Craniofacial injuries in professional cricket: no more a red herring

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

Concussion assessment and management - What do community-level cricket participants know?

OBJECTIVES

To explore Australian cricket participants' knowledge of concussion assessment and management, and awareness of current concussion guidelines.

DESIGN

Cross-sectional survey.

METHODS

Novel and validated surveys were disseminated online, among over 16 year Australian cricket players and officials at the end of the 2018/19 cricket season. Data were collected on knowledge and awareness of concussion and analysed using descriptive statistics and crosstabulations. Further comparisons were made for the players between injured and non-injured, and helmet wearers and non-helmet wearers using Fisher's exact statistical test.

RESULTS

Both players (n = 224, 93 %) and officials (n = 36, 100 %) demonstrated strong knowledge of the importance of immediately evaluating suspected concussions. In comparison with players without helmets (n = 11), those using helmets (n = 135) considered replacing their helmets after a concussion to be vital to concussion assessment (p = 0.02). Overall, 80-97 % of players and 81-97 % of officials understood the importance of many factors regarding concussion management. When concussion management knowledge was compared by injury status, injured players (n = 17, 94 %) believed someone with a concussion should be hospitalised immediately, in contrast to non-injured players (n = 154, 69 %) (p = 0.04). Players (63 %) were less aware of concussion guidelines than officials (81 %).

CONCLUSIONS

Overall, the knowledge of concussion assessment and management was satisfactory. However, there were discrepancies among players on some aspects of awareness of concussion guidelines. Increasing players' familiarity and experience in using the concussion guidelines is warranted. Targeted campaigns are needed to further improve concussion recognition and treatment at community-level cricket, so all participants play a role in making cricket a safe sport.

A systematic review of head, neck and-facial injuries in cricket

This systematic review was conducted to identify the incidence, nature and mechanisms of head, neck and facial (HNF) injuries in cricket and the reported use of helmets. Five databases were searched up to 30th November 2020. From peer-reviewed cricket injury studies published in English, studies reporting on HNF cricket injuries as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were selected. Twenty-nine studies were included. HNF injuries had a cumulative total of 794/5,886 injuries equating to 13% of all injuries. Non- specified HNF injuries (n=210, 26%) were the most prevalent type of injury followed by non-specified head injuries (n=130, 16%), other non-specified fractures (n=119, 15%) and concussions (n=60, 8%).The impact of the ball was reported as the most common mechanism for sustaining HNF injuries in cricket. The use of helmet was reported in only three studies (10%). From studies reporting on HNF cricket injuries, facial fractures, and concussions were the most common specified-types of injury. There is little evidence on reporting of HNF cricket injuries as per the international cricket consensus injury definitions, as well as the use of helmets at the time of injury.

Cricket-related injuries treated in United States emergency departments

BACKGROUND

Cricket is a popular spectator sport played all over the globe, including in the United States (US). However, most of the literature on cricket-related injuries is from outside the US. This study described cricket-related injuries treated at US emergency departments (EDs).

METHODS

Cases were cricket-related injuries reported to the National Electronic Injury Surveillance System (NEISS) during 2000-2019. Cases were identified by reviewing the record narrative for the term "crick." The distribution of the number of cases and national estimate were determined for selected variables.

RESULTS

A total of 485 cricket-related injuries treated at US EDs during 2000-2019 were identified, resulting in a national estimate of 13,729 injuries (95% confidence interval 10,324-17,135). The patients were 68.5% age 20-39 years, 97.5% male, and 68.6% non-white. The most common types of injuries were lacerations (24.0%), strains or sprains (21.4%), fractures (19.6%), and contusions or abrasions (13.2%). The most frequently affected body parts were the upper extremity (43.9%) and head or neck (29.9%). The patient was treated or examined at the ED and then released in 97.5% of the cases.

CONCLUSION

Cricket-related injuries treated at US EDs tended to involve patients who were adults, particularly age 20-39 years, male, and non-white. The majority of patients were treated or examined at the ED and then released.

The Gentleman’s Game Has New Rules for Concussion: Possible Impact and Controversies

Background When Jofra Archer bowled that fateful bouncer that felled Steve Smith, arguably the best batsman in the world, the gut-churning incident revived images of the horrific Phillip Hughes tragedy. Fortunately, Smith was soon up and about, but he was forced off the ground by the medicos. Less than an hour later, the 30-year-old came back to the crease to resume his innings on 80 not out but he did not look right. He soon fell for 92—the first time he was dismissed under a hundred in the series—to a misjudgment that he would never make normally. Following this, discussions regarding concussions in sports in general and cricket in particular had been reignited throughout the world.

Methods We reviewed all available literatures on concussion in cricket and also reviewed all possible guidelines issued by the International Cricket Council and Cricket Australia on concussion. The latest guidelines issued on May 23, 2019 were kept as the basis for this article. Causes and possible methods/steps in management of the same were considered.

Discussion Sport should not be played at the cost of lives and mental well-being of the players. The guidelines issued are very exhaustive and useful but have no meaning if they are not implemented properly. Sports-related injuries are often considered trivial but considering recent events, they are not. There is a spectrum ranging from craniofacial injuries to concussion, leading to career and even life-ending injuries in professional cricket. In retrospect, most of the injuries were concussions but they had a lasting impact on the players’ career.

Conclusion Appropriate medical personnel must be present at all times to cover all matches (preferably having experience in head injuries). The decision on the medical personnel pervades any stage of the game and substitutes should be considered immediately, with return to play only after proper evaluation, and clearance has been obtained.

A 3-year prospective study on ocular injuries with tennis or cricket ball while playing cricket: A case series

PURPOSE

The purpose of this study is to study the clinical features, visual outcome, management, and ocular complications of ocular injury, following trauma with tennis or cricket ball.

METHODS

A prospective, noncomparative case study of patients having injury with tennis/cricket ball while playing cricket was conducted between January 2013 and April 2016. Seventy-six eyes of 76 patients were studied. Presenting vision, age, gender, time since injury, general and ocular examination, intraocular pressure, indirect ophthalmoscopy, B scan, and X-ray/computed tomography scan findings were noted. Patients were managed medically or surgically as per the need and followed up at least for 6 months.

RESULTS

Seventy-six eyes of 76 patients were studied. All cases were male, except two. Majority (80.2%) were <25 years. Median presenting visual acuity (VA) was 6/36 and median final VA was 6/18. Significant findings in the decreasing order of frequency were sphincter tear (26.3%), retinal detachment (23.6%), angle recession (18.4%), choroidal rupture (17.1%), and Berlin's edema (15.7%). Most of the cases (69.7%) were managed medically. Only 30.2% cases needed surgical intervention. Final visual outcome in our study was depended on initial VA (P = 0.000). It was also correlating with presenting clinical feature (P = 0.010) and type of intervention (medical/surgical) (P = 0.001).

CONCLUSION

Cricket-related ocular injury generally has a poor prognosis with most cases being closed globe injury; retinal detachment is the most common vision-threatening presentation. In spite of being a common event, cricket-related injury is sparingly documented and hence needs further studies for proper documentation, prognostication, and formulation of definitive management plan.

Injuries in Cricket

Context:

Cricket is a popular global sport that requires a combination of physical fitness, skill, and strategy. Although a noncontact sport, overuse and impact injuries are common since players engage in a wide range of physical activities, including running, throwing, batting, bowling, catching, and diving. Significant or match time-loss injuries are defined as those that either prevent a player from being fully available for selection in a major match, or during a major match, cause a player to be unable to bat, bowl, or keep wicket when required by either the rules or the team’s captain. This review describes the various region-wise injuries sustained in cricket along with their epidemiology, biomechanics, treatment, and prevention.

Evidence Acquisition:

Data were collected from peer-reviewed articles (obtained via PubMed search) published through November 2016 that involved the medical, biomechanical, and epidemiological aspects of cricket injuries.

Study Design:

Clinical review.

Level of Evidence:

Level 4.

Results:

Cricket was one of the first sports to publish recommended methods for injury surveillance in 2005 from England, South Africa, Australia, the West Indies, and India. While the incidence of injuries is about the same, the prevalence of injuries has increased due to game format changes, increasing number of matches played, and decreased rest between matches. Bowling (41.3%), fielding, and wicket keeping (28.6%) account for most injuries. Acute injuries are most common (64%-76%), followed by acute-on-chronic (16%-22.8%) and chronic ones (8%-22%). The most common modern-day cricket injury is hamstring strain, and the most severe is lumbar stress fracture in young fast bowlers.

Conclusion:

With improved understanding of the scientific and medical aspects of cricket, along with advances in surgical and nonsurgical treatment techniques, the time to return to play has shortened considerably. While the prevalence of cricket injuries has increased, their severity has decreased over the past decades.