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Sprouse B, Chandran A, Rao N, Boltz AJ, Johnson M, Hennis P, Varley I. Injury and illness surveillance monitoring in team sports: a framework for all. Inj Epidemiol 2024; 11:23. [PMID: 38858694 PMCID: PMC11163858 DOI: 10.1186/s40621-024-00504-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/07/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Sport-related injuries and illnesses can negatively impact athlete welfare at all standards of participation in team sports. Injury and illness surveillance (IIS), and the development of monitoring systems, initiates the sequence of injury and illness prevention. Operational IIS monitoring systems help to appraise epidemiological estimates of injury and illness incidence and burden in various athlete populations. However, the methodological underpinnings of various monitoring systems are not harmonized or widely documented, with the presence of efficient and successful programmes rarely showcased at non-elite levels. The aim is to provide a framework that guides the development of IIS, which will enhance overall surveillance, to indirectly inform injury prevention strategies. METHODS The process involved all members of the research group initially discussing the research gaps, scope of the project, and the aims of the article. Unique experiences were shared, and specific and global challenges and barriers to IIS at all standards of team sport participation were identified. A tiered system of data collection with corresponding content were produced, with experiences and guidance provided throughout the article. RESULTS The literature has been reviewed and using first-hand experience in conducting IIS programmes in complex and diverse sport settings, the authors have identified key enablers and barriers for best practise as time, technological and human resources, reporter/practitioner training, and medical expertise. Areas of greatest importance regarding the conducting of IIS have been outlined, providing guidance and recommendations across all levels of team sport participation. These areas include definitions, data context, collection procedures, handling, security, ethics, storage, dissemination, quality, compliance, and analysis. Given the barriers to IIS, 3-tiered levels of data collection and content have been proposed. The levels indicate data collection variables, with a focus on sufficiency and achievability, aiming to support the successful conducting of IIS in team sports across all standards of participation. Future opportunities in IIS have been discussed, with several predictive measures and analytical techniques expanded upon. CONCLUSIONS The framework provides universal guidance for implementing IIS monitoring systems, facilitating athletes, coaches, parents/guardians, governing bodies and practitioners to implement IIS processes, identify challenges, complete analysis, and interpret outcomes at all standards of participation.
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Affiliation(s)
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
| | - Neel Rao
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
| | - Adrian J Boltz
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Ian Varley
- Nottingham Trent University, Nottingham, UK
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Jo J, Boltz AJ, Williams KL, Pasquina PF, McAllister TW, McCrea MA, Broglio SP, Zuckerman SL, Terry DP, Arbogast K, Benjamin HJ, Brooks A, Cameron KL, Chrisman SPD, Clugston JR, Collins M, DiFiori J, Eckner JT, Estevez C, Feigenbaum LA, Goldman JT, Hoy A, Kaminski TW, Kelly LA, Kontos AP, Langford D, Lintner LJ, Master CL, McDevitt J, McGinty G, Miles C, Ortega J, Port N, Rowson S, Schmidt J, Susmarski A, Svoboda S. Mechanisms of Injury Leading to Concussions in Collegiate Soccer Players: A CARE Consortium Study. Am J Sports Med 2024; 52:1585-1595. [PMID: 38656160 DOI: 10.1177/03635465241240789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Few previous studies have investigated how different injury mechanisms leading to sport-related concussion (SRC) in soccer may affect outcomes. PURPOSE To describe injury mechanisms and evaluate injury mechanisms as predictors of symptom severity, return to play (RTP) initiation, and unrestricted RTP (URTP) in a cohort of collegiate soccer players. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS The Concussion Assessment, Research and Education (CARE) Consortium database was used. The mechanism of injury was categorized into head-to-ball, head-to-head, head-to-body, and head-to-ground/equipment. Baseline/acute injury characteristics-including Sports Concussion Assessment Tool-3 total symptom severity (TSS), loss of consciousness (LOC), and altered mental status (AMS); descriptive data; and recovery (RTP and URTP)-were compared. Multivariable regression and Weibull models were used to assess the predictive value of the mechanism of injury on TSS and RTP/URTP, respectively. RESULTS Among 391 soccer SRCs, 32.7% were attributed to a head-to-ball mechanism, 27.9% to a head-to-body mechanism, 21.7% to a head-to-head mechanism, and 17.6% to a head-to-ground/equipment mechanism. Event type was significantly associated with injury mechanism [χ2(3) = 63; P < .001), such that more head-to-ball concussions occurred in practice sessions (n = 92 [51.1%] vs n = 36 [17.1%]) and more head-to-head (n = 65 [30.8%] vs n = 20 [11.1]) and head-to-body (n = 76 [36%] vs n = 33 [18.3%]) concussions occurred in competition. The primary position was significantly associated with injury mechanism [χ2(3) = 24; P < .004], with goalkeepers having no SRCs from the head-to-head mechanism (n = 0 [0%]) and forward players having the least head-to-body mechanism (n = 15 [19.2%]). LOC was also associated with injury mechanism (P = .034), with LOC being most prevalent in head-to-ground/equipment. Finally, AMS was most prevalent in head-to-ball (n = 54 [34.2%]) and head-to-body (n = 48 [30.4%]) mechanisms [χ2(3) = 9; P = .029]. In our multivariable models, the mechanism was not a predictor of TSS or RTP; however, it was associated with URTP (P = .044), with head-to-equipment/ground injuries resulting in the shortest mean number of days (14 ± 9.1 days) to URTP and the head-to-ball mechanism the longest (18.6 ± 21.6 days). CONCLUSION The mechanism of injury differed by event type and primary position, and LOC and AMS were different across mechanisms. Even though the mechanism of injury was not a significant predictor of acute symptom burden or time until RTP initiation, those with head-to-equipment/ground injuries spent the shortest time until URTP, and those with head-to-ball injuries had the longest time until URTP.
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Affiliation(s)
- Jacob Jo
- Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adrian J Boltz
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kristen L Williams
- Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paul F Pasquina
- Department of Physical Medicine and Rehabilitation at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA; Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Douglas P Terry
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kristy Arbogast
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Holly J Benjamin
- University of Chicago, Chicago, Illinois, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alison Brooks
- University of Wisconsin-Madison, Madison, Wisconsin, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kenneth L Cameron
- United States Military Academy, West Point, New York, USA)
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sara P D Chrisman
- University of Washington, Seattle, Washington, USA)
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James R Clugston
- University of Florida, Gainesville, Florida, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Micky Collins
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John DiFiori
- Hospital for Special Surgery, New York, New York, USA)
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James T Eckner
- University of Michigan, Michigan, USA)
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carlos Estevez
- United States Coast Guard Academy, New London, Connecticut, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Luis A Feigenbaum
- University of Miami, Coral Gables, Florida, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joshua T Goldman
- University of California, Los Angeles, Los Angeles, California, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - April Hoy
- Azusa Pacific University, Azusa, California, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Thomas W Kaminski
- University of Delaware, Newark, Delaware, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Louise A Kelly
- California Lutheran University, Thousand Oaks, California, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anthony P Kontos
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dianne Langford
- Temple University, Philadelphia, Pennsylvania, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura J Lintner
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christina L Master
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jane McDevitt
- Temple University, Philadelphia, Pennsylvania, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Gerald McGinty
- United States Air Force Academy, El Paso, Colorado, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chris Miles
- Wake Forest University, Winston-Salem, North Carolina, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justus Ortega
- California State Polytechnic University, Pomona, California, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nicholas Port
- Indiana University, Bloomington, Indiana, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steve Rowson
- Virginia Tech, Blacksburg, Virginia, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Julianne Schmidt
- University of Georgia, Athens, Georgia, USA)
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adam Susmarski
- United States Naval Academy, Annapolis, Maryland, USA)
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steven Svoboda
- MedStar Health, Columbia, Maryland, USA
- Investigation performed at the Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Chandran A, Moffit RE, DeJong Lempke AF, Boltz AJ, Alexander AS, Robison HJ, Kerr ZY, Collins CL, Wikstrom EA. Epidemiology of Lateral Ligament Complex Tears of the Ankle in National Collegiate Athletic Association (NCAA) Sports: 2014-15 Through 2018-19. Am J Sports Med 2023; 51:169-178. [PMID: 36592020 DOI: 10.1177/03635465221138281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Epidemiological studies of lateral ankle sprains in NCAA sports are important in appraising the burden of this injury and informing prevention efforts. PURPOSE To describe the epidemiology of lateral ankle sprains in NCAA sports during the 2014-15 through 2018-19 seasons. STUDY DESIGN Descriptive epidemiology study. METHODS Injury and exposure information collected within the NCAA Injury Surveillance Program (ISP) were examined. Counts, rates, and proportions of lateral ankle sprains were used to describe injury incidence by sport, event type (practices, competitions), season segment (preseason, regular season, postseason), injury mechanism (player contact, noncontact, and surface contact, injury history (new, recurrent), and time loss (time loss [≥1 day], non-time loss). Injury rate ratios (IRRs) were used to examine differential injury rates, and injury proportion ratios (IPRs) were used to examine differential distributions. RESULTS A total of 3910 lateral ankle sprains were reported (4.61 per 10,000 athlete exposures) during the study period, and the overall rate was highest in men's basketball (11.82 per 10,000 athlete exposures). The competition-related injury rate was higher than the practice-related rate (IRR, 3.24; 95% CI, 3.04-3.45), and across season segments, the overall rate was highest in preseason (4.99 per 10,000 athlete exposures). Lateral ankle sprains were most often attributed to player-contact mechanisms in men's (43.2%) and women's sports (35.1%), although injuries were more prevalently attributed to player contact in men's than in women's sports (IPR, 1.23; 95% CI, 1.13-1.34). Overall, 49.7% of all lateral ankle sprains were time loss injuries. CONCLUSIONS The findings of this study are consistent with previous epidemiological investigations of lateral ankle sprains among NCAA athletes. Results offer additional context on differential injury mechanisms between men's and women's sports and on injury risk across the competitive season. Future research may examine the effectiveness of deploying injury prevention programs before the start of a season.
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Affiliation(s)
- Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - Reagan E Moffit
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - Alexandra F DeJong Lempke
- Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA.,University of Michigan School of Kinesiology, Ann Arbor, Michigan, USA
| | - Adrian J Boltz
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA.,Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Hannah J Robison
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christy L Collins
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - Erik A Wikstrom
- Motion Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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