Epidemiology of Concussions in National Collegiate Athletic Association (NCAA) Sports: 2014/15-2018/19

BACKGROUND

Updated epidemiology studies examining sports-related concussions (SRCs) are critical in evaluating recent efforts aimed at reducing the incidence of SRCs in National Collegiate Athletic Association (NCAA) sports.

PURPOSE

To describe the epidemiology of SRCs in 23 NCAA sports during the 2014/15-2018/19 academic years.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

SRC and exposure data collected in the NCAA Injury Surveillance Program were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics by sport, event type (practices, competitions), injury mechanism (player contact, surface contact, equipment/apparatus contact), and injury history (new, recurrent). 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 3497 SRCs from 8,474,400 athlete-exposures (AEs) were reported during the study period (4.13 per 10,000 AEs); the competition-related SRC rate was higher than was the practice-related SRC rate (IRR, 4.12; 95% CI, 3.86-4.41). The highest SRC rates were observed in men's ice hockey (7.35 per 10,000 AEs) and women's soccer (7.15 per 10,000 AEs); rates in women's soccer and volleyball increased during 2015/16-2018/19. Player contact was the most prevalently reported mechanism in men's sports (77.0%), whereas equipment/apparatus contact was the most prevalently reported mechanism in women's sports (39.2%). Sex-related differences were observed in soccer, basketball, softball/baseball, and swimming and diving. Most SRCs reported in men's sports (84.3%) and women's sports (81.1%) were reported as new injuries.

CONCLUSION

Given the increasing SRC rates observed in women's soccer and volleyball during the latter years of the study, these results indicate the need to direct further attention toward trajectories of SRC incidence in these sports. The prevalence of equipment/apparatus contact SRCs in women's sports also suggests that SRC mechanisms in women's sports warrant further investigation. As most SRCs during the study period were reported as new injuries, the prevalence of recurrent SRCs in men's and women's ice hockey is also noteworthy.

Epidemiology of overuse injuries in U.S. secondary school athletics from 2014-2015 to 2018-2019 using the National Athletic Treatment, Injury and Outcomes Network Surveillance Program

CONTEXT

With 8 million annual participants in the United States, the epidemiology of sports-related injuries in high school athletics has garnered significant interest. The most recent studies examining overuse injury rates in high school sports reported data from 2012-2013 and therefore may not reflect current overuse injury rates in high school sports.

OBJECTIVE

To 1) to determine overuse time-loss (TL) and non-time-loss (NTL) injury rates among high school student athletes using NATION-SP data collected from 2014-2015 to 2018-2019 and 2) compare overuse injury rates based on student-athlete gender defined by sport, sport, and injury location.

DESIGN

Descriptive epidemiology study.

SETTING

Online injury surveillance from 211 high schools (345 individual years of high school data).

PATIENTS OR OTHER PARTICIPANTS

Athletes participating in secondary school-sponsored boys' and girls' sports.

MAIN OUTCOME MEASURES

Boys' and girls' overuse injury data from the National Athletic Treatment, Injury and Outcomes Network Surveillance Program (NATION-SP) from the 2014-2015 to 2018-2019 school years were analyzed. Overuse injuries were identified using a combination of reported injury mechanism and diagnosis. TL injuries resulted in restriction from participation beyond the day of injury; a NTL injury did not result in restriction from participation beyond the day of injury or lost no time due to the injury. Injury counts, rates, and rate ratios (IRRs) were reported with 95% confidence intervals (CIs).

RESULTS

The overall overuse injury rate was 5.3/10,000 AEs (95%CI=5.1, 5.7), the NTL overuse injury rate was 3.4/10,000 AEs (95%CI=3.1, 3.6), and the TL overuse injury rate was 2.0/10,000 AEs (95%CI=1.8, 2.2). The overuse injury rate was greater in girls' sports compared to boys' sports (IRR=1.9; 95%CI=1.7, 2.1). The highest rates of overuse injury were reported in girls' cross-country (19.2/10,000 AEs; 95%CI=15.0, 24.2), girls' track and field (16.0/10,000 AEs; 95%CI=13.5, 18.8), and girls' field hockey (15.1/10,000 AEs; 95%CI=10.2, 21.6). Overuse injury rates were highest for the lower extremity compared to the upper extremity (IRR=5.7; 95%CI=4.9, 6.7) and for the lower extremity compared to the trunk and spine (IRR=8.9; 95%CI=7.3, 10.8).

CONCLUSIONS

Awareness of overuse injury risk as well as prevention and intervention recommendations are necessary and should be specifically targeted towards cross-country, field hockey, and track and field athletes.

Secondary School Socioeconomic Status and Athletic Training Practice Characteristics

CONTEXT

Socioeconomic status (SES) is a significant predictor of morbidity and mortality across health outcomes. Limited information exists on how school SES impacts athletic training practice when a certified athletic trainer (AT) is present at secondary schools.

OBJECTIVE

To describe contact frequencies and service rates provided by ATs for injuries among secondary school student athletes and how these differ by school SES.

DESIGN

Cross-sectional study Setting: Athletic training room (ATR) visit days and AT services were collected from 77 secondary schools. Schools were separated into three school SES groups: affluent (n=31), average (n=29), and disadvantaged (n=17).

PATIENTS OR OTHER PARTICIPANTS

Secondary school student-athletes participating in 12 boys' and 11 girls' sports who visited the ATR during the 2014-2015 through 2018-2019 academic years and received athletic or non-athletic injury care.

MAIN OUTCOME MEASURES

Contact frequencies expressed as ATR visit days per injury, AT services per injury, and AT services per ATR visit day. Rates for service type utilized were expressed as the total count over reported athlete-exposures.

RESULTS

ATs documented 1,191 services. Affluent and average SES school communities provided greater contact frequencies for injury related care compared to disadvantaged school communities, particularly by AT services/injury (7.10±13.08 versus average: 9.30±11.60 and affluent: 9.40±12.20; p=0.020). Affluent school communities provided greater rates of services in five of the eleven service groups reported. No significant differences were observed among school SES groups in therapeutic exercises.

CONCLUSIONS

Our findings reflect that AT practice characteristics may differ by school SES, but these differences do not appear to result in less medical care. Given the complexity and widespread effects of SES, future investigations should utilize a complex method to determine SES as well as aim to identify how SES may impact secondary school student athletes outside of AT practice characteristics.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Gymnastics: 2014-2015 Through 2018-2019

CONTEXT

Women's gymnastics athletes in the National Collegiate Athletic Association (NCAA) constitute a unique population of NCAA athletes given the nature and dynamics of the sport.

BACKGROUND

Routine examination of women's gymnastics injuries is important for identifying the evolving burden of injuries in this sport.

METHODS

Exposure and injury data collected in the NCAA Injury Surveillance Program during 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics; injury rate ratios were used to examine differential injury rates.

RESULTS

The overall injury rate was 8.00 per 1000 athlete-exposures; injury incidence was greater in competitions than in practices (injury rate ratio = 1.84; 95% CI = 1.48, 2.29), though practice injury rates increased during 2015-2016 through 2018-2019. Most injuries were classified as strains (16.5%), sprains (16.4%), and inflammatory conditions (12.3%), with overuse injuries prevalent among practice injuries (22.5%). Concussions (8.4%) were the most commonly reported specific injury.

SUMMARY

The increasing trend in practice injury incidence is noteworthy although competition injury rates were higher overall. Findings also suggest that the etiologies of overuse injuries and inflammatory conditions as well as the biomechanical aspects of concussions warrant further attention.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Softball: 2014-2015 Through 2018-2019

CONTEXT

Women's softball athletes account for approximately 9% of all female athletes competing within the National Collegiate Athletic Association (NCAA).

BACKGROUND

Routine surveillance of NCAA women's softball injuries is important for identifying the emerging injury patterns in this sport.

METHODS

Exposure and injury data collected during competitive seasons in the NCAA Injury Surveillance Program during 2014-2015 through 2018-2019 (5 years) academic years were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics; injury rate ratios (IRRs) were used to examine differential injury rates.

RESULTS

The overall injury rate was 3.92 per 1000 athlete exposures. Practice and preseason injury rates increased during 2015/16 through 2018/19. Most injuries were shoulder (15.2%), hand/wrist (11.8%), knee (11.2%), and head/face injuries (11.2%) and were classified as contusions (14.2%), sprains (14.1%), and inflammatory conditions (14.1%). Concussion (6.8%) was the most commonly reported injury, and concussion incidence fluctuated during 2014-2015 through 2018-2019.

SUMMARY

Results indicate an increasing trend in practice and preseason injury incidence. Findings also suggest that workload accumulation in the shoulder and the mechanisms of concussion warrant further attention in this population.

Epidemiology of Injuries in National Collegiate Athletic Association Men's Ice Hockey: 2014-2015 Through 2018-2019

CONTEXT

The National Collegiate Athletic Association has supported men's ice hockey, a distinct sport that mandates high-velocity gamesmanship, since 1974.

BACKGROUND

Injury surveillance systems are designed to identify evolving injury trends and their temporal qualities. Continual monitoring of collegiate men's ice hockey athletes remains essential.

METHODS

Exposure and injury data collected in the National Collegiate Athletic Association Injury Surveillance Program from 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios (IRR) were used to examine differential injury rates.

RESULTS

The overall injury rate was 7.65 per 1000 athlete-exposures. Injuries from competition occurred at a rate nearly 7 times that from practice injuries (IRR = 6.54, 95% CI = 6.08, 7.04). The most common specific injury diagnoses were concussions (9.6%), acromioclavicular sprains (7.3%), and medial collateral ligament tears (3.7%).

SUMMARY

Injury rates by event type and season segment were higher than previously reported. Contusions accounted for nearly a quarter of all injuries, and acromioclavicular sprain rates increased notably across the study period.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Ice Hockey: 2014-2015 Through 2018-2019

CONTEXT

The National Collegiate Athletic Association (NCAA) has sponsored women's ice hockey championships since 2001, and sponsorship has grown over time.

BACKGROUND

Routine examinations of injuries sustained by athletes are important for identifying and understanding patterns that can be used to inform sport safety practices.

METHODS

Exposure and injury data collected in the NCAA Injury Surveillance Program from 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates.

RESULTS

The overall injury rate was 5.89 per 1000 athlete-exposures; preseason injury incidence rose sharply during 2016-2017 through 2018-2019. Head/face injuries (15.2%), knee injuries (13.2%), and shoulder injuries (12.9%) were the most commonly injured body parts, and injuries were most often classified as contusions (18.9%), strains (18.7%), and sprains (15.5%). Concussion (11.9%) was the most commonly reported specific injury, and concussion rates notably increased during 2017-2018 through 2018-2019.

SUMMARY

Study findings were generally consistent with the existing epidemiological evidence. Injury incidence in preseason and the etiology of strains warrant further attention in this population.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Swimming and Diving: 2014-2015 Through 2018-2019

CONTEXT

The number of women's swimming and diving teams sponsored by the National Collegiate Athletic Association has increased over the last 5 years.

BACKGROUND

Routine examinations of women's swimming and diving injuries are important for identifying emerging temporal patterns.

METHODS

Exposure and injury data collected in the National Collegiate Athletic Association Injury Surveillance Program during the 2014-2015 through 2018-2019 athletic seasons were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differences in injury rates.

RESULTS

The overall injury rate was 1.78 per 1000 athlete-exposures in swimmers and 2.49 per 1000 AEs in divers. Shoulder (33.0%) injuries accounted for the largest proportion of all swimming injuries; most injuries were classified as overuse (51.3%). Head or face (29.4%) and trunk (20.2%) injuries accounted for the largest proportions of all diving injuries.

SUMMARY

Findings indicated that shoulder and trunk injuries, as well as injuries resulting from overuse mechanisms, warrant further attention in swimming. Given the low in the National Collegiate Athletic Association Injury Surveillance Program observed across the study period, the need for greater participation in sports injury surveillance is also apparent.

Epidemiology of Injuries in National Collegiate Athletic Association Men's Basketball: 2014-2015 Through 2018-2019

CONTEXT

Basketball has remained a popular sport for players and spectators in the United States since before the first National Collegiate Athletic Association men's championship tournament in 1939.

BACKGROUND

Routine examinations of men's basketball injuries are important for identifying emerging temporal patterns.

METHODS

Exposure and injury data collected in the National Collegiate Athletic Association Injury Surveillance Program during 2014-2015 through 2018-2019 athletic seasons were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differences in injury rates.

RESULTS

The overall injury rate was 7.28 per 1000 athlete exposures, with competition rates twice those of practices (injury rate ratio = 2.07; 95% CI = 1.93, 2.22). Injuries to the ankle (22.2%), knee (13.0%), head/face (11.3%), and hand/wrist (10.1%) accounted for most reported injuries, with sprains (30.4%), contusions (14.3%), and strains (13.9%) most commonly reported. Ankle sprain rates initially trended upward and decreased between 2017-2018 and 2018-2019; concussion rates remained relatively stable during 2014-2015 through 2018-2019.

CONCLUSIONS

Findings suggest that common injury rates are trending downward relative to previous study findings.

Epidemiology of Injuries in National Collegiate Athletic Association Men's Tennis: 2014-2015 Through 2018-2019

CONTEXT

The National Collegiate Athletic Association (NCAA) has sponsored men's tennis programs since 1982. The popularity of tennis has grown, as has sponsorship of men's tennis within NCAA institutions.

BACKGROUND

Continued monitoring of athletic injuries is important for identifying emerging temporal patterns.

METHODS

Exposure and injury data collected in the NCAA Injury Surveillance Program during 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates.

RESULTS

The overall injury rate was 4.41 per 1000 athlete-exposures. Lateral ligament complex tears of the ankle (8.5%) were the most reported injury. Trunk (15.1%) and shoulder (13.2%) injuries accounted for the largest proportions of all injuries. Noncontact and overuse were the most common mechanisms of injury among all reported injuries, together accounting for 69.4% of all injuries.

CONCLUSIONS

Findings of this study differed slightly from previous studies, most notably in specific injuries reported. Continued monitoring of specific injury incidence as well as greater participation in injury surveillance is needed to inform the development of nuanced injury prevention strategies for this population.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Field Hockey: 2014-2015 Through 2018-2019

CONTEXT

The National Collegiate Athletic Association has sponsored women's field hockey since 1981, and team membership as well as student-athlete participation has grown over time.

BACKGROUND

Routine examinations of injuries sustained by athletes are important for identifying and understanding patterns that can be used to inform sport safety practices.

METHODS

Exposure and injury data collected in the National Collegiate Athletic Association Injury Surveillance Program from 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates.

RESULTS

The overall injury rate was 6.27 per 1000 athlete-exposures (AEs). Head/face injuries (16.0%) and thigh injuries (12.3%) were the most commonly injured body parts during the 2014-2015 through 2018-2019 academic years. Concussion (8.6%) was the most commonly reported injury, and concussion rates notably decreased between 2017-2018 and 2018-2019.

SUMMARY

Study findings were generally consistent with the existing epidemiologic evidence. Incidence rates and trajectories of commonly observed injuries warrant particular attention in the future.

Epidemiology of Injuries in National Collegiate Athletic Association Men's Baseball: 2014-2015 Through 2018-2019

CONTEXT

The National Collegiate Athletic Association has supported men's baseball championships since 1947. Since its inception, the number of participating teams and athletes has considerably expanded.

BACKGROUND

Frequently conducting injury surveillance of collegiate baseball athletes is essential for identifying developing temporal patterns.

METHODS

Exposure and injury data collected in the National Collegiate Athletic Association Injury Surveillance Program during 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics; injury rate ratios were used to examine differential injury rates.

RESULTS

The overall injury rate was 3.16 per 1000 athlete-exposures. The preseason injury rate was significantly higher than the regular season injury rate. The most commonly injured body parts were shoulder (16.1%), arm or elbow (16%), and hand or wrist (13.9%). The most reported specific injury was hamstring tear (7.9%).

CONCLUSIONS

The findings of this study aligned with previous studies-most injuries were due to noncontact and overuse mechanisms, less than one-half of injuries were related to upper extremity body parts, and one-third of all injuries were reported among pitchers.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Tennis: 2014-2015 Through 2018-2019

CONTEXT

The National Collegiate Athletic Association (NCAA) has sponsored women's tennis programs since 1966. Women's tennis has risen in global prominence and popularity within the NCAA.

BACKGROUND

Continued surveillance of athletic injuries in the NCAA is critical for identifying emerging injury trends and assessing injury prevention strategies.

METHODS

Exposure and injury data collected in the NCAA Injury Surveillance Program from 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates.

RESULTS

The overall injury rate was 4.16 per 1000 athlete exposures. Injury to the shoulder, foot, and trunk were the most prevalent throughout the study period. Approximately 30% of all injury diagnoses were related to inflammatory conditions. Also, 32.1% of all injuries were time-loss injuries, and 45.0% of all injuries were non-time-loss injuries.

CONCLUSIONS

The findings of this study differed slightly from those of previous investigations, most notably with regard to injury rate by season segment and commonly injured body parts. Future surveillance efforts should attempt to capture the nuances of tennis competitions.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Soccer: 2014-2015 Through 2018-2019

CONTEXT

The National Collegiate Athletic Association held the first women's soccer championship in 1982; sponsorship and participation have greatly increased since.

BACKGROUND

Routine examinations of athlete injuries are important for identifying emerging temporal patterns.

METHODS

Exposure and injury data collected in the National Collegiate Athletic Association Injury Surveillance Program during the 2014-2015 through 2018-2019 seasons were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates.

RESULTS

The overall injury rate was 8.33 per 1000 athlete-exposures. Lateral ligament complex tears (ankle sprains) (8.6%), concussions (8.3%), and quadriceps tears (5.0%) were the most commonly reported injuries. Rates of lateral ligament complex tears followed an increasing trajectory during the study period, whereas quadriceps tear rates fluctuated during the early years, and concussion rates decreased then increased.

SUMMARY

The findings of this study were mostly consistent with existing evidence; notable temporal patterns were observed with regard to lateral ligament complex tears and concussions.

Epidemiology of Injuries in National Collegiate Athletic Association Men's Lacrosse: 2014-2015 Through 2018-2019

CONTEXT

The popularity of National Collegiate Athletic Association (NCAA) men's lacrosse has been steadily increasing since the early 1980s.

BACKGROUND

Injury surveillance is an important tool to aid in identifying emerging patterns of sport-related injury in NCAA men's lacrosse.

METHODS

Injury data collected from a sample of men's lacrosse teams through the NCAA Injury Surveillance Program for the academic years 2014-2015 through 2018-2019 were analyzed. Athlete exposures were estimated and computed based on collected exposure data. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated to estimate differences in injury rates.

RESULTS

The overall injury rate was 4.90 per 1000 athlete exposures (AEs), and the competition injury rate was higher than the practice injury rate (IRR = 2.59; 95% CI = 2.35, 2.84). The overall preseason injury rate was higher than the regular and postseason injury rates. The most reported injuries were concussions (8.0%), ankle sprains (7.7%), and hamstring tears (6.9%).

CONCLUSIONS

Study findings were comparable with existing epidemiological evidence. The overall burden of concussions and lower extremity injuries warrant further attention in this population.

Epidemiology of Injuries in National Collegiate Athletic Association Men's Track and Field: 2014-2015 Through 2018-2019

CONTEXT

College athletes have been competing in championship track and field events since 1921; the numbers of competing teams and participating athletes have expanded considerably.

BACKGROUND

Monitoring injuries of men's track and field athletes using surveillance systems is critical in identifying emerging injury-related patterns.

METHODS

Exposure and injury data collected in the National Collegiate Athletic Association Injury Surveillance Program during the 2014-2015 through 2018-2019 academic years were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics; injury rate ratios were used to examine differential injury rates.

RESULTS

Overall, men's track and field athletes were injured at a rate of 2.37 per 1000 athlete-exposures; injuries occurred at a higher rate during competition compared with practice. Most injuries were to the thigh (26.2%), lower leg (17.3%), or knee (10.7%) and were caused by noncontact (37.2%) or overuse (31.5%) mechanisms. The most reported injury was hamstring tear (14.9%).

SUMMARY

The etiologies of thigh and lower-leg injuries warrant further attention in this population. Future researchers should also separately examine injury incidence during indoor and outdoor track and field seasons.

Epidemiology of Injuries in National Collegiate Athletic Association Men's Football: 2014-2015 Through 2018-2019

CONTEXT

Football is among the most popular collegiate sports in the United States, and participation in National Collegiate Athletic Association (NCAA) football has risen in recent years.

BACKGROUND

Continued monitoring of football injuries is important for capturing the evolving burden of injuries in NCAA football. The purpose of this study was to describe the epidemiology of football-related injuries among men's NCAA football players during the 2014-2015 through 2018-2019 academic years.

METHODS

Exposure and injury data collected in the NCAA Injury Surveillance Program were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates.

RESULTS

The overall injury rate was 9.31 per 1000 athlete-exposures. Most injuries occurred during general play (17.5%), blocking (15.8%), and tackling (14.0%). Concussions (7.5%), lateral ligament complex tears (6.9%), and hamstring tears (4.7%) were the most commonly reported injuries.

CONCLUSIONS

Results of this study were generally consistent with previous findings, though changes over time in rates of commonly reported injuries warrant attention. Continued monitoring of injury incidence is needed to appraise the effectiveness of recently implemented rules changes.

Epidemiology of Injuries in National Collegiate Athletic Association Men's Cross-Country: 2014-2015 Through 2018-2019

CONTEXT

The National Collegiate Athletic Association has sponsored men's cross-country programs since 1938, and the sport has grown greatly in scope since then.

BACKGROUND

Routine examinations of men's cross-country injuries are important for identifying emerging temporal patterns.

METHODS

Exposure and injury data collected in the National Collegiate Athletic Association Injury Surveillance Program during 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates.

RESULTS

The overall injury rate was 4.01 per 1000 athlete-exposures (AEs). Most reported injuries were inflammatory conditions (30.2%), strains (18.7%), and sprains (11.5%); rates of inflammatory conditions were highest in preseason. The most commonly reported injuries were lateral ligament complex tears (ankle sprains; 8.2%).

SUMMARY

Findings of this study were not entirely consistent with existing evidence; continued monitoring of competition injury rates and rates of commonly reported injuries is needed beyond 2018-2019.

Epidemiology of Injuries in National Collegiate Athletic Association Men's Soccer: 2014-2015 Through 2018-2019

CONTEXT

The National Collegiate Athletic Association has sponsored men's soccer programs since 1959, and the popularity of the sport has grown over time.

BACKGROUND

Routine examinations of athlete injuries are important for identifying emerging temporal patterns.

METHODS

Exposure and injury data collected in the National Collegiate Athletic Association Injury Surveillance Program from 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates.

RESULTS

The overall injury rate was 8.51 per 1000 athlete exposures. Lateral ligament complex tears (ankle sprains) (9.2%), hamstring tears (7.0%), and concussions (5.2%) were the most commonly reported injuries. Rates of lateral ligament complex tears remained stable from 2014-2015 through 2018-2019, whereas hamstring tear rates decreased and concussion rates increased.

SUMMARY

The findings of this study were in line with the existing epidemiological evidence, although notable temporal patterns were observed. Incidence trajectories of commonly observed injuries warrant particular attention in the future.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Cross-Country: 2014-2015 Through 2018-2019

CONTEXT

Women's cross-country is a thriving sport at the National Collegiate Athletic Association (NCAA) level with over 1000 sponsored programs association-wide.

BACKGROUND

Routine examinations of women's cross-country injuries are important for identifying emerging time trends in injury incidence and outcomes.

METHODS

Exposure and injury data collected in the NCAA Injury Surveillance Program from 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates.

RESULTS

The overall injury rate was 3.96 per 1000 athlete-exposures. Most reported injuries were inflammatory conditions (33.6%), strains (17.7%), and fractures (9.1%). The most commonly reported injuries were medial tibial stress syndrome (10.0%) and lateral ligament complex tears (ankle sprains; 4.2%).

SUMMARY

Findings of this study were not entirely consistent with existing evidence. Future studies are needed to examine the nature of inflammatory conditions and fractures in this population, as well as temporal patterns in commonly reported injuries.

Methods of the National Collegiate Athletic Association Injury Surveillance Program, 2014-2015 Through 2018-2019

BACKGROUND

Since 1982, the National Collegiate Athletic Association (NCAA) has collaborated with athletic trainers (ATs) to create the largest ongoing collegiate sports injury database in the world. This report provides an operational update of the NCAA Injury Surveillance Program (NCAA ISP) during the academic years 2014-2015 through 2018-2019.

SURVEILLANCE SYSTEM STRUCTURE

The NCAA ISP used a convenience sampling technique via a rolling recruitment model. The ATs at contributing institutions voluntarily submitted data into their respective electronic medical record systems; common data elements were pushed to and maintained by the Datalys Center. The ATs provided information about all team-related activities, even if no injury occurred during that activity, as well as detailed reports on each injury, including condition and circumstances.

SUMMARY

The NCAA ISP has a long-standing role in supplying NCAA stakeholders with crucial injury surveillance data, playing a critical part in safeguarding student-athletes participating in collegiate sports.

Epidemiology of Injuries in National Collegiate Athletic Association Men's Swimming and Diving: 2014-2015 Through 2018-2019

CONTEXT

The National Collegiate Athletic Association (NCAA) has sponsored men's swimming and diving since 1937.

BACKGROUND

Routine examinations of men's swimming and diving injuries are important for identifying emerging injury-related patterns.

METHODS

Exposure and injury data collected in the NCAA Injury Surveillance Program during the 2014-2015 through 2018-2019 academic years were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differences in injury rates.

RESULTS

The overall injury rate was 1.56 per 1000 athlete-exposures (AEs) for swimmers and 1.52 per 1000 AEs for divers. Shoulder (27.0%) injuries accounted for the largest proportion of all swimming injuries, and most injuries were attributed to overuse mechanisms (42.6%). Shoulder (23.3%) and trunk (23.3%) injuries accounted for the largest proportion of all diving injuries, and most injuries resulted from surface contact (32.6%).

CONCLUSIONS

Findings were consistent with existing literature on swimming and diving. The need for continued surveillance, coupled with more robust participation by swimming and diving programs was also highlighted.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Basketball: 2014-2015 Through 2018-2019

CONTEXT

Frequent inspection of sports-related injury epidemiology among National Collegiate Athletic Association (NCAA) women's basketball student-athletes is valuable for identifying injury-related patterns.

BACKGROUND

Emerging patterns in epidemiology of NCAA women's basketball injuries are unknown though general sports medicine practices, and playing rules and regulations have evolved in recent years.

METHODS

Athlete exposures (AEs) and injury incidence data were reported to the NCAA Injury Surveillance Program between 2014-2015 and 2018-2019. Injury counts, rates, and proportions were used to examine injury characteristics, and injury rate ratios (IRRs) were used to assess injury rate differences.

RESULTS

Practice and competition injury rates were 5.93 and 10.35 per 1000 AEs, respectively. Preseason injury rates were higher than regular (IRR = 1.41; 95% CI = 1.31, 1.53) and postseason (IRR = 3.12; 95% CI = 2.39, 4.07). Ankle sprains (14.3%), concussions (7.5%), and anterior cruciate ligament tears (2.5%) were the most commonly reported injuries.

SUMMARY

Higher rates of practice and competition injuries, as well as ankle sprains, were observed relative to previous reports; continuous monitoring is necessary to identify potential contributing factors to these trends.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Track and Field: 2014-2015 Through 2018-2019

CONTEXT

Women's track and field events at the National Collegiate Athletic Association level have grown in popularity in recent years, and track and field athletes are vulnerable to a broad range of potential injuries.

BACKGROUND

Routine examination of track and field injuries is important for identifying emerging patterns in injury incidence.

METHODS

Exposure and injury data collected in the National Collegiate Athletic Association Injury Surveillance Program during the 2014-2015 to 2018-2019 academic years were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates.

RESULTS

The overall injury rate was 2.20 per 1000 athlete exposures; the competition injury rate was higher than the practice injury rate (injury rate ratio = 1.73; 95% confidence interval = 1.51, 1.97). Hamstring tears (8.9%), medial tibial stress syndrome (5.4%), and lateral ligament complex tears (4.2%) were the most reported injuries.

CONCLUSIONS

Given the results of this study, further attention may be directed toward factors associated with noncontact injury risk in the competitions. The changing injury rates of most reported injuries also warrant monitoring post 2018-2019.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Volleyball: 2014-2015 Through 2018-2019

CONTEXT

Women's volleyball is a globally popular sport with widespread participation at the National Collegiate Athletic Association (NCAA) level.

BACKGROUND

Routine examinations of NCAA women's volleyball injuries are important for recognizing emerging injury-related patterns in this population.

METHODS

Exposure and injury data collected in the NCAA Injury Surveillance Program during the 2014-2015 through 2018-2019 athletic years were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differences in injury rates.

RESULTS

The overall injury rate was 6.73 per 1000 athlete-exposures. Knee (14.6%) and ankle (13.8%) injuries accounted for the largest proportion of all reported injuries, and most injuries were attributed to overuse (26.1%) or noncontact (22.7%) mechanisms. Lateral ankle ligament complex tears (11.1%) and concussions (7.3%) were the most commonly reported specific injury.

SUMMARY

Results indicate an increasing burden of practice-related injuries and the need to further examine overuse injuries. Lower-extremity injury prevention strategies and mechanisms of concussion also warrant further attention.

Epidemiology of Injuries in National Collegiate Athletic Association Men's Wrestling: 2014-2015 Through 2018-2019

CONTEXT

The first men's wrestling National Collegiate Athletic Association (NCAA) Championship was sponsored in 1928; since then, participation has increased.

BACKGROUND

Continued study of wrestling injury data is essential to identify areas for intervention based on emerging trends.

METHODS

Exposure and injury data collected in the NCAA Injury Surveillance Program during 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios (IRRs) were used to examine differential injury rates.

RESULTS

The overall injury rate was 8.82 per 1000 athlete exposures. The competition injury rate was significantly higher than practice injury rate (IRR = 4.11; 95% CI = 3.72, 4.55). The most commonly injured body parts were the knee (21.4%), shoulder (13.4%), and head/face (13.3%), and the most prevalently reported specific injury was concussion.

SUMMARY

These findings provide the most current update to injury incidence and outcomes in NCAA men's wrestling. We identify notable trends that warrant consideration in future research.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Lacrosse: 2014-2015 Through 2018-2019

CONTEXT

Lacrosse is an increasingly popular sport; the number of teams participating in collegiate women's lacrosse has increased by 21.4% in the past 5 years.

BACKGROUND

The growth of National Collegiate Athletic Association women's lacrosse, coupled with the ongoing discussions surrounding protective equipment, necessitates further epidemiologic studies in this population.

METHODS

Exposure and injury data collected in the National Collegiate Athletic Association Injury Surveillance Program during 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios with 95% CIs were used to examine differential injury rates.

RESULTS

The overall injury rate was 4.99 per 1000 athlete exposures. Less than 30% of injuries were time-loss injuries; injuries were most commonly attributed to noncontact (26.6%) and overuse (25.2%) mechanisms. The most commonly reported specific injuries were lateral ligament complex tears (ankle sprains; 9.1%), concussions (7.2%), and hamstring tears (3.8%).

SUMMARY

Findings from this study were consistent with the existing epidemiologic evidence in previous studies. Injury incidence in practices, in preseason, and as a result of player contact warrant further attention in this population.

Methods of the National Athletic Treatment, Injury and Outcomes Network Surveillance Program (NATION-SP), 2014-2015 Through 2018-2019

BACKGROUND

The National Athletic Treatment, Injury and Outcomes Network Surveillance Program (NATION-SP) was established in 2011 to provide a comprehensive appraisal of injuries sustained by high school student-athletes who received services from athletic trainers (ATs). The purpose of this article is to update the surveillance methods of the NATION-SP for data reported during the 2014-2015 through 2018-2019 academic years.

SURVEILLANCE SYSTEM STRUCTURE

The NATION-SP used a rolling recruitment model to identify a convenience sample of US high schools with access to ATs. The ATs at participating institutions volunteered to contribute data via electronic medical records systems; common data elements were then pushed to and maintained by the Datalys Center for Sports Injury Research and Prevention. The ATs completed detailed reports on each injury, including the condition and circumstances. The treatments component was used to comprehensively assess the services provided to athletes by ATs. The outcomes companion component was developed to monitor patient-reported outcomes after athletic injury.

SUMMARY

The NATION-SP continues to serve a critical purpose in informing injury-prevention and treatment efforts among high school athletes.

Fundamentals of Sports Analytics

Recently, the importance of statistics and analytics in sports has increased. This review describes measures of sports injury and fundamentals of sports injury research with a brief overview of some of the emerging measures of sports performance. We describe research study designs that can be used to identify risk factors for injury, injury surveillance programs, and common measures of injury risk and association. Finally, we describe measures of physical performance and training and considerations for using these measures. This review provides sports medicine clinicians with an understanding of current research measures and considerations for designing sports injury research studies.

Abstract TP301: Outlier Analysis of NIHSS Change in a Regional Database of Acute Ischemic Stroke

Introduction: Change in NIH Stroke Scale from admission to discharge has been proposed as an outcome-based method of assessing quality of care in the inpatient setting. Using the Kentucky Appalachian Stroke Registry database, statistical outliers were identified as potential targets for investigation. We aimed to use the analysis of this subset of patients to identify characteristics favoring exceptionally good or poor outcome.

Methods: De-identified patient data was obtained from the Kentucky Appalachian Stroke Registry for all acute ischemic stroke patients from January 1, 2013 to December 31, 2014 using discharge diagnoses. Statistical process control methodology was used to identify hospitalizations with positive or negative NIHSS change more than three standard deviations from the mean. The statistical outliers underwent manual chart review to validate the data obtained from the registry and supplement it qualitatively to identify common characteristics. Chi-square tests were conducted to assess the association between patient characteristics and being a positive or negative outlier.

Results: Positive outliers were less likely to have hypertension and more likely to have received intravenous thrombolysis. Negative outliers were more likely to have carotid stenosis. Both groups were more likely to have a diagnosis of cardiac arrhythmia and to have received mechanical thrombectomy.

Conclusions: Gathering registry data regarding NIHSS outliers is a feasible and potentially useful tool in understanding and improving care. The absence of hypertension may represent positive predictive recovery potential in severe stroke. Patients with significant carotid disease on presentation may be at risk of neurological decline. Furthermore, patients with large vessel occlusions undergoing thrombectomy represent a high-variance population with the greatest improvements and greatest deteriorations during inpatient hospitalization.

Cluster analysis of risk factor genetic polymorphisms in Alzheimer's disease

Multiple genetic variants may contribute to the risk of developing Alzheimer's disease. We have analyzed polymorphisms in 9 genes to determine whether particular combinations would contribute to this risk. The genes were APOE, LDLr, CST3, CTSD, TNF, BACE1, MAPT, STH, eNOS, and TFCP2. Three risk groups for the disease were identified. Risk group I was younger, was heterozygous for the CST3 (GA), CTSD2936 (AG), TNF -308 (AG) genetic variants. Risk group II was older, was homozygous for the -427 APOE promoter polymorphism (TT), and heterozygous for the MAPT deletion and for the STH variant (QR). Group III had both the youngest and oldest subjects, were heterozygous for the -863 (AC) and -1031 (CT) TNF promoter polymorphisms. All three groups carried the APOE 4 allele and were heterozygous for both BACE1 polymorphisms. The control groups were carriers of the APOE 3 allele and were homozygous for the BACE1 genetic variants.

Role of pharmacists in reducing occupational exposure to HIV

The role of pharmacists in reducing the occupational hazard of human immunodeficiency virus (HIV) transmission via needle-stick injuries is described. Some 40% of all pharmaceuticals used in hospitals are now administered by injection, and sales of large-volume injectable drug products continue to grow. Most needle-stick injuries in which health-care workers are exposed to HIV-contaminated blood occur during recapping of used needles, picking up and carrying the needle, or placing it in a receptacle. Pharmacists are responsible not only for the purchase, storage, dispensing, and use of drug products but also for providing information about their administration and safe disposal. Single-use vials, ampuls, and prefilled syringes must all be evaluated for availability, ease of use, and disposal. A major factor in drug-purchasing decisions must be the safety of nurses. Syringes that have been redesigned to eliminate the need for recapping offer a major safety advantage. Needle disposal units should be made more conveniently accessible. Pharmacists can help prevent the transmission of HIV to health-care workers by using their influence as educators and decision makers to reduce the risk of needle-stick injury.

Usefulness of Q-wave response to exercise as a predictor of coronary artery disease

In lead CM5, the Q-wave response to exercise has been reported as an effective index in predicting coronary artery disease (CAD) and CAD with left anterior descending (LAD) disease. The purpose of this study was to verify these findings when the Q wave was analyzed in lead CC5 in 135 patients. The sensitivity for abnormal ST depression was 77%, specificity 83% and predictive value 78%. The corresponding values for the abnormal Q-wave response (reduction or no change in Q-wave amplitude) were 70%, 61% and 59%. These differences (except sensitivity) were significant. When either a positive ST or Q-wave response was used, sensitivity, specificity and predictive value did not significantly increase compared with the ST segment alone. In addition, only 45% of normal subjects with false-positive ST depression had a normal Q-wave response (increase) and 57% of patients with false-negative ST responses had an abnormal Q-wave response. When a positive response for CAD with an LAD lesion and for multivessel CAD with LAD narrowing was defined as having a Q-wave reduction, the sensitivities were extremely low (15% and 17%), but both the specificities and the predictive values were 100%. Therefore, the Q-wave analysis in lead CC5 is no more sensitive for detecting CAD than the ST-segment response. However, when a decreased Q-wave amplitude is observed, multivessel CAD and LAD narrowing can be predicted.

Complementary value of two-dimensional exercise echocardiography to routine treadmill exercise testing

Two-dimensional echocardiograms were done during rest and after exercise in 95 patients who subsequently had coronary arteriography. Prior myocardial infarction was present in 36 patients, 35 of whom had wall motion abnormalities. There was no evidence of prior infarction in 59 patients, 44 of whom had coronary disease. In these 44 patients, the exercise electrocardiogram showed ischemia in 19, was normal in 13, and was nondiagnostic in 12. Exercise echocardiograms were abnormal in 35 of these 44 patients. In 15 patients without coronary disease, the treadmill response was nondiagnostic in 6, ischemic in 1, and normal in 8. Exercise echocardiograms were normal in 13 of these 15 patients. We conclude that exercise echocardiography is a valuable addition to routine treadmill testing. It may be of special value in patients with an abnormal resting electrocardiogram or a nondiagnostic response to treadmill testing or when a false-negative treadmill test is suspected.

The abnormal exercise electrocardiogram in apparently healthy men: a predictor of angina pectoris as an initial coronary event during long-term follow-up

A group of 916 apparently healthy men between the ages of 27 and 55 years (mean 37) were followed up with serial medical and exercise test evaluations for a period of 8 to 15 years (mean 12.7) to determine (1) the prevalence and specific types of new coronary events observed in subjects with and without abnormal ST segment responses to exercise and (2) the predictive value of a serial conversion to an abnormal ST segment response to exercise for new coronary events. During the initial evaluation there were 23 subjects (2.5%) with an abnormal ST segment response to exercise. During follow-up there were nine (39%) coronary events in this group: eight cases of angina and one of sudden death. With serial testing, an additional 38 subjects (5.1%) experienced conversion to an abnormal ST segment response to exercise. During follow-up there were 12 (32%) coronary events in this group: 10 cases of angina, one of myocardial infarction, and one other. There were 833 subjects with normal ST segment responses to exercise with all tests. In this group there were 44 (5.3%) coronary events: 25 cases of myocardial infarction, seven of sudden death, and 12 of angina. We conclude that in apparently healthy middle-aged men an abnormal ST segment response to exercise is predictive of angina pectoris but not of myocardial infarction or sudden cardiac death as an initial coronary event.

Prevalence and magnitude of S-T segment and T wave abnormalities in normal men during continuous ambulatory electrocardiography

Fifty asymptomatic normal male volunteers, mean age 44.6 years (range 35 to 59), were prospectively studied to ascertain the prevalence and magnitude of S-T segment and T wave changes detected during continuous ambulatory electrocardiographic monitoring. Transient S-T segment depression of 1.0 mm or more was recorded in 15 (30 percent) of the subjects, and labile T wave inversion of up to 3 mm occurred in an additional 18 (36 percent). The presence of ST-T changes during monitoring did not correlate with age, daily activity status or heart rate. There was also no correlation with the S-T segment response or work performance during treadmill exercise testing. It is concluded that S-T segment depression and T wave inversions are commonly observed during ambulatory electrocardiographic monitoring of normal men. Therefore, similar changes observed in patients with coronary artery disease should be interpreted with caution.

Relation of exercise-induced physiologic S-T segment depression to R wave amplitude in normal subjects

Exercise electrocardiography was performed in 100 asymptomatic male volunteers with a mean age of 42.6 years. The R wave and total RS amplitude and the magnitude of physiologic S-T segment depression at the J junction were quantitated for a modified bipolar CC5 lead and a vertically oriented bipolar lead (VL) using computer-averaged groups of 25 consecutive QRS complexes from each of seven stages of rest and exercise. Computer-generated X-Y plots were used to examine the correlations between the magnitude of S-T depression and the R wave and total RS amplitudes. The magnitude of S-T depression and of the R wave amplitude were unrelated at standing rest but showed increasing correlation with progressive increases in exercise heart rate (correlation coefficient = 0.425, p < 0.00001 at maximal exercise). The total RS amplitude was also related to the magnitude of S-T depression during exercise, but the correlations did not improve progressively with increases in exercise heart rate. The magnitude of S-T depression was more closely related to R wave amplitude and total RS amplitude in the vertically oriented lead than in the CC5 lead. These data demonstrate a significant relation between the magnitude of R wave and total RS amplitudes and the magnitude of physiologic S-T segment depression in normal subjects during exercise. They suggest the need for evaluation of S-T depression corrected for R wave amplitude in an attempt to improve the diagnostic accuracy of the exercise electrocardiogram. The data also suggest that the criteria for abnormal S-T depression should take into consideration the different R wave voltages reflected by different types of recording leads.