dislocations (81.8% males among patients with shoulder dislocation vs 57.8% among those with other injuries), finger dislocations (72.0% vs 58.0%), upper arm fractures (74.9% vs 57.6%), and forearm fractures (68.3% vs 57.3%).

CONCLUSION:

Upper extremity injuries are frequent in high school- and college-aged soccer players presenting to the ED. Efforts to reduce soccer-related injuries should include strategies targeting the upper extremity, perhaps reducing the incidence of high-energy falls.

CLINICAL RELEVANCE:

Efforts to reduce soccer-related injuries should include strategies targeting upper extremity injuries, particularly among males and college-aged players.

ACL graft compression: a method to allow reduced tunnel sizes in ACL reconstruction

PURPOSE

A common problem during ACL reconstruction is asymmetry of proximal-distal graft diameter leading to tunnel upsizing and graft-tunnel mismatch. Compression downsizing provides a graft of uniform size, allowing easy passage into a smaller tunnel. The purpose of this study was to quantify the graft compression technique and its effects on graft biomechanics and stability. It was hypothesised that compression downsizing would significantly reduce cross-sectional area (CSA); that no significant changes in graft biomechanics would occur; graft fixation stability would be improved.

METHOD

Sixty-eight non-irradiated peroneus longus (PL) tendons were investigated. Twenty were halved and paired into ten four-strand grafts, 20 strands were compressed by 0.5-1 mm diameter and changes in CSA recorded using an alginate mould technique. The following properties were compared with 20 control strands: cyclic strain when loaded 70-220 N for 1000 cycles; stiffness; ultimate tensile load and stress; Young's modulus. 24 PL tendons were quadrupled into grafts, 12 were compressed and all 24 were submerged in Ringer's solution at 37 °C and the CSA recorded over 12 h. Twelve compressed and 12 control quadrupled grafts were mounted in porcine femurs, placed in Ringer's solution for 12 h at 37 °C and graft displacement at the bone tunnel aperture recorded under cyclic loading.

RESULTS

Mean decreases in CSA of 31% under a stress of 471 kPa and 21% under a stress of 447 kPa were observed for doubled and quadrupled grafts, respectively. Compressed grafts re-expanded by 19% over 12 h compared to 2% for controls. No significant differences were observed between compressed and control grafts in the biomechanical properties and graft stability; mean cyclic displacements were 0.3 mm for both groups.

CONCLUSIONS

No detrimental biomechanical effects of graft compression on allograft PL tendons were observed. Following compression, the grafts significantly increased in size during in vitro joint simulation. No significant difference was observed in graft stability between groups. Graft compression did not cause adverse mechanical effects in vitro. Smaller tunnels for compressed grafts reduce bone loss and ease anatomical placement.

Epidemiologic comparisons of soccer-related injuries presenting to emergency departments and reported within high school and collegiate settings

BACKGROUND

Few studies compare sports injury patterns in different settings. This study described the epidemiology of soccer injuries presenting to emergency departments (EDs) and compared injuries presenting to EDs to injuries presenting to collegiate and high school athletic trainers (ATs).

METHODS

Soccer-related injuries (product code 1267) in the National Electronic Injury Surveillance System (NEISS) that were sustained by individuals at least two years of age in 2004-2013 were included. High School Reporting Information Online (HS RIO) data for high school soccer injuries during the 2005/06-2013/14 academic years were compared to NEISS data for those aged 14-17 years in 2005-2013. National Collegiate Athletic Association Injury Surveillance Program (NCAA-ISP) data for collegiate soccer injuries during the 2009/10-2013/14 academic years were compared to NEISS data for those aged 18-22 years in 2009-2013. All datasets included weights to calculate national estimates. Injury proportion ratios (IPRs) with 95% confidence intervals (CIs) compared nationally estimated injury distributions between the HS RIO/NCAA-ISP and NEISS data subsets.

RESULTS

During the study period, 63,258 soccer-related injuries were captured by NEISS, which translates to an estimated 2,039,250 injuries seen at US EDs nationwide. Commonly injured body parts included the head/face (19.1%), ankle (17.6%), hand/wrist (15.3%), and knee (12.2%). Common diagnoses included sprains/strains (34.0%), fractures (22.2%), and contusions (17.7%). Compared to their respective age ranges in NEISS, sprains/strains comprised a larger proportion of injuries in HS RIO (48.3% vs. 33.7%; IPR = 1.38; 95% CI: 1.33, 1.42) and NCAA-ISP (51.3% vs. 37.0%; IPR = 1.39; 95% CI: 1.31, 1.46). In contrast, fractures comprised a smaller proportion of injuries in HS RIO than in NEISS (7.5% vs. 18.6%; IPR = 0.43; 95% CI: 0.39, 0.47) and NCAA-ISP (2.8% vs. 15.7%; IPR = 0.18; 95% CI: 0.14, 0.22).

CONCLUSIONS

ATs more commonly reported injuries that are easily diagnosed and treated (e.g., sprains/strains); EDs more commonly reported injuries with longer recovery times and rehabilitation (e.g., fractures). Although ED surveillance data can identify the most severe sports-related injuries, high school and college sports surveillance may better describe the breadth of sports-related injuries. Our findings may provide further support for school-based sports medicine professionals, but further research is needed to comprehensively examine the potential economic and health-related benefits.

A Comparative Analysis of International Knee Documentation Committee Scores for Common Pediatric and Adolescent Knee Injuries

BACKGROUND

Several different etiologies cause knee pain in the pediatric and adolescent population, including anterior knee/patellofemoral pain, patellar instability, anterior cruciate ligament (ACL) tears, meniscal tears, osteochondritis dissecans (OCD) lesions, and discoid meniscus. The purpose of the current study was to determine the relative morbidity of different causes of knee pain in children and adolescents using the International Knee Documentation Committee (IKDC) score.

METHODS

We performed a retrospective review of prospectively collected data of a cohort of pediatric and adolescent patients with knee pain who presented to a single surgeon. Each patient completed an IKDC questionnaire at the time of diagnosis and patients were grouped by diagnosis for analysis. Statistical analysis was performed to compare the IKDC scores of the 7 diagnostic groups, and a P-value <0.05 was considered significant.

RESULTS

The IKDC mean score for all 242 patients was 50.3±18.3. The mean IKDC score for patients with isolated meniscal tears was 41.2±16.0, combined ACL and meniscal injuries was 50.2±13.9, and isolated ACL tears was 48.1±14.1. The mean IKDC score for patients with symptomatic discoid meniscus was 46.3±13.2, anterior knee pain/patellofemoral pain was 49.0±17.4, patellar instability was 49.2±22.1, and OCD lesions was 62.2±19.5.

CONCLUSIONS

The IKDC scores of most of the diagnostic groups were similar to the overall average score, with the notable exception of patients with OCD lesions exhibiting statistically significant less morbidity reflected by a higher IKDC score. Although symptoms in each individual clinical presentation may vary, knowledge of the relative morbidity of these diagnostic groups is valuable in counseling patients and their families regarding these common pediatric and adolescent sources of knee pain.

LEVEL OF EVIDENCE

Level IV.

Soccer-Related Injuries Treated in Emergency Departments: 1990-2014

OBJECTIVE

To investigate the epidemiology of youth soccer-related injuries treated in emergency departments in the United States.

METHODS

A retrospective analysis was conducted of soccer-related injuries among children 7 through 17 years of age from 1990 through 2014 with data from the National Electronic Injury Surveillance System. Injury rates were calculated from soccer participation data.

RESULTS

An estimated 2 995 765 (95% confidence interval [CI], 2 309 112-3 682 418) children 7 through 17 years old were treated in US emergency departments for soccer-related injuries during the 25-year study period, averaging 119 831 (95% CI, 92 364-147 297) annually. The annual injury rate per 10 000 soccer participants increased significantly, by 111.4%, from 1990 to 2014. Patients 12 to 17 years old accounted for 72.7% of injuries, 55.5% of patients were male, and most injuries occurred in a place of sport or recreation (68.5%) or school (25.7%). Struck by (38.5%) and fell (28.7%) were the leading mechanisms of injury. Injuries most commonly were diagnosed as sprain or strain (34.6%), fracture (23.2%), and soft tissue injury (21.9%), and occurred to the upper extremity (20.7%), ankle (17.8%), and head or neck (17.7%). Concussions or other closed head injuries accounted for 7.3% of the injuries, but the annual rate of concussions/closed head injuries per 10 000 participants increased significantly, by 1595.6%, from 1990 to 2014.

CONCLUSIONS

This study is the first to comprehensively investigate soccer-related injuries and calculate injury rates based on soccer participation data among children at the national level. The increasing number and rate of pediatric soccer-related injuries, especially soccer-related concussions/closed head injuries, underscore the need for increased efforts to prevent these injuries.

Paediatric ACL repair reinforced with temporary internal bracing

PURPOSE

Instability following non-operative treatment of anterior cruciate ligament (ACL) rupture in young children frequently results in secondary chondral and/or meniscal injuries. Therefore, many contemporary surgeons advocate ACL reconstruction in these patients, despite the challenges posed by peri-articular physes and the high early failure rate. We report a novel management approach, comprising direct ACL repair reinforced by a temporary internal brace in three children.

METHODS

Two patients (aged 5 and 6 years) with complete proximal ACL ruptures and a third (aged seven) with an associated tibial spine avulsion underwent direct surgical repair, supplemented with an internal brace that was removed after 3 months.

RESULTS

Second-look arthroscopy, examination and imaging at 3 months confirmed knee stability and complete ACL healing in all cases. Normal activities were resumed at 4 months, and excellent objective measures of function, without limb growth disturbance, were noted beyond 2 years.

CONCLUSION

ACL repair in young children using this technique negates the requirement and potential morbidity of graft harvest and demonstrates the potential for excellent outcome as an attractive alternative to ACL reconstruction, where an adequate ACL remnant permits direct repair.

LEVEL OF EVIDENCE

IV.

Middle school injuries: a 20-year (1988-2008) multisport evaluation

CONTEXT

Data on the incidence of injury in middle school sports are limited.

OBJECTIVE

To describe overall, practice, and game injury rate patterns in 29 middle school sports.

DESIGN

Descriptive epidemiology study.

SETTING

Injury data collected over a 20-year period (1988-2008) at a single school.

PATIENTS OR OTHER PARTICIPANTS

Boy (n = 8078) and girl (n = 5960) athletes participating in 14 and 15 middle school sports, respectively.

MAIN OUTCOME MEASURE(S)

Injury status and athlete-exposures (AEs) were collected by certified athletic trainers. Incidence rates per 1000 AEs (injuries/AEs) were calculated for overall incidence, practices and games, injury location, injury type, and injury severity (time lost from participation). Rate ratios (RRs) and 95% confidence intervals (CIs) were used to compare injury rates for sex-matched sports.

RESULTS

Football had the highest injury rate for all injuries (16.03/1000 AEs) and for time-loss injuries (8.486/1000 AEs). In matched middle school sports, girls exhibited a higher injury rate for all injuries (7.686/1000 AEs, RR = 1.15, 95% CI = 1.1, 1.2) and time-loss injuries (2.944/1000 AEs, RR = 1.09, 95% CI = 1.0, 1.2) than boys (all injuries: 6.684/1000 AEs, time-loss injuries: 2.702/1000 AEs). Girls had a higher injury rate during practices (3.30/1000 AEs) than games (1.67/1000 AEs, RR = 1.97, 95% CI = 1.7, 2.4) for all sports. Only gymnastics (RR = 0.96, 95% CI = 0.3, 3.8) had a higher game injury rate for girls. Practice and game injury rates were nearly identical for boys in all sports (RR = 0.99, 95% CI = 0.9, 1.1). Only football (RR = 0.49, 95% CI = 0.4, 0.6) and boys' wrestling (RR = 0.50, 95% CI = 0.3, 0.8) reported higher game injury rates. Tendinitis injuries accounted for 19.1% of all middle school injuries.

CONCLUSIONS

The risk for sport-related injury at the middle school level was greater during practices than games and greater for girls than boys in sex-matched sports. Conditioning programs may be needed to address the high rate of tendinitis injuries.

Soccer-Related Injuries in Children and Adults Aged 5 to 49 Years in US Emergency Departments From 2000 to 2012

Background:

An increase in soccer-related injuries occurred in the United States between 2000 and 2012; however, most studies of soccer-related injuries have only examined the pediatric population and not adults.

Hypothesis:

The number of soccer injuries is increasing in both the pediatric and adult populations. There are differences in injury types and counts when comparing male and female players within various age groups.

Study Design:

Descriptive epidemiology study.

Level of Evidence:

Level 4.

Methods:

This retrospective analysis surveyed the US Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS) database from 2000 to 2012 for soccer-related injuries in children and adults aged 5 to 49 years.

Results:

From 2000 to 2012, there were an estimated 2,472,066 soccer-related injuries among 5- to 49-year-olds; 629,994 (25.5%) in adults (aged 20-49 years). The overall estimated pediatric injury count increased significantly over the time period (R² = 0.764, P < 0.001). In the 20- to 49-year age range, there was also a significant increase in the estimated number of injuries over the 13-year period, from 41,292 injuries in 2000 to 55,743 in 2012 (R² = 0.719, P < 0.001). The estimated injury counts for male players were significantly higher than female players in any given year for all age groups (P < 0.001). Girls aged 5 to 19 years were more likely to have lower extremity injuries than boys (odds ratio [OR], 1.256; 95% CI, 1.214-1.299; P < 0.001). The most common injuries reported were strain/sprains (33.3%), fractures (23.7%), and contusions and abrasions (17.4%) within the 5- to 49-year age category. In both sexes, strains and sprains were significantly lower among 5- to 19-year-olds in comparison with 20- to 49-year-olds (OR, 0.740; 95% CI, 0.714-0.766; P < 0.001).

Conclusion:

There are age- and sex-related differences in estimated injury count, body part injured, type of injury, and hospital admissions for soccer. Also, estimated injury count increased over the 2000 to 2012 time period.

Clinical Relevance:

This study demonstrates that there are differences between pediatric and adult injuries, based on sex, body part, type of injury, and hospital admissions.

Football injuries in children and adolescent players: are there clues for prevention?

Football (soccer) is the world's most popular sport with most players being younger than 18 years. Playing football can induce beneficial health effects, but there is also a high risk of injury. Therefore, it is necessary to implement measures for preventing injuries. The present review analyzes and summarizes published scientific information on the incidence and characteristics of football injuries in children and adolescent players to arrive at sound conclusions and valid considerations for the development of injury-prevention programs. A literature search was conducted up to November 2012. Fifty-three relevant scientific publications were detected. Thirty-two studies fulfilled the inclusion criteria for pooled analysis. Additional information from the remaining 21 studies was considered where appropriate to obtain a broader perspective on the injury problem in children and youth football. Training injury incidence was nearly constant for players aged 13-19 years, ranging from 1 to 5 injuries per 1,000 h training. Match injury incidence tended to increase with age through all age groups, with an average incidence of about 15 to 20 injuries per 1,000 match hours in players older than 15 years. Between 60 and 90 % of all football injuries were classified as traumatic and about 10-40 % were overuse injuries. Most injuries (60-90 %) were located at the lower extremities with the ankle, knee, and thigh being mostly affected. The frequency of upper-extremity and head/face injuries was higher in those studies that analyzed match injuries only. The most common injury types were strains, sprains, and contusions (10 up to 40 % each). There is some evidence that the risk of traumatic injuries and, in particular, of sustaining a fracture, contusion, or concussion was higher during match play than in practice sessions. Fractures were more frequent in children younger than 15 years than in older players. About half of all time-loss injuries led to an absence from sport of less than 1 week, one third resulted in an absence between 1 and 4 weeks, and 10 to 15 % of all injuries were severe. Separate data for players under the age of 11 years are almost absent. Maturation status seems to have an influence on injury characteristics, although evidence is not conclusive at this time. Three main areas seem to be of particular relevance for future prevention research in young football players: (1) the substantial number of severe contact injuries during matches, (2) the high number of fractures in younger players, and (3) the influence of maturation status and growth spurts.

Epidemiology of knee injuries among U.S. high school athletes, 2005/2006-2010/2011

PURPOSE

U.S. high school athletes sustain millions of injuries annually. Detailed patterns of knee injuries, among the most costly sports injuries, remain largely unknown. We hypothesize that patterns of knee injuries in U.S. high school sports differ by sport and sex.

METHODS

U.S. high school sports-related injury data were collected for 20 sports using the National High School Sports-Related Injury Surveillance System, High School RIO™. Knee injury rates, rate ratios (RR), and injury proportion ratios were calculated.

RESULTS

From 2005/2006 to 2010/2011, 5116 knee injuries occurred during 17,172,376 athlete exposures (AE) for an overall rate of 2.98 knee injuries per 10,000 AE. Knee injuries were more common in competition than in practice (rate ratio = 3.53, 95% confidence interval [CI] = 3.34-3.73). Football had the highest knee injury rate (6.29 per 10,000 AE) followed by girls' soccer (4.53) and girls' gymnastics (4.23). Girls had significantly higher knee injury rates than boys in sex-comparable sports (soccer, volleyball, basketball, baseball/softball, lacrosse, swimming and diving, and track and field; RR = 1.52, 95% CI = 1.39-1.65). The most commonly involved structure was the medial collateral ligament (reported in 36.1% of knee injuries), followed by the patella/patellar tendon (29.5%), anterior cruciate ligament (25.4%), meniscus (23.0%), lateral collateral ligament (7.9%), and posterior cruciate ligament (2.4%). Girls were significantly more likely to sustain anterior cruciate ligament injuries in sex-comparable sports (RR = 2.38, 95% CI = 1.91-2.95). Overall, 21.2% of knee injuries were treated with surgery; girls were more often treated with surgery than boys in sex-comparable sports (injury proportion ratio = 1.30, 95% CI = 1.11-1.53).

CONCLUSIONS

Knee injury patterns differ by sport and sex. Continuing efforts to develop preventive interventions could reduce the burden of these injuries.

Correlation between the Child Health Questionnaire and the International Knee Documentation Committee score in pediatric and adolescent patients with an anterior cruciate ligament tear

BACKGROUND

The modified International Knee Documentation Committee (Pedi-IKDC) Subjective Knee Evaluation Form has recently been shown to be valid, reliable, and responsive in a pediatric and adolescent population. The correlations between the Pedi-IKDC and quality-of-life-related health measures have not been studied in depth to determine how a knee injury affects patients in this age group. The purpose of this study was to examine the association between the Pedi-IKDC score and the Child Health Questionnaire (CHQ) in a group of pediatric patients with an anterior cruciate ligament (ACL) injury.

METHODS

A prospectively collected registry of patients with ACL injuries was searched to indentify all patients who had completed both the Pedi-IKDC and CHQ (CHQ-CF87) questionnaires. These were analyzed to determine significant correlations between domains of the CHQ and the Pedi-IKDC.

RESULTS

A total of 135 patients were included (80 male, 55 female) with a median age of 15.3 years (range, 13.1 to 17.2 y). The cohort included patients treated both operatively (120) and nonoperatively (15). The total Pedi-IKDC score was found to correlate with the majority of the CHQ including expected domains such as physical function (correlation coefficient = 0.64), bodily pain (0.7), and family activities (0.41), in addition to emotional role (0.45), mental health (0.46), self-esteem (0.45), and social limitations--physical (0.38) (P < 0.001 for all correlations).

CONCLUSIONS

Seven of the 12 domains on the CHQ are significantly correlated with the IKDC in adolescent patients with an ACL tear. Self-esteem, mental health, emotional role, and social limitations categories are significantly correlated with knee function suggesting that quality-of-life in this population is affected in domains outside of physical function and pain. A greater understanding of the psychosocial impact of injury may be of utility in these patients.

STUDY DESIGN

Level III cross-sectional study.

Football (soccer) safety equipment use and parental attitudes toward safety equipment in a community youth sports program

While a growing number of children are playing football (soccer), there are limited data on prevalence of injuries, actual use of football safety equipment (SE), and parental attitudes about football SE. We distributed a self-administered survey by mail to parents of all players enrolled in a community recreation youth football program. Parents of 865 children responded. Overall, 32 (3.7%) children were reported as having injuries requiring medical/dental evaluation. Upper/lower extremities were the most commonly injured sites. Shinguards (SGs) were the only equipment commonly used. While there was high parental support for SG use (97.4%) and moderate support for mouthguards (MGs; 53.8%), there was less support for other SE. Many parents were unfamiliar with available SE, but they were mostly willing to pay for it. In a community youth sports program, reports of football injuries were low as was the use of football SE other than SGs.

Soccer injuries in female youth players: comparison of injury surveillance by certified athletic trainers and internet

CONTEXT

Few authors have evaluated sports injury-surveillance systems that use parental, Internet-based surveys for data collection.

OBJECTIVE

To determine whether certified athletic trainers (ATs) and parental, Internet-based surveys provided comparable data for identifying soccer injuries.

DESIGN

Prospective feasibility cohort study.

SETTING

A soccer association in Seattle, Washington.

PATIENTS OR OTHER PARTICIPANTS

Eighty female youth soccer players, ages 12 to 14 years.

MAIN OUTCOME MEASURE(S)

We compared the data provided by ATs attending 1 soccer practice per week with a weekly soccer-parent, Internet-based system. We measured athlete-exposure hours (AEHs) for each player. We compared injury rates reported by ATs only, Internet-based surveys only, and both systems combined. We evaluated the 2 surveillance systems for agreement on injured body region and laterality of injury using the kappa statistic.

RESULTS

For ATs only, Internet-based surveys only, and both systems combined, we found acute injury rates of 3.0 per 1000 AEHs, 3.9 per 1000 AEHs, and 4.7 per 1000 AEHs and overuse injury rates of 1.0 per 1000 AEHs, 2.9 per 1000 AEHs, and 2.9 per 1000 AEHs, respectively. Players sustained 27 acute injuries (44% ankle, 11% knee, 11% hip) reported by at least 1 of the 2 systems, with 63% reported by ATs and 85% by Internet-based survey. Players sustained 17 overuse injuries (35% knee, 29% lower leg) reported by either system, with 35% reported by ATs and 100% by Internet-based survey. Among players for whom we had both ATs' and Internet-based survey injury data, body region injured and laterality had very good agreement (kappa = 0.73 to 1.0).

CONCLUSIONS

The injury rate based on the weekly parental, Internet-based survey was similar to the rate based on the ATs' reporting and had comparable classifications of injured body region and laterality of injury.

Dynamic valgus alignment and functional strength in males and females during maturation

CONTEXT

Sex differences in dynamic measures have been established in physically mature populations. Gaining information on maturation's effect on dynamic performance measures implicated in injury risk may enable us to better design injury prevention programs.

OBJECTIVE

To examine sex differences in dynamic valgus alignment and triple-hop distance measures across maturational stages in males and females. A secondary purpose was to determine if a field test of strength and power predicts dynamic valgus alignment.

DESIGN

Cross-sectional study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

157 young athletes (78 females, 79 males) aged 9 to 18 years.

INTERVENTION(S)

Subjects performed drop-jump landings and single-leg triple-hop tests as part of a broader injury screening.

MAIN OUTCOME MEASURE(S)

Maturational status was ascertained from self-report questionnaires and grouped according to Tanner stages 1 and 2 (MatGrp1), 3 and 4 (MatGrp2), and 5 (MatGrp3). Frontal-plane knee valgus displacement, which served as a measure of dynamic valgus alignment, and single-leg triple-hop distance were assessed.

RESULTS

Males demonstrated less dynamic valgus alignment during drop jumps in the latter maturational stages (MatGrp1 = 13.1 degrees +/- 8.7 degrees , MatGrp2 = 9.0 degrees +/- 6.2 degrees , MatGrp3 = 9.2 degrees +/- 9.4 degrees ), whereas females increased dynamic valgus alignment throughout maturation (MatGrp1 = 11.5 degrees +/- 6.9 degrees , MatGrp2 = 12.8 degrees +/- 8.8 degrees , MatGrp3 = 15.5 degrees +/- 8.7 degrees ). Thus, in the more mature groups, males had less dynamic valgus alignment than females. Both males (MatGrp1 = 393.5 +/- 63.7 cm, MatGrp2 = 491.8 +/- 95.1 cm, MatGrp3 = 559.3 +/- 76.3 cm) and females (MatGrp1 = 360.3 +/- 37.1 cm, MatGrp2 = 380.1 +/- 44.3 cm, MatGrp3 = 440.0 +/- 66.2 cm) increased triple-hop distance, but males increased more. Within each subgroup of MatGrp and sex, triple-hop distance had no predictive ability for dynamic malalignment.

CONCLUSIONS

When dynamic valgus alignment and strength were assessed, sex and maturational status displayed an interaction. However, functional strength did not predict degree of dynamic valgus alignment.

Soccer injuries in children

Soccer is the most popular sport in the world, with FIFA recognising more than 265 million amateur players. Despite the fact that soccer is a contact sport, it is perceived to be relatively safe to play, a factor that has contributed to its status as the fastest growing team sport in the USA. Acute and minor injuries predominate in the statistics, with contusions and abrasions being the most commonly recorded. As would be expected, the majority of soccer injuries are to the lower limbs, with serious truncal and spinal trauma being rare. This article examines the type and anatomic location of injuries sustained by children and adolescents who play soccer, and the main mechanisms whereby such injuries occur. The risk factors underpinning injury occurrence are considered, along with injury avoidance tactics.

Acute subdural hematoma: potential soccer injury in an otherwise healthy child

A 16-year-old adolescent boy presented with headache, dizziness, loss of consciousness, and a tonic-clonic seizure after heading a soccer ball in a competitive match. A computed tomographic scan of the head revealed an acute subdural hematoma with a mass effect. The patient was emergently referred to a tertiary care facility where he eventually recovered completely with conservative care. No predisposing medical conditions were found. To the best of our knowledge, this is the first report of an intracranial hemorrhage secondary to the heading of a soccer ball alone in an otherwise healthy child without any underlying predisposing central nervous system abnormalities.

The prevalence of injury of any type in an urban emergency department population

BACKGROUND

National estimates of injury prevalence in the Emergency Department (ED) are based on medical record review and vary considerably. By using a more robust approach to surveillance, we (1) determine the prevalence of injury of any type in an urban ED population and (2) explore the association between violence-related injury and personal characteristics of injury victims.

METHODS

This cross-sectional study was performed at an urban level I trauma center from June to August, 2005. We prospectively screened 4,246 consecutive ED patients for injury during a randomized schedule of shifts totaling 336 hours. The ED record of each injured patient was reviewed to catalogue injury type and intent (International Classification of External Causes of Injury, Short Form) as well as to estimate injury severity (New Injury Severity Score). We interviewed noncritically injured, adult patients who provided consent to collect demographic (race, income, and education) and personal information (substance abuse, domestic violence, handgun ownership, and homelessness). We sought independent associations between these variables and violence-related injury in an exploratory analysis using multivariate logistic regression.

RESULTS

Injury contributed to 1,036 of 4,246 ED visits (24.4%, 95% confidence interval [CI], 23.1-25.7%). Eleven percent of injured patients were admitted to the hospital and two patients died in the ED. The majority of patients (75%) suffered minor injury. Among the 434 injured patients consenting to interview, the prevalence of established injury risk factors, such as substance use or handgun ownership, varied by gender. The adjusted odds of violence-related injury among this subset of patients were increased for males (odds ratio [OR], 2.22; 95% CI, 1.17-4.23), patients with an annual income less than $5,000 (OR, 2.85; 95% CI, 1.64-4.97), those reporting a history of domestic violence (OR, 2.69; 95% CI, 1.43-5.07), and heavy alcohol users (OR, 1.79; 95% CI, 1.01-3.19).

CONCLUSION

One in four ED visits to this urban, county hospital is due, at least in part, to injury. Patient characteristics associated with violence-related injury may generate hypotheses for further study.

Epidemiology of non-canine bite and sting injuries treated in U.S. emergency departments, 2001-2004

OBJECTIVES

This study was conducted to estimate the burden of non-canine-related bite and sting injuries in the U.S.; describe the affected population, injury severity, and bite or sting source; and provide considerations for prevention strategies.

METHODS

Data were from the 2001 through 2004 National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) (a stratified probability sample of U.S. hospitals). Records included information about age, body part affected, cause, diagnosis, disposition, and gender. Narrative descriptions were coded for the source of the bite or sting.

RESULTS

Between 2001 and 2004, an estimated 3.6 million people were treated in emergency departments for injuries related to non-canine bites and stings. Results detail the reported sources of the bite or sting, and examine sources by gender and age group. Common sources included bees (162,000 cases annually), spiders (123,000 cases annually), and cats (66,000 cases annually). Female adults were more likely than male adults to be treated for cat bites. Although rare, of the known venomous snakebites, more than half (58.4%) of the patients were hospitalized.

CONCLUSIONS

Our results demonstrate the public health burden of non-canine-related bite and sting injuries. More than 900,000 people were treated in emergency departments annually for non-canine bite or sting injuries, or roughly 1.7 injuries per minute. Treatment consumes substantial health-care resources. While preventing these injuries should be the first line of defense, resources could be conserved by educating the public about immediate first aid and when warning signs and symptoms indicate the need for professional or emergency care.

Epidemiology of 1.6 million pediatric soccer-related injuries presenting to US emergency departments from 1990 to 2003

BACKGROUND

As soccer participation in the United States increases, so does the number of children at risk for injury.

PURPOSE

To examine pediatric soccer-related injuries presenting to US emergency departments from 1990 to 2003.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

A descriptive analysis of nationally representative, pediatric, soccer-related injury data from the US Consumer Product Safety Commission's National Electronic Injury Surveillance System.

RESULTS

Among those 2 to 18 years of age, a nationally estimated 1597528 soccer-related injuries presented to US emergency departments from 1990 to 2003. Mean age was 13.2 years (range, 2-18 years); 58.6% were male. From 1990 to 2003, there was an increase in the absolute number of injuries among girls (P < .0001). The wrist/finger/hand (20.3%), ankle (18.2%), and knee (11.4%) were the most commonly injured body parts. The most common diagnoses were sprain/strain (35.9%), contusion/abrasion (24.1%), and fracture (23.2%). Boys were more likely to have face and head/neck injuries (17.7%; relative risk, 1.40; 95% confidence interval, 1.32-1.49; P < .01) and lacerations/punctures (7.5%; relative risk, 3.31; 95% confidence interval, 2.93-3.74; P < .01) than were girls (12.7% and 2.3%, respectively). Girls were more likely to have ankle injuries (21.8%; relative risk, 1.38; 95% confidence interval, 1.33-1.45; P < .01) and knee injuries (12.9%; relative risk, 1.25; 95% confidence interval, 1.15-1.35; P < .01) than were boys (15.7% and 10.4%, respectively). Girls were more likely to have sprains or strains (42.4%) than were boys (31.3%; relative risk, 1.36; 95% confidence interval, 1.31-1.40; P < .01). Children 2 to 4 years old sustained a higher proportion of face and head/neck injuries (41.0%) than did older children (15.5%; relative risk, 2.65; 95% confidence interval, 2.09-3.36; P < .01).

CONCLUSION

When comparing these data to available national statistics that estimate participation in youth soccer, true injury rates may actually be decreasing for boys and girls. Young children should be closely supervised because of risk of head injuries and rate of hospitalization. The establishment of a national database of soccer participation and injury data is needed to better identify injury risks.