A comparison of high school sports injury surveillance data reporting by certified athletic trainers and coaches

Injury and illness surveillance monitoring in team sports: a framework for all

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.

Descriptive Epidemiology of Game-Related Youth Flag Football Injuries

CONTEXT

Flag football is promoted as a safer alternative to tackle football. This may be 1 reason why participation rates have risen by 39% over the past 3 years. Despite rising participation, epidemiologic research on sport-specific injuries and associated relative risk is lacking.

OBJECTIVE

To prospectively document the epidemiology of injuries in youth flag football.

DESIGN

Descriptive epidemiology study.

SETTING

Regional and national youth flag football tournaments.

PATIENTS OR OTHER PARTICIPANTS

Athletes (N = 1939; 1744 boys and 195 girls), ages 6 to 12 years. An athletic trainer prospectively monitored the athletes for sport-related injury and exposures.

MAIN OUTCOME MEASURE(S)

Athlete risks of injury and injury rates were calculated overall and by sex. Injury characteristics were reported for the total population and by sex.

RESULTS

Forty-seven injuries to unique individuals were recorded in 1939 athletes with a total of 9228 athlete-exposures (AEs). The overall risk of injury was 2.4% (95% CI = 1.79%, 3.21%), with an overall injury rate of 5.1 per 1000 AEs (95% CI = 3.75, 6.77). Of the 47 injuries, 36 occurred in boys (8365 AEs), and 11 occurred in girls (863 AEs). A higher risk in girls was evidenced by both the injury risk ratio (2.73; 95% CI = 1.41, 5.30) and injury rate ratio of 2.96 (95% CI = 1.51, 5.82). The most common injury sites were the head/face/neck (n = 15, 31.9%), followed by the ankle/foot (n = 9, 19.1%). The most frequent types of injury were contusion (55.3%), sprain/subluxation (14.9%), and general trauma (10.6%); 74.5% of all injuries resulted from direct impact.

CONCLUSIONS

Although the competition injury rate for youth flag football was lower than the values from studies reporting comparable tackle football data, the frequencies by body part, type, and mechanism were similar. Given that most injuries were related to some form of impact and predominantly contusions, adopting minimal protective equipment or padding may reduce the numbers of these injuries.

Biomechanical Characteristics of Scapular and Glenohumeral Movements during Pitching Motion in Injury-prone College Baseball Pitchers

OBJECTIVES

The coordination of glenohumeral (GH) and scapular movements is central to the injury prevention of baseball pitchers. However, there is no objective data establishing the direct relationship between pitching injuries and associated GH and scapular movements. Therefore, this study demonstrated the biomechanical differences in the scapular and GH movements during pitching between injury-prone pitchers and healthy college baseball pitchers.

METHODS

A total of 30 collegiate baseball pitchers were classified into two groups according to their injury status: injury-prone group (n = 15) and control group (n = 15). We obtained pitching motion data using three-dimensional motion analysis technique.

RESULTS

The horizontal abduction angles of the GH joint during cocking and acceleration phases were considerably greater in the injury-prone pitchers (19.0° at stride foot contact [SFC], -4.0° at maximum external rotation [MER], and -0.3° at ball release) than those in healthy controls (11.7° at SFC, -10.0° at MER, and -6.9° at ball release). Additionally, in the cocking phase, the amount of angular change in the scapular external rotation (ER) was significantly smaller in the injury-prone group than that in the control group (mean difference, -13.0).

CONCLUSION

These results suggest that the injury-prone pitchers have less internal rotation of the scapula and a more horizontal abduction of the GH joint during the cocking and acceleration phases. Therefore, sports medicine practitioners may need to pay considerable attention to the coordination of scapular and GH horizontal movements during pitching for prevention of shoulder injuries.

An analysis of pain intensity, injury incidence, and their associations with socio-demographic factors in high school athletes: A cross-sectional study during the COVID-19 pandemic

This cross-sectional study explored the relationship between pain intensity, injury incidence, and sociodemographic factors in 120 high school athletes (mean age 16.78±0.91) participating in various sports. The aims of this study are to examine the correlation between factors and Verbal Rating Scale (VRS) for pain intensity, to investigate the correlation between sport types and injured region, and to explore the correlation between injured regions and VRS during training and game competition. Using VRS, we found 64 (53.3%) participants experienced pain during training, with varying degrees of intensity. Chi-square analysis revealed a significant association between VRS scores and school grade (p = 0.044) and cool-down practices (p = 0.037). However, no significant associations were found with gender, age, or sport type. In game competition, 29 (24.2%) participants reported experiencing pain. Here, there was no significant association between VRS and any considered variables. Lower limb injuries were predominant (n = 64), particularly to the knee (n = 23) and ankle/foot (n = 18). Certain sports, like Athletics, Karate-Do, Football, and Western Boxing, demonstrated multiple injury sites, whereas Thai boxing was associated primarily with ankle and foot injuries. Pain intensity varied by injury location, with the highest 'worst pain' reported for elbow injuries during training and knee injuries during competition. Significant associations were found between injured region and pain intensity level during both training and competition (p<0.001). Our findings highlight the need for injury prevention strategies and pain management among high school athletes, emphasizing proper cool-down activities. Further research is warranted to confirm these findings and explore underlying mechanisms.

Fair Play as an Injury Prevention Intervention: Do Yellow Card Accumulation Policies Reduce High School Soccer Injuries?

OBJECTIVES

Evaluate yellow card policies' (YCPs) effectiveness in reducing competition contact injuries (CCIs).

DESIGN

Retrospective cohort.

SETTING

High schools.

PARTICIPANTS

Soccer players from High School (HS) Reporting Information Online participating schools, 2005/06 to 2017/18.

INDEPENDENT VARIABLES

Athlete exposure (AE), CCIs from HS competitions collected from states with/without YCPs.

MAIN OUTCOME MEASURES

Rate and rate ratio (RR) of athlete-athlete CCIs recorded by athletic trainers were compared between states with/without YCPs and pre-YCPs/post-YCPs among the states with YCPs using Poisson regressions. Proportions of severe athlete-athlete CCIs were also described in states with/without YCPs.

RESULTS

Fifteen states implemented YCPs between 2005/06 and 2017/18; 901 athlete-athlete CCIs occurred during 352 775 competition AEs in states with YCPs, and 3525 injuries during 1 459 708 competition AEs in states without YCPs. There was no significant difference in injury rates between schools in states with/without YCPs (RR 1.07; 95% confidence interval [CI]: 0.97-1.17). Among state with YCPs, injury rates were not significantly different between pre-YCP and post-YCP implementation (RR 1.15; 95% CI: 0.98-1.34). Although a significantly lower proportion of injuries resulting in >3 weeks' time loss (TL) occurred in states with YCPs (injury proportion ratio 0.81; 95% CI: 0.66-0.997), no significant differences were observed in proportions of other severe athlete-athlete CCIs between states with/without YCPs.

CONCLUSIONS

Yellow card policies were ineffective in lowering HS soccer athlete-athlete CCI rates, although injuries resulting in >3 weeks' TL were less prevalent in states with YCPs. Implementation of YCPs alone, without proper enforcement, may not be a sufficient injury prevention strategy.

Injury Incidence and Pattern in Elite Young Male and Female Trail Runners

The aim of this study was to analyze the injury incidence in young trail runners according to the body region, type, mode of onset, and moment of occurrence, both in total and detailed by sex. Thirty-five male and sixteen female young elite trail runners, aged between 15 and 22 years, completed a questionnaire regarding the injury incidence in the last 2 years. Comparison of the proportions of the injury incidence within groups (all, male, and female runners) and between groups (male vs. female runners) was computed using z and Fisher’s exact tests. Results showed that most of the injuries in male runners occurred in ankle (54.3%; p < 0.001; ES = 0.520). New injuries were the most common type in male (60.0%; p < 0.001; ES = 0.829) and female runners (52.0%; p = 0.005; ES = 0.585). Acute sudden onset (55.7%; p = 0.002; ES = 0.722) and repetitive sudden onset injuries (48.0%; p = 0.002; ES = 0.141) were the most frequent in male and female athletes, respectively. Joint sprains (48.6%; p < 0.001; 0.464) were the most reported injuries in male runners. Comparative analysis between sexes showed that exacerbation injuries were higher in females (24.0%) than in male runners (8.6%), with p = 0.046 (ES = 0.205). However, female runners reported less incidence by acute sudden onset injuries (32.0%) than male runners (55.7%), with p = 0.042 (ES = 0.209). Young trail runners showed a specific injury profile due to the distinctive characteristics of the mountain terrain compared to the athletic modalities.

Acute Musculoskeletal Sports Injuries in School Age Children in Britain

OBJECTIVES

To determine the relative number of acute musculoskeletal injuries sustained by children due to different sports in a region of the UK, and assess the burden upon the NHS, through a cross sectional study.

METHODS

Collection of data for every child aged 6-18 seen at the Peterborough City Hospital fracture clinic, whose sports injury was from 1^st September 2018 - 31^st August 2019 (1 school year; n=689). Data was gathered throughout the year by three children's orthopaedic surgeons, who consulted the clinic records, notes and x-rays of all children who had attended clinic.

RESULTS

Boys were 2.7 times more likely to sustain injury than girls. Children aged 6-9 had few injuries (mean 24 injuries each year group), 10-15 had a large number of injuries (mean 84), and 16-18 again had few injuries (mean 35). Football and rugby were responsible for the majority of injuries (61% between them), as well as the majority of physiotherapy appointments (72%). Sports with the highest likelihood that an injury will be sufficiently serious to require surgery were equestrian (42% of injuries required surgery), gymnastics (27%), ice skating (25%) and rugby (22%). Popular sports in which injuries were relatively rare include swimming, athletics, cricket, hockey, tennis and badminton.

CONCLUSION

The sports that caused the most injuries were football and rugby. Considering relative participation in different sports, it is clear that rugby has a disproportionate number of musculoskeletal injuries in total, of severe injuries requiring surgery, and requiring rehab from physiotherapy.

A Nation-Wide Survey of High School Baseball Coaches' Perceptions Indicates their Arm Care Programs Play a Role in Injury Prevention

BACKGROUND

Arm care programs consisting of upper extremity strengthening and stretching have been recommended for injury prevention for pitchers of all ages. There has been no investigation into high school baseball coaches' usage and perceptions of arm care programs to mitigate physical impairments associated with injuries in baseball players.

HYPOTHESIS/PURPOSE

The purpose of this study was to investigate the current usage of arm care programs by high school baseball coaches. The primary objective was to determine if coaches use group-based or individualized arm care programs. The secondary objective sought to determine if the use of arm care programs is influenced by coaches' age, education, and experience level. Finally, this study explored the potential barriers to arm care implementation and high school baseball coaches' current awareness and beliefs of injury prevention.

STUDY DESIGN

Descriptive cross-sectional survey.

METHODS

A 29-item online survey was emailed to 18,500 high school baseball coaches throughout the United States. Data were collected for three months, and the response rate was 3.7%.

RESULTS

A total of 87.3% (n=571/654) of responding coaches use arm care programs with their players. Of coaches performing arm care, only 18.5% of 571 individualize their arm care exercises based on specific player needs. However, older and more experienced coaches are more likely to individualize their programs. Among the 12.7% (n=83/654) of coaches who do not use arm care programs, the two most commonly cited reasons for not implementing arm care were lack of observed benefit (41%) and insufficient staff (31%). Although 42% of 654 coaches recognized reduced shoulder mobility as a major contributor to injury, risk factors such as throwing with a fatigued arm, previous injury history, and throwing > 8 months per year were not consistently identified as primary risk factors.

CONCLUSION

The results of this study suggest that the majority high school baseball coaches implement group-based arm care exercise programs to prevent injury. Lack of confidence in the effectiveness and staffing limitations were major barriers to implementation of arm care programming. However, the responding coaches exhibited inconsistent risk factor awareness and dated injury prevention beliefs. Therefore, better educational collaboration between rehabilitation professionals and high school coaches regarding injury risk factors and preventative strategies is warranted.

LEVEL OF EVIDENCE

Level 3.

Epidemiology of Concussions in High School Boys' Ice Hockey, 2008/09 to 2016/17 School Years

OBJECTIVE

This study examined the epidemiology of concussions in high school boys' ice hockey during the 2008/09 to 2016/17 school years.

DESIGN

Prospective cohort study. Athletic trainers from an average 33 high schools annually reported boys' ice hockey concussion and athlete-exposure (AE) data for the High School Reporting Information Online system.

SETTING

Convenience sample of high school boys' ice hockey programs during the 2008/09 to 2016/17 school years.

PATIENTS OR OTHER PARTICIPANTS

High school boys' ice hockey players (aged ∼14-18 years).

INDEPENDENT VARIABLES

Concussion data on event type, injury mechanism, symptom resolution time, and time loss were obtained.

MAIN OUTCOME MEASURES

Concussion rates with 95% confidence intervals (CIs) and distributions were calculated.

RESULTS

Overall, 348 concussions were reported in boys' ice hockey during the 2008/09 to 2016/17 academic years, leading to a concussion rate of 0.68/1000 AEs (95% CI, 0.61-0.75). Most occurred in competitions (85.6%), particularly after the first period (72.1% of all competition concussions). Among practice concussions, most occurred after the first hour of practice (60.0%). Most concussions were due to player contact (47.7%) and boards/glass contact (31.9%). Although 69.0% of concussed athletes had symptoms resolve in less than 7 days, only 14.1% returned to activity within a week.

CONCLUSIONS

Most concussions occurred within the second and third periods. Preventive strategies that counter an increased risk of concussion due to a greater intensity of gameplay coupled with increased fatigue may be warranted. Moreover, athletes may further benefit from prevention efforts that focus on anticipating impacts during gameplay.

A Systematic Review of the Orthopedic Literature Involving National Hockey League Players

Background

Orthopedic injuries of National Hockey League (NHL) players are common and may significantly affect players’ health and careers. Evidence-based injury management is important in guiding players’ timely return to sport and their ability to play at their pre-injury levels of competition.

Purpose

To summarize all data published between January 1980 and March 2020 on orthopedic injuries experienced by professional ice hockey players competing in the NHL.

Study Design

Systematic review.

Methods

A literature review of studies examining orthopedic injuries in the NHL was performed using the Embase, PubMed, and CINAHL databases. The review included studies focusing on NHL players and players attending the NHL Combine and preseason NHL team camps. Studies pertaining to non-orthopedic injuries and case reports were excluded.

Results

A total of 39 articles met the inclusion criteria and were analyzed. The articles were divided by anatomic site of injury for further analysis: hip and pelvis (24%), general/other (14%), ankle (10%), knee (10%), foot (7%), shoulder (7%), thigh (7%), trunk (7%), spine (6%), elbow (4%), and hand and wrist (4%). The majority of articles were Level IV Evidence (51.3%), followed by Level III Evidence (38.5%). Most studies obtained data from publicly available internet resources (24.7%), player medical records (19.5%) or surveys of team physicians and athletic trainers (15.5%). A much smaller number of studies utilized the NHL Injury Surveillance System (NHLISS) (6.5%) or the Athlete Health Management System (AHMS) (2.6%).

Conclusion

This systematic review provides NHL team physicians with a single source of the current literature regarding orthopedic injuries in NHL players. Most research was published on hip and pelvis (24%) injuries, did not utilize the NHLISS and consisted of Level IV Evidence.

Concussion Symptom Characteristics and Resolution in 20 United States High School Sports, 2013/14-2017/18 Academic Years

BACKGROUND

High school (HS) sport-related concussions (SRCs) remain a public health concern in the United States.

OBJECTIVE

To describe patterns in symptom prevalence, symptom resolution time (SRT), and return-to-play time (RTP) for SRCs sustained in 20 HS sports during the 2013/14-2017/18 academic years.

METHODS

A convenience sample of athletic trainers reported concussion information to the HS RIOTM surveillance system. Symptom prevalence, average number of symptoms, and SRT and RTP distributions were examined and compared by event type (practice, competition), injury mechanism (person contact, nonperson contact), sex, and contact level (collision, high contact, and low contact) with chi-square tests and Wilcoxon rank-sum tests.

RESULTS

Among all SRCs (n = 9542), headache (94.5%), dizziness (73.8%), and difficulty concentrating (56.0%) were commonly reported symptoms. On average, 4.7 ± 2.4 symptoms were reported per SRC. Overall, 51.3% had symptoms resolve in <7 d, yet only 7.9% had RTP < 7 d. Differential prevalence of amnesia was seen between practice and competition-related SRCs (8.8% vs 13.0%; P < .001); nonperson-contact and person-contact SRCs (9.3% vs 12.7%; P < .001); and female and male SRCs in low-contact sports (5.8% vs 17.5%; P < .001). Differential prevalence of loss of consciousness was seen between practice and game-related SRCs (1.3% vs 3.2%; P < .001); and female and male SRCs in high contact sports (1.2% vs 4.0%; P < .001). Differential longer SRT (>21 d) was seen between new and recurrent SRCs (9.4% vs 15.9%; P < .001).

CONCLUSION

Headache was the most commonly reported symptom. Notable group differences in the prevalence of amnesia, loss of consciousness, and SRT may be associated with more severe SRCs, warranting further attention.

Second Impact Syndrome. Myth or reality?

INTRODUCTION

Second impact syndrome (SIS) is a devastating condition occurring in sport-induced mild brain injury. SIS is drastically defined by anamnestic, clinical and radiological criteria, which is unusual in the field of cranial traumatology. The purpose of this study was to provide a literature review of this syndrome.

MATERIAL AND METHODS

We conducted a literature review of all published studies on PubMed. The keywords were "second impact syndrome and catastrophic head injury", "second impact syndrome and sport", "repeat concussion and catastrophic brain injury", "catastrophic head injury and concussion", "catastrophic head injury", "concussion and second impact syndrome", "concussion and repetitive head injury".

RESULTS

Eighty-two full-text articles were assessed for eligibility. Finally, 41 studies were included in qualitative synthesis and 21 were included in quantitative synthesis.

DISCUSSION

The number of cases reported in the literature was extremely small compared to the population at risk, i.e., the number of athletes exposed to repeated concussions. SIS was similar to talk and die syndrome, with which it shares certain characteristics. If we consider SIS according to "talk and deteriorate tables", it opens up interesting perspectives because they are specific in children and adolescents. Taking into account the scarcity of this syndrome, one may question whether athlete-intrinsic features may be involved in at least some cases of SIS. On a pathophysiological level, many explanations remained unsatisfactory because they were unable to explain all the clinical phenomena and observed lesions. Triggering the trigeminocardiac reflex is a crucial element in explaining the sequence of clinical events. Its association with a state of neurogenic inflammation provides an almost complete explanation for this particular condition. Finally, on a practical level, a concussion occurring during the playing of a sport must be considered as any other injury before allowing a return to play.

A Comparison of Emergency Preparedness Between High School Coaches and Club Sport Coaches

CONTEXT

Recent studies suggested that a large population of high school-aged athletes participate on club sport teams. Despite attempts to document emergency preparedness in high school athletics, the adherence to emergency and medical coverage standards among club sport teams is unknown.

OBJECTIVE

To determine if differences in emergency preparedness and training existed between coaches of high school teams and coaches of high school-aged club teams.

DESIGN

Cross-sectional survey.

SETTING

Online questionnaire.

PATIENTS OR OTHER PARTICIPANTS

A total of 769 coaches (females = 266, 34.6%) completed an anonymous online questionnaire regarding their emergency preparedness and training.

MAIN OUTCOME MEASURE(S)

The questionnaire consisted of (1) demographics and team information, (2) emergency preparedness factors (automated external defibrillator [AED] availability, emergency action plan [EAP] awareness, medical coverage), and (3) emergency training requirements (cardiopulmonary resuscitation/AED, first aid).

RESULTS

High school coaches were more likely than club sport coaches to be aware of the EAP for their practice venue (83.9% versus 54.4%, P < .001), but most coaches in both categories had not practiced their EAP in the past 12 months (70.0% versus 68.9%, P = .54). High school coaches were more likely to be made aware of the EAP during competitions (47.5% versus 37.1%, P = .02), but the majority of coaches in both categories indicated that they were never made aware of EAPs. High school coaches were more likely than club coaches to (1) have an AED available at practice (87.9% versus 58.8%, P < .001), (2) report that athletic trainers were responsible for medical care at practices (31.2% versus 8.8%, P < .001) and competitions (57.9% versus 31.2%, P < .001), and (3) be required to have cardiopulmonary resuscitation, AED, or first-aid training (P < .001).

CONCLUSIONS

High school coaches displayed much greater levels of emergency preparedness and training than coaches of high school-aged club teams. Significant attention and effort may be needed to address the lack of emergency preparedness and training observed in club coaches.

Descriptive Epidemiology of Injuries in Professional Ultimate Frisbee Athletes

CONTEXT

Injuries in professional ultimate Frisbee (ultimate) athletes have never been described.

OBJECTIVE

To determine injury rates, profiles, and associated factors using the first injury-surveillance program for professional ultimate.

DESIGN

Descriptive epidemiology study.

SETTING

American Ultimate Disc League professional ultimate teams during the 2017 season.

PATIENTS OR OTHER PARTICIPANTS

Sixteen all-male teams.

MAIN OUTCOME MEASURE(S)

Injury incidence rates (IRs) were calculated as injuries per 1000 athlete-exposures (AEs). Incidence rate ratios were determined to compare IRs with 95% confidence intervals, which were used to calculate differences.

RESULTS

We observed 299 injuries over 8963 AEs for a total IR of 33.36 per 1000 AEs. Most injuries affected the lower extremity (72%). The most common injuries were thigh-muscle strains (12.7%) and ankle-ligament sprains (11.4%). Running was the most frequent injury mechanism (32%). Twenty-nine percent of injuries involved collisions; however, the concussion rate was low (IR = 0.22 per 1000 AEs). Injuries were more likely to occur during competition and in the second half of games. An artificial turf playing surface did not affect overall injury rates (Mantel-Haenszel incidence rate ratio = 1.28; 95% confidence interval = 0.99, 1.67).

CONCLUSIONS

To our knowledge, this is the first epidemiologic study of professional ultimate injuries. Injury rates were comparable with those of similar collegiate- and professional-level sports.

Variability in the identification and reporting of overuse injuries among sports injury surveillance data collectors

Purpose

This study examined variability in identifying and reporting overuse injuries among Certified Athletic Trainers (ATs).

Methods

This cross-sectional study of ATs participating in the National Collegiate Athletic Association's Injury Surveillance Program, utilized a novel online-only survey, consisting of seven hypothetical clinical scenarios representing various clinical presentations including overuse and acute elements. Participants reported clinical opinions regarding the role overuse played in each scenario (major contributor, not a major contributor, not enough information) and probability (0-100%) of classifying each scenario as having an overuse injury mechanism, then completed open-ended questions addressing their decision-making process.

Results

74 ATs (25%) completed the survey. Six of the seven scenarios generated discordance in responses among the participating ATs. Variability in AT decisions involved: the progression of injury, duration of symptoms, and activity at time of injury.

Conclusion

Developing a formalized definition of overuse injury may improve consistency and standardize methods for identifying and reporting overuse injuries within injury research.

Concussion Incidence and Trends in 20 High School Sports

BACKGROUND

Ongoing monitoring of concussion rates and distributions is important in assessing temporal patterns. Examinations of high school sport-related concussions need to be updated. This study describes the epidemiology of concussions in 20 high school sports during the 2013-2014 to 2017-2018 school years.

METHODS

In this descriptive epidemiology study, a convenience sample of high school athletic trainers provided injury and athlete exposure (AE) data to the National High School Sports-Related Injury Surveillance Study (High School Reporting Information Online). Concussion rates per 10 000 AEs with 95% confidence intervals (CIs) and distributions were calculated. Injury rate ratios and injury proportion ratios examined sex differences in sex-comparable sports (soccer, basketball, baseball and softball, cross country, track, and swimming). We also assessed temporal trends across the study period.

RESULTS

Overall, 9542 concussions were reported for an overall rate of 4.17 per 10 000 AEs (95% CI: 4.09 to 4.26). Football had the highest concussion rate (10.40 per 10 000 AEs). Across the study period, football competition-related concussion rates increased (33.19 to 39.07 per 10 000 AEs); practice-related concussion rates decreased (5.47 to 4.44 per 10 000 AEs). In all sports, recurrent concussion rates decreased (0.47 to 0.28 per 10 000 AEs). Among sex-comparable sports, concussion rates were higher in girls than in boys (3.35 vs 1.51 per 10 000 AEs; injury rate ratio = 2.22; 95% CI: 2.07 to 2.39). Also, among sex-comparable sports, girls had larger proportions of concussions that were recurrent than boys did (9.3% vs 6.4%; injury proportion ratio = 1.44; 95% CI: 1.11 to 1.88).

CONCLUSIONS

Rates of football practice-related concussions and recurrent concussions across all sports decreased. Changes in concussion rates may be associated with changes in concussion incidence, diagnosis, and management. Future research should continue to monitor trends and examine the effect of prevention strategies.

The impact of high school athletic trainer services on medical payments and utilizations: a microsimulation analysis on medical claims

Background

Increasing athletic trainer (AT) services in high schools has attracted widespread interest across the nation as an effective instrument to manage injuries and improve children’s health, but there is a lack of evidence on potential medical savings. Our study aimed to address this knowledge gap and provide evidence of AT impacts on medical payments and utilizations to inform public policy decision.

Methods

We obtained medical claims of patients aged 14 to 18 years from the 2011–2014 Oregon All Payer All Claims limited dataset. We calculated payer payments and utilizations for medical claims under AT’s scope of practice. We used zip codes to link patients with the enrollment boundaries of Oregon public high schools, which were classified as either “AT group” or “non-AT group”. We implemented an innovative microsimulation analysis to address the uncertainty of linkage between children and schools.

Results

Our analysis included 64,115 and 84,968 eligible children with Medicaid and commercial insurance, respectively. Associated with high school AT services, Medicaid saved an average of $64 per patient during the study period, while commercial insurance payment rarely changed. AT services may reduce emergency visits for both insurance types but increase total visits for commercially insured patients.

Conclusions

Our study provides evidence for the differential impacts of AT services on medical payments and utilizations. The legislators should consider to allocate funds for high schools to directly employ ATs. This will encourage ATs to work to their highest ability to improve children’s wellbeing while containing avoidable medical cost.

The Epidemiology and Management of Exertional Heat Illnesses in High School Sports During the 2012/2013–2016/2017 Academic Years

Context: Recent data on exertional heat illness (EHI) in high school sports are limited yet warranted to identify specific settings with the highest risk of EHI. Objective: To describe the epidemiology of EHI in high school sports during the 2012/2013-2016/2017 academic years. Design: Descriptive epidemiology study. Setting: Aggregate injury and exposure data collected from athletic trainers working in high school sports in the United States. Patients or Other Participants: High school athletes during the 2012/2013-2016/2017 academic years. Intervention: High School Reporting Information Online surveillance system data from the 2012/2013-2016/2017 academic years were analyzed. Main Outcome Measures: EHI counts, rates per 10,000 athlete exposures (AEs), and distributions were examined by sport, event type, and US census region. EHI management strategies provided by athletic trainers were analyzed. Injury rate ratios with 95% confidence intervals (CIs) compared EHI rates. Results: Overall, 300 EHIs were reported for an overall rate of 0.13/10,000 AE (95% CI, 0.11 to 0.14). Of these, 44.3% occurred in American football preseason practices; 20.7% occurred in American football preseason practices with a registered air temperature ≥90°F and ≥1 hour into practice. The EHI rate was higher in American football than all other sports (0.52 vs 0.04/10,000 AE; injury rate ratio = 11.87; 95% CI, 9.22 to 15.27). However, girls' cross-country had the highest competition EHI rate (1.18/10,000 AE). The EHI rate was higher in the South US census region than all other US census regions (0.23 vs 0.08/10,000 AE; injury rate ratio = 2.96; 95% CI, 2.35 to 3.74). Common EHI management strategies included having medical staff on-site at the onset of EHI (92.7%), removing athlete from play (85.0%), and giving athlete fluids via the mouth (77.7%). Conclusions: American football continues to have the highest overall EHI rate although the high competition EHI rate in girls' cross-country merits additional examination. Regional differences in EHI incidence, coupled with sport-specific variations in management, may highlight the need for region- and sport-specific EHI prevention guidelines.

Involving research-invested clinicians in data collection affects injury incidence in youth football

It is well established that differences in injury definition and recording methodology restrict comparisons between injury surveillance programmes. There is, however, little documentation of the variation that can exist between data recorders. The aim of this study was, therefore, to explore the effect on reported injuries when team recorders or supervisors are involved in research. Injury data collected prospectively over five seasons for the U16, U17, and U18 age groups in a youth football (soccer) academy were used to compare different recording settings based on the research involvement of the clinicians. A research-invested team physiotherapist reported an 8.8 times greater incidence (P < 0.001) of non-time-loss injuries and a 2.5 times greater incidence (P < 0.001) of minimal injuries (1-3 days lost) compared to a setting where neither the team physiotherapists nor the supervisor relied on the collected data for research purposes. When team physiotherapists were not invested in research themselves but were supervised by a researcher, the incidence of non-time-loss injuries and minimal injuries was 2.5 times (P < 0.001) and 2.0 times greater (P < 0.01) than in the non-invested setting, respectively. However, there were no differences between recording settings for overall incidence of time-loss injuries. The results from this study demonstrate that involving clinicians that are relying on the collected data for research purposes can significantly affect the reported rates of non-time-loss and minimal injuries. Time-loss injuries overall were not affected by research investment, and should therefore be preferred for comparisons between teams and seasons.

Head Impact Locations in U.S. High School Boys' and Girls' Soccer Concussions, 2012/13-2015/16

This study describes concussions and concussion-related outcomes sustained by high school soccer players by head impact location, sex, and injury mechanism. Data were obtained for the 2012/13-2015/16 school years from the National High School Sports-Related Injury Surveillance System, High School RIO™. This Internet-based sports injury surveillance system captures data reported by athletic trainers from an annual average of 162 U.S. high schools. Data were analyzed to describe circumstances of soccer concussion (e.g., symptomology, symptom resolution, and return-to-play time) by impact location (i.e., front- [face included], back-, side-, and top-of-the-head) and sex. Most concussions were from front-of-the-head impacts (boys, 30.5%; girls, 34.0%). Overall, 4.1 ± 2.2 and 4.6 ± 2.3 symptoms were reported in boys and girls, respectively. In boys, symptom frequency was not associated with head impact location (p = 0.66); an association was found in girls (p = 0.02), with the highest symptom frequency reported in top-of-the-head impacts (5.4 ± 2.2). Head impact location was not associated with symptom resolution time (boys, p = 0.21; girls, p = 0.19) or return-to-play time (boys, p = 0.18; girls, p = 0.07). Heading was associated with 28.0% and 26.5% of concussions in boys and girls, respectively. Most player-player contact concussions during heading occurred from side-of-the-head impacts (boys, 49.4%; girls, 43.2%); most heading-related ball contact concussions occurred from front-of-the-head (boys, 41.4%; girls, 42.6%) and top-of-the-head (boys, 34.5%; girls, 36.9%) impacts. Head impact location was generally independent of symptom resolution time, return-to-play time, and recurrence among high school soccer concussions. However, impact location may be associated with reported symptom frequency. Further, many of these clinical concussion descriptors were associated with sex.

The design, development, implementation and evaluation of IRISweb; A rugby-specific web-based injury surveillance system

OBJECTIVES

To describe the development, implementation and evaluation of a comprehensive injury surveillance system.

DESIGN

The four phases; i) A survey of 58 medical professionals working in amateur rugby. ii) The design of a web-based injury surveillance system (IRISweb). iii) Recruitment of 21 of the top 58 amateur clubs to use IRISweb. iv) An evaluation survey of the 21 participating clubs.

SETTING

Irish amateur rugby clubs.

PARTICIPANTS

Medical professionals working in amateur rugby.

MAIN OUTCOME MEASURES

Phase one investigated the injury monitoring practices in operation prior to the IRIS project. Phase four investigated the effectiveness and usefulness of IRISweb.

RESULTS

Twenty-one clubs were recruited, however 2 clubs failed to provide a full season of data (10% dropout rate). Eighty-two percent of the remaining 19 clubs rated IRISweb as 'good' or 'very good'. Facilitators of injury surveillance were; increased player adherence (65%) and notifications to update the system (59%), however, poor player adherence (71%) and medical staff availability (24%) were the main barriers.

CONCLUSIONS

The IRIS project is the first prospective long-term injury surveillance system in Irish amateur rugby, effectively tracking injuries to guide future evidence-based injury prevention strategies. This study highlights facilitators and barriers to injury surveillance within amateur sport.

Incidence of Sport-Related Internal Organ Injuries Due to Direct-Contact Mechanisms Among High School and Collegiate Athletes Across 3 National Surveillance Systems

CONTEXT

Although sport-related internal organ injuries among athletes are relatively infrequent, combining data sources enables a more comprehensive examination of their incidence.

OBJECTIVE

To describe the incidence and characteristics of sport-related internal organ injuries due to direct-contact mechanisms among high school (HS) and collegiate athletes from 2005-2006 through 2014-2015.

DESIGN

Descriptive epidemiology study.

SETTING

United States HS and collegiate sports data from 3 national sports injury-surveillance systems: High School Reporting Information Online (HS RIO), the National Collegiate Athletic Association Injury Surveillance Program (ISP), and the National Center for Catastrophic Sport Injury Research.

PATIENTS OR OTHER PARTICIPANTS

High school and collegiate athletes in organized sports.

MAIN OUTCOME MEASURE(S)

Characteristics of the athlete, event, and injury were examined and stratified by data source and sport. Descriptive statistics of internal organ injuries via direct-contact mechanisms consisted of frequencies and incidence rates (IRs) per 1 000 000 athlete-exposures and 95% confidence intervals (CIs).

RESULTS

During the 10-year period, 174 internal organ injuries were captured: 124 in HS RIO and 41 in the ISP; 9 were catastrophic. Most noncatastrophic injuries occurred among males (RIO = 85%, ISP = 89%), in football (RIO = 65%, ISP = 58%), and during competitions (RIO = 67%, ISP = 49%) and were due to player-player contact (RIO = 78%, ISP = 68%). The highest injury rates were in male contact sports: RIO football (IR = 11.7; 95% CI = 9.1, 14.2) and lacrosse (IR = 10.0; 95% CI = 3.1, 16.9); ISP: football (IR = 8.3; 95% CI = 5.0, 11.6) and ice hockey (IR = 7.9; 95% CI = 1.0, 14.7). A quarter of noncatastrophic injuries were season ending (RIO = 25%, ISP = 23%). Of the 9 catastrophic injuries, most occurred in HS (7/9) and football (7/9) and were due to player-player contact (6/9). Four resulted in death.

CONCLUSIONS

Direct-contact internal organ injuries occur infrequently; yet when they do occur, they may result in severe outcomes. These findings suggest that early recognition and a better understanding of the activities associated with the event and use or nonuse of protective equipment are needed.

Estimating Concussion Incidence Using Sports Injury Surveillance Systems: Complexities and Potential Pitfalls

Numerous sports injury surveillance systems exist with the capability of tracking concussion incidence data. It is important for the consumers of sport-related concussion data, be they researchers or the public, to have a comprehensive understanding of the strengths and limitations of sports injury surveillance systems. This article discusses issues of system design and analysis that affect the interpretation and understanding of sport-related concussion incidence data from sports injury surveillance systems. Such understanding will help inform the design of sports injury surveillance systems and research studies that aim to identify risk factors, develop prevention strategies, and evaluate prevention mechanisms.

Injuries in girls' soccer and basketball: a comparison of high schools with and without athletic trainers

Background

Sports injuries impose physical and economic burdens on high school athletes, yet only 37% of high schools have access to a fulltime certified athletic trainer (AT). Although intuitively there are multiple benefits of AT coverage, research demonstrating the measurable effect of AT coverage on rates and patterns of injury is limited. Our objective was to investigate the epidemiology of girls’ basketball and soccer injuries in high schools with and without an AT.

Methods

We compared data captured by two similar sports injury surveillance systems during the 2006/07–2008/09 academic years. High School Reporting Information Online (RIO) included a national sample of schools with ATs, and the Sports Injury Surveillance System (SISS) included a sample of Chicago public high schools without ATs.

Results

Overall injury rates were higher in schools without ATs than schools with ATs in girls’ soccer (RR: 1.73, 95% CI: 1.51–2.00) and basketball (RR: 1.22, 95% CI: 1.03–1.45). Recurrent injury rates were even higher in schools without ATs compared to schools with ATs in soccer (RR: 6.00 95% CI: 4.54-7.91) and basketball (RR: 2.99, 95% CI: 2.12–4.14). Conversely, concussion rates were higher in schools with ATs than schools without ATs in soccer (RR: 8.05, 95% CI: 2.00–32.51) and basketball (RR: 4.50, 95% CI: 1.43–14.16). Other injury patterns were similar between the two samples.

Conclusions

This study demonstrated the effectiveness of AT coverage of high school girls’ soccer and basketball, both in reducing overall and recurrent injury rates and in identifying athletes with concussions. Future studies should evaluate the effect of ATs on other high school sports and on youth sports to determine if these findings are generalizable across sports and age groups.

Epidemiology of Quadriceps Strains in National Collegiate Athletic Association Athletes, 2009-2010 Through 2014-2015

CONTEXT

  Few researchers have examined the rates and patterns of quadriceps strains in student-athletes in the National Collegiate Athletic Association (NCAA).

OBJECTIVE

  To describe the epidemiology of quadriceps strains in 25 NCAA sports during the 2009-2010 through 2014-2015 academic years.

DESIGN

  Descriptive epidemiology study.

SETTING

  Convenience sample of NCAA programs from 25 sports during the 2009-2010 through 2014-2015 academic years. Patients or Other Particpants:  Collegiate student-athletes participating in men's and women's NCAA athletics during the 2009-2010 through 2014-2015 academic years.

MAIN OUTCOME MEASURE(S)

  Aggregate quadriceps strain injury and exposure data from the NCAA Injury Surveillance Program during the 2009-2010 through 2014-2015 academic years were analyzed. Quadriceps strain injury rates and injury rate ratios (IRRs) were reported with 95% confidence intervals (CIs).

RESULTS

  Overall, 517 quadriceps strains were reported, resulting in an injury rate of 1.07/10 000 athlete-exposures (AEs). The sports with the highest overall quadriceps strain rates were women's soccer (5.61/10 000 AEs), men's soccer (2.52/10 000 AEs), women's indoor track (2.24/10 000 AEs), and women's softball (2.15/10 000 AEs). Across sex-comparable sports, women had a higher rate of quadriceps strains than men overall (1.97 versus 0.65/10 000 AEs; IRR = 3.03; 95% CI = 2.45, 3.76). The majority of quadriceps strains were sustained during practice (77.8%). However, the quadriceps strain rate was higher during competition than during practice (1.29 versus 1.02/10 000 AEs; IRR = 1.27; 95% CI = 1.03, 1.56). Most quadriceps strains occurred in the preseason (57.8%), and rates were higher during the preseason compared with the regular season (2.29 versus 0.63/10 000 AEs; IRR = 3.60; 95% CI = 3.02, 4.30). Common injury mechanisms were noncontact (63.2%) and overuse (21.9%). Most quadriceps strains restricted participation by less than 1 week (79.3%).

CONCLUSIONS

  Across 25 sports, higher quadriceps strain rates were found in women versus men, in competitions versus practices, and in the preseason versus the regular season. Most quadriceps strains were minor in severity, although further surveillance is needed to better examine the risk factors associated with incidence and severity.

Descriptive Epidemiology of Non-Time-Loss Injuries in Collegiate and High School Student-Athletes

CONTEXT

  Research on non-time-loss (NTL) injuries, which result in less than 24 hours of restriction from participation, is limited.

OBJECTIVE

  To describe the epidemiology of NTL injuries among collegiate and high school student-athletes.

DESIGN

  Descriptive epidemiology study.

SETTING

  Aggregate injury and exposure data collected from a convenience sample of National College Athletic Association varsity teams and 147 high schools in 26 states.

PATIENTS OR OTHER PARTICIPANTS

  Collegiate and high school student-athletes participating in men's and boys' baseball, basketball, football, lacrosse, soccer, and wrestling and women's and girls' basketball, field hockey, lacrosse, soccer, softball, and volleyball during the 2009-2010 through 2013-2014 and the 2011-2012 through 2013-2014 academic years, respectively, participated. Collegiate student-athletes participating in men's and women's ice hockey were also included.

MAIN OUTCOME MEASURE(S)

  Injury data from the National Collegiate Athletic Association Injury Surveillance Program and the National Athletic Treatment, Injury and Outcomes Network were analyzed. Injury counts, rates per 1000 athlete-exposures (AEs), and rate ratios were reported with 95% confidence intervals (CIs).

RESULTS

  A total of 11 899 and 30 122 NTL injuries were reported in collegiate and high school student-athletes, respectively. The proportion of NTL injuries in high school student-athletes (80.3%) was 1.61 times greater than that of collegiate student-athletes (49.9%; 95% CI = 1.59, 1.63). The NTL injury rate in high school student-athletes (8.75/1000 athlete-exposures [AEs]) was 2.18 times greater than that of collegiate student-athletes (4.02/1000 AEs; 95% CI = 2.13, 2.22). Men's ice hockey (5.27/1000 AEs) and boys' football (11.94/1000 AEs) had the highest NTL injury rates among collegiate and high school athletes, respectively. Commonly injured body parts in collegiate and high school student-athletes were the hip/thigh/upper leg (17.5%) and hand/wrist (18.2%), respectively. At both levels, contusions, sprains, and strains were the most frequent diagnoses. Contact with another player was the most cited injury mechanism (college = 38.0%, high school = 46.3%).

CONCLUSIONS

  Non-time-loss injuries compose large proportions of collegiate and high school sports injuries. However, the NTL injury rate was higher in high school than in collegiate student-athletes. Tracking NTL injuries will help to better describe the breadth of injuries sustained by athletes and managed by athletic trainers.

Timing of Lower Extremity Injuries in Competition and Practice in High School Sports

Background:

Laboratory-based experiments demonstrate that fatigue may contribute to lower extremity injury (LEI). Few studies have examined the timing of LEIs during competition and practice, specifically in high school athletes across multiple sports, to consider the possible relationship between fatigue and LEIs during sport events.

Hypothesis:

The purpose of this study was to describe the timing of LEIs in high school athletes within games and practices across multiple sports, with a hypothesis that more and severe injuries occur later in games and practices.

Study Design:

Descriptive epidemiologic study.

Level of Evidence:

Level 4.

Methods:

Using the National High School RIO (Reporting Information Online) sport injury surveillance system, LEI severity and time of occurrence data during practice and competition were extracted for 9 high school sports.

Results:

During the school years 2005-2006 through 2013-2014, 16,967,702 athlete exposures and 19,676 total LEIs were examined. In all sports surveyed, there was a higher LEI rate, relative risk for LEI, and LEI requiring surgery during competition than practice. During practice, the majority of LEIs occurred over an hour into practice in all sports. In quarter-based competition, more LEIs occurred in the second (31% to 32%) and third quarters (30% to 35%) than in the first (11% to 15%) and fourth quarters (22% to 26%). In games with halves, the majority (53% to 66%) of LEIs occurred in the second half. The greater severity LEIs tended to occur earlier in games.

Conclusion:

Fatigue may play a role in the predominance of injuries in the second half of games, though various factors may be involved. Greater severity of injuries earlier in games may be because of higher energy injuries when athletes are not fatigued.

Clinical Relevance:

These findings can help prepare sports medicine personnel and guide further related research to prevent LEIs.

Sports Injury Surveillance Systems: A Review of Methods and Data Quality

BACKGROUND AND AIMS

Data from sports injury surveillance systems are a prerequisite to the development and evaluation of injury prevention strategies. This review aimed to identify ongoing sports injury surveillance systems and determine whether there are gaps in our understanding of injuries in certain sport settings. A secondary aim was to determine which of the included surveillance systems have evaluated the quality of their data, a key factor in determining their usefulness.

METHODS

A systematic search was carried out to identify (1) publications presenting methodological details of sports injury surveillance systems within clubs and organisations; and (2) publications describing quality evaluations and the quality of data from these systems. Data extracted included methodological details of the surveillance systems, methods used to evaluate data quality, and results of these evaluations.

RESULTS

Following literature search and review, a total of 15 sports injury surveillance systems were identified. Data relevant to each aim were summarised descriptively. Most systems were found to exist within professional and elite sports. Publications concerning data quality were identified for seven (47%) systems. Validation of system data through comparison with alternate sources has been undertaken for only four systems (27%).

CONCLUSIONS

This review identified a shortage of ongoing injury surveillance data from amateur and community sport settings and limited information about the quality of data in professional and elite settings. More surveillance systems are needed across a range of sport settings, as are standards for data quality reporting. These efforts will enable better monitoring of sports injury trends and the development of sports safety strategies.

Concussive Injuries in Rugby 7s: An American Experience and Current Review

PURPOSE

There is a comparative lack of concussion incidence data on the new Olympic sport Rugby 7s. This study aimed to determine the incidence (number of concussions per 1000 playing hours [ph]), mean and median severity (days absence), and cause of concussive injuries.

METHODS

This is a prospective epidemiology study, amateur to elite/national candidate, male (9768) and female (3876) players in USA Rugby sanctioned tournaments, compliant with the international consensus statement for studies in rugby union.

RESULTS

Concussions in US Rugby 7s were 7.7/1000 ph (n = 67). Women encountered concussions at 8.1/1000 ph, and men at 7.6/1000 ph (risk ratio [RR] = 1.10, P = 0.593). Elite/national-level players encountered concussions at higher rates (18.3/1000 ph) than lower levels (6.4/1000 ph; RR = 5.48, P < 0.001). Nonelite backs had higher concussive injury rates compared with forwards (7.7/1000 ph; 3.6/1000 ph; RR = 1.28, P = 0.024). Women missed 36.7 d absence from play, meanwhile men missed 27.9 d (P = 0.245). Retrospective history recall reflected previous concussive injuries occurred in 43% of the current study's cohort; of these, 57% encountered multiple concussions within 1 yr. The incidence of repetitive concussions was not statistically different between genders (RR = 1.09, P = 0.754). Most concussions occurred from tackles (63%) and collisions (24%) (P = 0.056).

CONCLUSIONS

Sports-related concussions occurred with frequency among US amateur Rugby 7s players. US Elite tournament players sustained concussions at much higher rates than international male Rugby 7s counterparts. A substantial portion of US players who sustained a concussion had previous concussion injuries. Given the high rate of concussion, including repetitive concussive injuries, US Rugby 7s may benefit from concussion prevention measures similar to other contact sports such as instruction on proper tackling techniques, in-game and postgame medical assessment, and a standardized return-to-play protocol.

Economic analysis of athletic team coverage by an orthopedic practice

OBJECTIVE

Coverage of high school football by orthopedic sports medicine specialists is considered standard of care in many localities. Determining the economic viability of this endeavor has never been investigated. The primary purpose of the present investigation was to perform an economic analysis of local high school sports coverage by an orthopedic sports medicine practice.

METHODS

From January 2010 to June 2012, a prospective injury report database was used to collect sports injuries from five high school athletic programs covered by a single, private orthopedic sports medicine practice. Patients referred for orthopedic care were then tracked to determine expected cost of care (potential revenue). Evaluation and management codes and current procedure terminology codes were obtained to determine the value of physician visits and surgical care rendered. Overhead costs were calculated based on historical rates within our practice and incorporated to determine estimated profit.

RESULTS

19,165 athletic trainer contacts with athletes playing all sports, including both those 'on-field' and in the training room, resulted in 473 (2.5%) physician referrals. The covering orthopedic practice handled 89 (27.9%) of the orthopedic referrals. Of orthopedic physician referrals, 26 (5.4%) required orthopedic surgical treatment. The covering team practice handled 17/26 (65%) surgical cases. The total revenue collected by the covering team practice was $26,226.14. The overhead cost of treatment was $9441.41. Overall estimated profit of orthopedic visits and treatment during this period for the covering practice was $16,784.73.

CONCLUSIONS

The covering team practice handled 28% of the orthopedic referrals, 65% of the surgical cases and captured 59% of the potential profit. An increase in physician referrals could increase the benefit for orthopedic surgeons.

Injury Rates in Age-Only Versus Age-and-Weight Playing Standard Conditions in American Youth Football

BACKGROUND

American youth football leagues are typically structured using either age-only (AO) or age-and-weight (AW) playing standard conditions. These playing standard conditions group players by age in the former condition and by a combination of age and weight in the latter condition. However, no study has systematically compared injury risk between these 2 playing standards.

PURPOSE

To compare injury rates between youth tackle football players in the AO and AW playing standard conditions.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

Athletic trainers evaluated and recorded injuries at each practice and game during the 2012 and 2013 football seasons. Players (age, 5-14 years) were drawn from 13 recreational leagues across 6 states. The sample included 4092 athlete-seasons (AW, 2065; AO, 2027) from 210 teams (AW, 106; O, 104). Injury rate ratios (RRs) with 95% CIs were used to compare the playing standard conditions. Multivariate Poisson regression was used to estimate RRs adjusted for residual effects of age and clustering by team and league. There were 4 endpoints of interest: (1) any injury, (2) non-time loss (NTL) injuries only, (3) time loss (TL) injuries only, and (4) concussions only.

RESULTS

Over 2 seasons, the cohort accumulated 1475 injuries and 142,536 athlete-exposures (AEs). The most common injuries were contusions (34.4%), ligament sprains (16.3%), concussions (9.6%), and muscle strains (7.8%). The overall injury rate for both playing standard conditions combined was 10.3 per 1000 AEs (95% CI, 9.8-10.9). The TL injury, NTL injury, and concussion rates in both playing standard conditions combined were 3.1, 7.2, and 1.0 per 1000 AEs, respectively. In multivariate Poisson regression models controlling for age, team, and league, no differences were found between playing standard conditions in the overall injury rate (RRoverall, 1.1; 95% CI, 0.4-2.6). Rates for the other 3 endpoints were also similar (RRNTL, 1.1 [95% CI, 0.4-3.0]; RRTL, 0.9 [95% CI, 0.4-1.9]; RRconcussion, 0.6 [95% CI, 0.3-1.4]).

CONCLUSION

For the injury endpoints examined in this study, the injury rates were similar in the AO and AW playing standards. Future research should examine other policies, rules, and behavioral factors that may affect injury risk within youth football.

Self-reported previous knee injury and low knee function increase knee injury risk in adolescent female football

Knee injuries are common in adolescent female football. Self-reported previous knee injury and low Knee injury and Osteoarthritis Outcome Score (KOOS) are proposed to predict future knee injuries, but evidence regarding this in adolescent female football is scarce. The aim of this study was to investigate self-reported previous knee injury and low KOOS subscale score as risk factors for future knee injuries in adolescent female football. A sample of 326 adolescent female football players, aged 15-18, without knee injury at baseline, were included. Data on self-reported previous knee injury and KOOS questionnaires were collected at baseline. Time-loss knee injuries and football exposures were reported weekly by answers to standardized text-message questions, followed by injury telephone interviews. A priori, self-reported previous knee injury and low KOOS subscale scores (< 80 points) were chosen as independent variables in the risk factor analyses. The study showed that self-reported previous knee injury significantly increased the risk of time-loss knee injury [relative risk (RR): 3.65, 95% confidence (CI) 1.73-7.68; P < 0.001]. Risk of time-loss knee injury was also significantly increased in players with low KOOS subscale scores (< 80 points) in Activities of Daily Living (RR: 5.0), Sport/Recreational (RR: 2.2) and Quality of Life (RR: 3.0) (P < 0.05). In conclusion, self-reported previous knee injury and low scores in three KOOS subscales significantly increase the risk of future time-loss knee injury in adolescent female football.

The National Athletic Treatment, Injury and Outcomes Network (NATION): Methods of the Surveillance Program, 2011-2012 Through 2013-2014

CONTEXT

Previous epidemiologic researchers have examined time-loss (TL) injuries in high school student-athletes, but little is known about the frequency of non-time-loss (NTL) injuries in these athletes.

OBJECTIVE

To describe the methods of the National Athletic Treatment, Injury and Outcomes Network (NATION) Surveillance Program and provide descriptive epidemiology of TL and NTL injuries across athletes in 27 high school sports.

DESIGN

Descriptive epidemiology study.

SETTING

Aggregate injury and exposure data collected from 147 high schools in 26 states.

PATIENTS OR OTHER PARTICIPANTS

High school student-athletes participating in 13 boys' sports and 14 girls' sports during the 2011-2012 through 2013-2014 academic years.

MAIN OUTCOME MEASURE(S)

Athletic trainers documented injuries and exposures using commercially available injury-tracking software packages. Standard injury-tracking software was modified by the software vendors to conform to the surveillance needs of this project. The modified software exported a set of common data elements, stripped of personally identifiable information, to a centralized automated verification and validation system before they were included in the centralized research database. Dependent measures were injury and exposure frequencies and injury rates with 95% confidence intervals stratified by sport, sex, and injury type (TL or NTL).

RESULTS

Over the 3-year period, a total of 2337 team seasons across 27 sports resulted in 47 014 injuries and 5 146 355 athlete-exposures. The NTL injuries accounted for 38 765 (82.45%) and TL injuries for 8249 (17.55%) of the total.

CONCLUSIONS

The NTL injuries accounted for a substantial amount of the total number of injuries sustained by high school student-athletes. This project demonstrates the feasibility of creating large-scale injury surveillance systems using commercially available injury-tracking software.

Injury and illness epidemiology at a summer sport-camp program, 2008 through 2011

CONTEXT

University-sponsored summer sport camps often employ athletic trainers; however, there is a dearth of epidemiologic studies describing the injury and illness experience of sport-camp participants to guide clinicians.

OBJECTIVE

To describe the injury and illness experience of youth participants at a university-sponsored summer sport-camp program during a 4-year period.

DESIGN

Descriptive epidemiology study.

SETTING

A National Collegiate Athletic Association Division I university that sponsored 76 to 81 camps for 28 sports each summer.

PATIENTS OR OTHER PARTICIPANTS

A total of 44, 499 camp participants enrolled during the 4 years. Male and female participants ranged in age from 10 to 17 years and in athletic skill from novice to elite.

MAIN OUTCOME MEASURE(S)

Data from handwritten injury and illness log books, maintained by sports health care personnel, were accessed retrospectively, entered into an electronic spreadsheet, and coded. Data were applied to the National Athletic Injury/Illness Reporting System. Participant-personnel contacts, defined as any instance when a participant sought health care services from personnel, were calculated per 100 participants. Injury and illness rates were calculated per 10 ,000 exposures, measured in participant-days. The distribution of injury and illness conditions and affected body regions were calculated.

RESULTS

There were 11 ,735 contacts, for an overall rate of 26 per 100 participants, and 4949 injuries and illnesses, for a rate of 1 per 10, 000 participant-days. Participants at single-sex camps were less likely to sustain injuries and illnesses than participants at coeducational camps (rate ratio [RR] = 0.49; 95% confidence interval = 0.45, 0. 35; P < .001, and RR = 0.47; 95% confidence interval = 0.43, 0.51; P < .001, respectively). The lower extremity was injured most frequently (27.9%). Most injury and illness conditions were dermatologic (37.1%).

CONCLUSIONS

The contact and injury and illness differences observed among sports and between sexes demonstrated potential differences in the sports health care needs of camp participants. These data can be used to make evidence-based clinical decisions, such as determining injury-prevention strategies and sports health care staffing needs.

High injury incidence in adolescent female soccer

BACKGROUND

Previous studies report varying rates of time-loss injuries in adolescent female soccer, ranging from 2.4 to 5.3 per 1000 athlete-exposures or 2.5 to 3.7 per 1000 hours of exposure. However, these studies collected data using traditional injury reports from coaches or medical staff, with methods that significantly underestimate injury rates compared with players' self-reports.

PURPOSE

The primary aim was to investigate the injury incidence in adolescent female soccer using self-reports via mobile telephone text messaging. The secondary aim was to explore the association between soccer exposure, playing level, and injury risk.

STUDY DESIGN

Descriptive epidemiology study and cohort study; Level of evidence, 2 and 3.

METHODS

During a full adolescent female soccer season in Denmark (February-June 2012), a population-based sample of 498 girls aged 15 to 18 years was included in the prospective registration of injuries. All players were enrolled on a team participating in Danish Football Association series. Soccer injuries and exposure were reported weekly by answers to standardized text message questions, followed by individual injury interviews. Soccer exposure and playing levels were chosen a priori as the only independent variables of interest in the risk factor analyses. Injury rates and relative risks were estimated using Poisson regression. Generalized estimation equations were used to take into account that players were clustered within teams.

RESULTS

There were 498 players who sustained a total of 424 soccer injuries. The incidence of injuries was 15.3 (95% CI, 13.1-17.8), the incidence of time-loss injuries was 9.7 (95% CI, 8.2-11.4), and the incidence of severe injuries was 1.1 (95% CI, 0.7-1.6) per 1000 hours of soccer exposure. Higher average exposure in injury-free weeks was associated with a lower injury risk (P value for trend <.001), and players with low exposure (≤1 h/wk) were 3 to 10 times more likely to sustain a time-loss injury compared with other players (P < .01). Playing level was not associated with the risk of time-loss injuries (P = .18).

CONCLUSION

The injury incidence in adolescent female soccer is high, and this includes many severe injuries. Players with low soccer participation (≤1 h/wk) have a significantly higher injury risk compared with players participating more frequently.

Impact locations and concussion outcomes in high school football player-to-player collisions

BACKGROUND

Little research has examined concussion outcomes in terms of impact location (ie, the area on the head in which the impact occurred). This study describes the epidemiology of concussions resulting from player-to-player collision in high school football by impact location.

METHODS

National High School Sports-Related Injury Surveillance Study data (2008/2009-2012/2013) were analyzed to calculate rates and describe circumstances of football concussion (eg, symptomology, symptom resolution time, return to play) resulting from player-to-player collisions by impact location (ie, front-, back-, side-, and top-of-the-head).

RESULTS

Most concussions resulting from player-to-player collisions occurred from front-of-the-head (44.7%) and side-of-the-head (22.3%) impacts. Number of symptoms reported, prevalence of reported symptoms, symptom resolution time, and length of time to return to play were not associated with impact location. However, a larger proportion of football players sustaining concussions from top-of-the-head impacts experienced loss of consciousness (8.0%) than those sustaining concussions from impacts to other areas of the head (3.5%) (injury proportion ratio 2.3; 95% confidence interval 1.2-4.2; P = .008). Players had their head down at the time of impact in a higher proportion of concussions caused by top-of-the-head impacts (86.4%) than concussions from impacts to other areas of the head (24.0%) (injury proportion ratio 3.6; 95% confidence interval 3.2-4.0; P < .001).

CONCLUSIONS

Among high school football players who sustained concussions due to player-to-player collisions, concussion outcomes were generally independent of impact location. Recommended strategies for reducing the proportion of top-of-the-head impacts include improved education regarding tackling with proper "head-up" technique.

Syndesmosis and lateral ankle sprains in the National Football League

Syndesmosis sprains in the National Football League (NFL) can be a persistent source of disability, especially compared with lateral ankle injuries. This study evaluated syndesmosis and lateral ankle sprains in NFL players to allow for better identification and management of these injuries. Syndesmosis and lateral ankle sprains from a single NFL team database were reviewed over a 15-year period, and 32 NFL team physicians completed a questionnaire detailing their management approach. A comparative analysis was performed analyzing several variables, including diagnosis, treatment methods, and time lost from sports participation. Thirty-six syndesmosis and 53 lateral ankle sprains occurred in the cohort of NFL players. The injury mechanism typically resulted from direct impact in the syndesmosis and torsion in the lateral ankle sprain group (P=.034). All players were managed nonoperatively. The mean time lost from participation was 15.4 days in the syndesmosis and 6.5 days in the lateral ankle sprain groups (P⩽.001). National Football League team physicians varied treatment for syndesmosis sprains depending on the category of diastasis but recommended nonoperative management for lateral ankle sprains. Syndesmosis sprains in the NFL can be a source of significant disability compared with lateral ankle sprains. Successful return to play with nonoperative management is frequently achieved for syndesmosis and lateral ankle sprains depending on injury severity. With modern treatment algorithms for syndesmosis sprains, more aggressive nonoperative treatment is advocated. Although the current study shows that syndesmosis injuries require longer rehabilitation periods when compared with lateral ankle sprains, the time lost from participation may not be as prolonged as previously reported.

A multisport epidemiologic comparison of anterior cruciate ligament injuries in high school athletics

BACKGROUND

The knee joint is the second most commonly injured body site after the ankle and the leading cause of sport-related surgeries. Knee injuries, especially of the anterior cruciate ligament (ACL), are among the most economically costly sport injuries, frequently requiring expensive surgery and rehabilitation.

OBJECTIVE

To investigate the epidemiology of ACL injuries among high school athletes by sport and sex.

DESIGN

Descriptive epidemiology study.

MAIN OUTCOME MEASURE(S)

Using an Internet-based data-collection tool, Reporting Information Online (RIO), certified athletic trainers from 100 nationally representative US high schools reported athlete-exposure and injury data for athletes from 9 sports during the 2007/08-2011/12 academic years. The outcome of interest in this study was ACL injuries.

RESULTS

During the study period, 617 ACL injuries were reported during 9 452 180 athlete exposures (AEs), for an injury rate of 6.5 per 100 000 AEs. Nationally, in the 9 sports studied, an estimated 215 628 ACL injuries occurred during the study period. The injury rate was higher in competition (17.6) than practice (2.4; rate ratio [RR] = 7.3, 95% confidence interval [CI] = 6.08, 8.68). Girls' soccer had the highest injury rate (12.2) followed by boys' football (11.1), with boys' basketball (2.3) and boys' baseball (0.7) having the lowest rates. In sex-comparable sports, girls had a higher rate (8.9) than boys (2.6; RR = 3.4, 95% CI = 2.64, 4.47). Overall, 76.6% of ACL injuries resulted in surgery. The most common mechanisms of injury were player-to-player contact (42.8%) and no contact (37.9%).

CONCLUSIONS

Anterior cruciate ligament injury rates vary by sport, sex, and type of exposure. Recognizing such differences is important when evaluating the effectiveness of evidence-based, targeted prevention efforts.

Injury/illness physician referral profile from a youth university-sponsored summer sport camp program

Participation at university-sponsored summer sport camps is popular among youth athletes; however, there is a dearth of information to describe the injuries/illnesses experienced by camp participants. Data from a university-sponsored sport camp program from 2008 to 2011 were accessed retrospectively. The sport camp program had approximately 80 camps for 28 sports over 12 weeks annually. Male and female participants were 10 to 17 years old. Athletic trainers maintained medical documentation and provided medical referrals. Referrals were made for 9.9% (n=478) of all injuries/illnesses. Emergency department referrals were made for 2.9% of injuries/illnesses. University health services received 42.5% of referrals. There were 1.1 referrals per 100 participants. Boys comprised 60.7% of referrals. Rugby had the highest referral rate--5.0 per 100 participants. These data help increase physician preparedness and guide the delivery of sports medicine services for related sport camp programs as a means to improve quality of care delivered to participants.

Pediatric sports injuries: an age comparison of children versus adolescents

BACKGROUND

Significant knowledge deficits exist regarding sports injuries in the young child. Children continue to engage in physically demanding, organized sports to a greater extent despite the lack of physical readiness, predisposing themselves to injury.

PURPOSE

To evaluate sports injuries sustained in very young children (5-12 years) versus their older counterparts (13-17 years) with regard to the type and location of injuries, severity, and diagnosis.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

A retrospective chart review was performed on a 5% random probability sample (final N = 2133) of 5- to 17-year-old patients treated for sports injuries in the Division of Sports Medicine at a large, academic pediatric medical center between 2000 and 2009. Using descriptive statistics, correlates of injuries by age group, injury type, and body area are shown.

RESULTS

Five- to 12-year-old patients differed in key ways from older patients. Children in this category sustained injuries that were more often traumatic in nature and more commonly of the upper extremity. Older patients (13-17 years) were more likely to be treated for injuries to the chest, hip/pelvis, and spine. A greater proportion of the older children were treated for overuse injuries, as compared with their younger counterparts (54.4% vs. 49.2%, respectively), and a much larger proportion of these injuries were classified as soft tissue injuries as opposed to bony injuries (37.9% vs. 26.1%, respectively). Injury diagnosis differed between the 2 age groups. The 13- to 17-year age group sustained more anterior cruciate ligament injuries, meniscal tears, and spondylolysis, while younger children were diagnosed with fractures, including physeal fractures, apophysitis, and osteochondritis dissecans. The 5- to 12-year-old patients treated for spine injuries were disproportionately female (75.8%); most of these injuries were overuse (78.8%) and bony (60.6%); over one third of the youngest children were diagnosed with spondylolysis. Surgery was required in 40% of the injuries in the full sample.

CONCLUSION

Sports injuries to children differ by age in injury diagnosis, type, and body area. Older children sustain a greater proportion of overuse injuries classified as soft tissue in nature. Children of all ages are sustaining significant sports injuries that require surgical intervention.

Caracterização de lesões desportivas no basquetebol

INTRODUÇÃO: O basquete apresenta altos índices de lesão. Na literatura ainda não se definiu existem ou não diferenças entre os sexos. OBJETIVO: Caracterizar e analisar a incidência de lesões desportivas em atletas de basquetebol, com comparação entre os sexos. MATERIAIS E MÉTODOS: Quinze atletas de cada sexo, da categoria sub-23, foram entrevistados com o inquérito de morbidade referida. RESULTADOS: A média de idade das equipes feminina e masculina foi de 18 ± 0,65 e 18,20 ± 1,57 anos, respectivamente. A equipe masculina apresentou mais lesões que a feminina (2,6 ± 1,45 contra 1,2 ± 1,18 respectivamente, p < 0,05). A lesão articular foi o tipo de lesão mais comum na equipe masculina, representando 58,97%, e o segundo mais comum na feminina (33,33%). Os membros inferiores foram a região mais acometida por lesões (80,95% na feminina e 69,23% na masculina). O mecanismo de lesão mais comum na equipe masculina foi a aterrissagem (43,59%) e na feminina o salto vertical (28,57%). Em ambas as equipes, a maior parte das lesões ocorreu durante os treinos (61,9% na feminina e 71,8% na masculina). Foi necessário o afastamento em 47,62% (feminina) e 56,41% (masculina). A maioria dos atletas não realizou tratamento (61,9% e 51,28% feminino e masculino, respectivamente). O retorno às atividades, na maioria das vezes, foi sintomático, tanto na equipe feminina quanto na masculina (85,71% e 84,62% respectivamente). CONCLUSÃO: A incidência de lesões no basquetebol é maior nos membros inferiores. A equipe masculina mostra-se mais propensa a sofrer lesões, e os principais mecanismos de lesão foram diferentes entre as equipes masculina e feminina.

Baseball and softball sliding injuries: incidence and correlates during one high school league varsity season

OBJECTIVE

To estimate injury rates associated with sliding in high school baseball and softball.

DESIGN

Prospective cohort study.

SETTING

Community high school athletic events.

PARTICIPANTS

Ten high school varsity baseball and softball teams over 1 season.

ASSESSMENT OF RISK FACTORS

All sliding attempts were recorded during each game and recorded as headfirst, feetfirst, or diveback. Base type, playing surface, and field conditions were also noted.

MAIN OUTCOME MEASURES

Injury exposure rates by game exposures and sliding/diveback exposures.

RESULTS

Data were collected from 153 baseball games and 166 softball games. A greater proportion of slides were associated with injury in softball than in baseball (42.0 and 4.9 per 1000 slides; P < 0.05). Headfirst slides led to more injuries than feetfirst slides in baseball (16.8 vs 0 per 1000 slides; P < 0.05) but not in softball (55 vs 35 per 1000 slides; P = 0.74).

CONCLUSIONS

More powerful studies are required to determine whether efforts to prevent baseball sliding injuries at the high school level should focus on better education in sliding technique or changes in equipment. Softball players are vulnerable to injury when wearing inadequate protective sliding apparel.

Trends in concussion incidence in high school sports: a prospective 11-year study

BACKGROUND

Understanding the risk and trends of sports-related concussion among 12 scholastic sports may contribute to concussion detection, treatment, and prevention.

PURPOSE

To examine the incidence and relative risk of concussion in 12 high school boys' and girls' sports between academic years 1997-1998 and 2007-2008.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

Data were prospectively gathered for 25 schools in a large public high school system. All schools used an electronic medical record-keeping program. A certified athletic trainer was on-site for games and practices and electronically recorded all injuries daily.

RESULTS

In sum, 2651 concussions were observed in 10 926 892 athlete-exposures, with an incidence rate of 0.24 per 1000. Boys' sports accounted for 53% of athlete-exposures and 75% of all concussions. Football accounted for more than half of all concussions, and it had the highest incidence rate (0.60). Girls' soccer had the most concussions among the girls' sports and the second-highest incidence rate of all 12 sports (0.35). Concussion rate increased 4.2-fold (95% confidence interval, 3.4-5.2) over the 11 years (15.5% annual increase). In similar boys' and girls' sports (baseball/softball, basketball, and soccer), girls had roughly twice the concussion risk of boys. Concussion rate increased over time in all 12 sports.

CONCLUSION

Although the collision sports of football and boys' lacrosse had the highest number of concussions and football the highest concussion rate, concussion occurred in all other sports and was observed in girls' sports at rates similar to or higher than those of boys' sports. The increase over time in all sports may reflect actual increased occurrence or greater coding sensitivity with widely disseminated guidance on concussion detection and treatment. The high-participation collision sports of football and boys' lacrosse warrant continued vigilance, but the findings suggest that focus on concussion detection, treatment, and prevention should not be limited to those sports traditionally associated with concussion risk.

Level of agreement between field-based data collectors in a large scale injury prevention randomised controlled trial

In sports injury prevention field trials, data collectors are often club volunteers with considerable knowledge of the game but with limited detailed medical backgrounds or knowledge of formal scientific processes. The aim of this paper is to determine the agreement among trained primary data collectors (PDCs) with a sport science background and no prior involvement in data collection in a large randomised controlled trial. During the 'Preventing Australian Football Injury through eXercise' (PAFIX) project, player participation and injury data were collected by trained PDCs at training and games over the 2007 and 2008 playing seasons in 40 community level Australian football teams. PDC-collected data relating to player exposure and whether or not a player sustained an injury and subsequently left the field of play was compared to the same information from independent observers (IOs) who attended one randomly selected game for each of the 40 teams. There was 98% agreement between the PDC and the IO on game details (i.e., date, time, grade and score), 79% (ICC 0.9, 95% CI 0.85-0.95) agreement on the number of players per game and 76% (ICC 0.8, 95% CI 0.69-0.91) agreement on the number of injuries sustained in the games. There was 100% agreement on whether the player left the field for all injuries. This study found that exercise and sport science students are reliable data collectors in sports injury fieldwork studies.