Are high school girls' lacrosse players at increased risk of concussion because they are not allowed to wear the same helmet boys' lacrosse players are required to wear?

BACKGROUND: Boys' lacrosse (LAX), a full contact sport allowing body and stick checking, mandates hard shell helmets with full face masks. Girls' LAX, which prohibits body checking and whose sphere rule is supposed to prevent stick checking to the head, allows optional flexible headgear with/without integrated eye protection. Whether the required boys' LAX helmets should also be mandated in girls' LAX has been debated. METHODS: In this retrospective cohort study we used LAX concussion data from a national high school sports-related injury surveillance study to determine if girls' LAX players were at increased risk of concussion from stick or ball contact due to differences in helmet regulations by calculating the attributable risk and attributable risk percent (AR%) for concussion resulting from ball or stick impacts. RESULTS: From 2008-09 through 2018-19, boys' LAX players sustained 614 concussions during 1,318,278 athletic exposures (AEs) (4.66 per 10,000 AEs) and girls' LAX players sustained 384 concussions during 983,291 AEs (3.91 per 10,000 AEs). For boys, athlete-athlete contact was the most common mechanism of concussion accounting for 66.4% of all concussions, while stick or ball contact accounted for 23.5%. For girls, stick or ball contact accounted for 72.7% of all concussions, while athlete-athlete contact accounted for 19.8%. Concussion rates from stick or ball contact were significantly higher in girls vs. boys (RR = 2.60, 95% CI 2.12-3.18). The attributable risk associated with playing girls' vs. boys' LAX for concussion resulting from stick or ball contact was 1.75 concussions per 10,000 AEs (95% CI 1.37-2.12) and the AR% was 61.5% (95% CI 52.9-68.5). An estimated 44.7% of all girls' LAX concussions could have been prevented if girls' LAX players wore the helmet mandated in boys' LAX. CONCLUSIONS: Girls' LAX players who are allowed, but not required, to wear a flexible headgear are at increased risk of concussions from stick or ball impacts compared to boys' LAX players, who are required to wear a hard shell helmet with full face mask. Additional research is needed to determine if there are any defendable arguments to continue justifying restricting girls' LAX players access to this effective piece of protective equipment.

Evaluating the effectiveness of traumatic brain injury state laws among high school athletes.

BACKGROUND: Traumatic brain injury legislation varies across states. A comprehensive nationwide evaluation of state traumatic brain injury laws is vital given growing populations of high school athletes. This study evaluates the effectiveness of traumatic brain injury laws by examining longitudinal trends in incident and recurrent concussion rates and determines if state level variations in legislation's language affected the observed trends. METHODS: In this retrospective ecological study of a large national sample of US high schools from 2005/06 through 2017/18, piecewise regression models along with a profile likelihood approach were utilized to examine longitudinal trends in incident and recurrent concussion rates. RESULTS: Overall incident concussion rates increased by an additional 1.85%/standardized month (STDM) (95% confidence interval (CI): 1.14, 2.56%) prior to law passage and decreased by an additional 1.08%/ STDM (95%CI: - 1.43, - 0.72%) after law passage. Similar trends were observed for overall recurrent concussion rates. Among states that specified the category of healthcare provider for return to play clearance, post-law recurrent concussion rates decreased on average by an additional 1.59%/STDM (95%CI: - 3.42, 0.22%) compared to states that did not specify the category of healthcare provider. CONCLUSIONS: The passage of state level traumatic brain injury laws was associated with an increase in overall incident and recurrent concussion rates prior to law passage and a decrease in rates after law passage. Although not statistically significant, states with traumatic brain injury laws specifying the category of healthcare provider for return to play clearance had a greater rate of decline in post-law recurrent concussion rates compared to states not specifying the category of healthcare provider. The findings suggest that state traumatic brain injury laws may benefit from specifying the category of healthcare provider allowed to provide return to play clearance, if they do not already include such language.

The Eternally Wounded Athlete: How Medical Professionals and Sports Injury Researchers Have Limited Female Athletes' Sport Participation and Biased the Interpretation of Sports Injury Research.

Purpose of Review: Female sports participation has long been diminished compared to male sports participation. This review contextualizes current findings in historical implicit gender bias. Recent Findings: The transition from the recognition of the Female Athlete Triad Syndrome to the Relative Energy Deficiency in Sport Syndrome (RED-S Syndrome) to the newly proposed Male Athlete Triad Syndrome demonstrates the power of implicit gender bias on sports injury research efforts, clinical practices, and policy decisions. Similarly, anterior cruciate ligament (ACL) injuries have long been portrayed as a young female athlete injury, a perception which has affected the sports medicine world in a way that has resulted in both male and female athletes not fully benefitting from possible research and clinical advances. Summary: This review explores the history of female exclusion from sport and considers how modern sport and exercise medicine has, perhaps because of implicit gender biases, inadvertently contributed to that exclusion.

Epidemiologic comparison of ankle injuries presenting to US emergency departments versus high school and collegiate athletic training settings.

BACKGROUND: Ankle sprains account for a large proportion of injuries presenting to both United States (US) emergency departments (EDs) as well as high school (HS) and collegiate school athletic training settings. The epidemiologic differences across these settings by both sport and diagnosis have not been well differentiated. Ankle injury data from 3 national surveillance datasets. Athletic training setting data from the National High School Sports-Related Injury Surveillance System and the National Collegiate Athletic Association Injury Surveillance Program was from academic years 2009/10 through 2013/14 and the US Consumer Product Safety Commission's National Electronic Injury Surveillance System (ED setting) data was from calendar years 2009 through 2013. Data was analyzed for patients 14-22 years old participating in 12 sports (male football, baseball, basketball, lacrosse, soccer, and wrestling, and female softball, basketball, lacrosse, soccer, volleyball, and field hockey). We calculated sport-specific injury rates, proportions, and rate ratios (RRs) with 95% confidence intervals (CI). RESULTS: During the study period, the surveillance systems captured 20,261 ankle injuries presenting to EDs plus 5546 HS and 2725 collegiate injuries presenting to school athletic training settings. Rates were higher in collegiate compared to HS athletes presenting in the athletic training setting. Football accounted for the largest proportion of ankle injuries presenting to HS (31.2%) and college (41.0%) athletic training settings; male basketball accounted for the largest proportion presenting to EDs among both HS (41.0%) and college (65.8%) aged patients. Sprains/strains accounted for over 80% of injuries in all three settings. Fractures accounted for a larger proportion of ankle injuries presenting to EDs (9.5%) compared to HS (3.8%) and college (0.8%) athletic training settings. There was no change in injury rates during the study period across the three settings. CONCLUSIONS: Injury rates and patterns varied by sport and presentation setting, with athletic trainers evaluating more ankle injuries overall in the collegiate setting compared to the high school setting. Ankle injuries presenting to EDs were more commonly fractures, suggesting that more severe injuries present to this setting. Understanding the epidemiology of such patterns will help readers interpret differences in publications reporting data from varied clinical settings.

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.

Hand and Wrist Injuries Among US High School Athletes: 2005/06-2015/16.

BACKGROUND: The risk of hand/wrist injuries is present across various sports. Little is known about the epidemiology of such injuries. The objective of this study was to calculate the rates of hand/wrist injuries and investigate injury patterns among high school athletes. METHODS: Athlete exposure (AE) and hand/wrist injury data were collected during 11 academic years, 2005/06 through 2015/16, from a large sample of US high schools as part of the National High School Sports-Related Injury Surveillance Study. RESULTS: There were 6723 hand/wrist injuries sustained during 40 195 806 AEs, a rate of 1.7 per 10 000 AEs. The rate of injury in competition (3.3) was higher than in practice (1.1) (95% confidence interval: 2.8-3.1). Rates of hand/wrist injuries varied by sport, with the highest rates in football (4.3), boys' lacrosse (1.9), girls' softball (1.9), wrestling (1.8), girls' field hockey (1.7), boys' ice hockey (1.7), and girls' basketball (1.7). The most common injuries were fracture (45.0%), contusion (11.6%), and ligament sprain (9.0%). Athletes most frequently returned to play in <7 days (45.7%), but 12.4% of injuries kept athletes out ≥3 weeks. CONCLUSIONS: High school athletes are at risk for hand/wrist injuries. Such injuries can keep athletes out of play and many require substantial medical treatment. Stick and ball or puck sports and full contact sports have high rates of hand/wrist injuries relative to other sports, which is indicative of a need for sport-specific prevention efforts.

A Paired Comparison of Initial and Recurrent Concussions Sustained by US High School Athletes Within a Single Athletic Season.

OBJECTIVE: To compare initial and recurrent concussions regarding average number of days between concussions, acute concussion symptoms and symptom resolution time, and return to play time. SETTING/PARTICIPANTS: High school athletes sustaining multiple concussions linked within sport seasons drawn from a large sports injury surveillance study. DESIGN: Retrospective analysis of longitudinal surveillance data. MEASURES: Number of days between concussions, number of symptoms endorsed, specific symptoms endorsed, symptom resolution time, return to play time. RESULTS: Median time between initial and recurrent concussions was 21 days (interquartile range = 10-43 days). Loss of consciousness, the only significant symptom difference, occurred more frequently in recurrent (6.8%) than initial (1.7%) concussions (P = .04). No significant difference was found in the number of symptoms (P = .84) or symptom resolution time (P = .74). Recurrent concussions kept athletes from play longer than initial concussions (P < .0001); 26.6% of recurrent concussions were season ending. CONCLUSIONS: We found that athletes' initial and recurrent concussions had similar symptom presentations and resolution time. Despite these similarities, athletes were restricted from returning to play for longer periods following a recurrent concussion, indicating clinicians are managing recurrent concussions more conservatively. It is probable that concussion recognition and management are superior now compared with when previous studies were published, possibly improving recurrent concussion outcomes.

Epidemiology of High School Sports-Related Injuries Resulting in Medical Disqualification: 2005-2006 Through 2013-2014 Academic Years.

BACKGROUND: Although rare, season- or career-ending injuries in young athletes are concerning because they can result in time lost from sport participation and school, social costs, and economic costs of medical care. PURPOSE: To describe rates and patterns of medically disqualifying (MDQ) injuries among United States high school athletes overall and by sport, sex, type of athletic activity, and mechanism. STUDY DESIGN: Descriptive epidemiological study. METHODS: Sports-related injury data on high school athletes were collected during the 2005-2006 through 2013-2014 academic years from a large national sample of United States high schools via High School Reporting Information Online (RIO). MDQ injuries were defined as season- or career-ending injuries. RESULTS: From 2005-2006 through 2013-2014, High School RIO captured 59,862 total injuries including 3599 MDQ injuries (6.0% of all injuries). Most MDQ injuries (60.4%) occurred in competition. Football had the highest injury rate (26.5 per 100,000 athlete-exposures), followed by gymnastics (18.6) and wrestling (17.9). MDQ injury rates were higher among girls in the sex-comparable sports of basketball (rate ratio [RR], 1.6; 95% CI, 1.3-2.0), cross-country (RR, 2.6; 95% CI, 1.0-7.5), soccer (RR, 1.6; 95% CI, 1.3-1.9), and track and field (RR, 2.6; 95% CI, 1.7-4.0). Player-player contact (48.2%) was the most common MDQ injury mechanism. The most commonly injured body site was the knee (33.7%). The most common MDQ injury diagnosis was sprains/strains (35.9%); the most common specific MDQ injury was knee sprains/strains (25.4%), with the anterior cruciate ligament being the most commonly injured knee structure. Among boys, fracture was the most common diagnosis in 3 sports, and sprain/strain was the most common in 6 sports. Among girls, sprain/strain was the most common diagnosis in 9 sports, and fracture was the most common only in softball. CONCLUSION: MDQ injuries vary by sport, sex, and type of athletic activity and occur most frequently as a result of player-player contact. These findings should prompt additional research into the development, implementation, and evaluation of targeted injury prevention efforts.

Epidemiology of Injuries in United States High School Track and Field: 2008-2009 Through 2013-2014.

BACKGROUND: Track and field is one of the most popular high school sports among boys and girls, but epidemiological research on the sport and its individual events has been limited. PURPOSE: To describe injury rates and patterns in boys' and girls' high school track and field. STUDY DESIGN: Descriptive epidemiology study. METHODS: A retrospective epidemiological analysis of injury and exposure data from a longitudinal national high school sports injury surveillance system was conducted. RESULTS: From 2008-2009 through 2013-2014, 2485 track and field injuries occurred during 2,962,308 athlete exposures (0.84 injuries per 1000 athlete exposures). Injury rates were higher in competition versus practice for both sexes. Girls had higher injury rates than boys overall (rate ratio, 1.37; 95% CI, 1.27-1.48) and in practice (rate ratio, 1.60; 95% CI, 1.46-1.76), but competition injury rates did not differ. Overuse/chronic injuries accounted for 27.5% and 36.2% of boys' and girls' track and field injuries, respectively. The majority of injuries were to the lower extremity. Sprints, distance running, and jumps accounted for over 65% of all track injuries. Boys sustained a greater proportion of injuries in relay events (injury proportion ratio, 2.02; 95% CI, 1.69-2.36) but fewer in hurdle events (injury proportion ratio, 0.51; 95% CI, 0.23-0.78). CONCLUSION: Injury rates varied by event, sex, and competition versus practice exposure. To increase effectiveness, targeted strategies for injury prevention should be driven by an understanding of such differences. Because many track and field injuries are overuse/chronic across sexes and for both competitions and practices, coaches and athletic trainers should be adept at recognizing early injury symptoms, intervene to treat minor injuries in order to prevent severe injuries, and ensure the prompt diagnosis and management of all injuries.

Cheerleading Injuries in United States High Schools.

BACKGROUND AND OBJECTIVES: Approximately 400 000 students participate in US high school cheerleading annually, including 123,386 involved in competitive spirit squads. The degree of athleticism and the difficulty of cheerleading skills have increased in recent decades, renewing safety concerns. This study describes the epidemiology of high school cheerleading injuries and compares cheerleading injury rates and patterns relative to other sports. METHODS: Data collected by the longitudinal, National High School Sports-Related Injury Surveillance Study from 2009/2010 through 2013/2014 were analyzed. RESULTS: Injury rates in cheerleading ranked 18th of 22 sports, with an overall injury rate of 0.71 per 1000 athlete-exposures (AEs). Competition (0.85) and practice (0.76) injury rates were similar, whereas performance rates were lower (0.49). Although 96.8% of injured cheerleaders were girls, the overall injury rate was higher in boys (1.33 vs 0.69, rate ratio [RR]: 1.93, 95% confidence interval [CI]: 1.30-2.88). Although concussions were the most common cheerleading injury (31.1% of injuries), concussion rates were significantly lower in cheerleading (2.21 per 10,000 athlete-exposures) than all other sports combined (3.78; RR: 0.58, 95% CI: 0.51-0.66) and all other girls' sports (2.70; RR: 0.82, 95% CI: 0.72-0.93). Over half of all injuries occurred during stunts (53.2%). CONCLUSIONS: Although safety remains a concern among cheerleaders, overall injury rates are lower than most other high school sports. Although overall injury rates are relatively low, cheerleading injuries may be more severe when they do occur. A detailed knowledge of cheerleading injury patterns relative to other sports is needed to drive targeted, evidence-based prevention efforts.

Mouthguard BITES (behavior, impulsivity, theory evaluation study): what drives mouthguard use among high school basketball and baseball/softball athletes.

Although mouthguards are effective, inexpensive, easy to use, and readily available, this form of protective equipment has been underutilized. "Impulsive delay discounting" (an index of impulsive behavior) among high school athletes may help explain their decision making regarding use of protective equipment such as mouthguards. We investigated the relationship between high school baseball, softball, and basketball players' mouthguard use, impulsive delay discounting, and the precaution adoption process model (a behavior change theory). A convenience sample of boys' and girls' basketball and baseball/softball players at 21 high schools in the Greater Columbus, Ohio, metro area completed a self-administered survey that captured their demographic information, knowledge, attitudes, and beliefs regarding mouthguard use, impulsive delay discounting, and precaution adoption process model stage. We surveyed a total of 1636 students (55.9 % male, 43.8 % female, 0.3 % unknown). Only 12.3 % reported using a mouthguard either every time or sometimes during practice or competition. The primary reasons reported for not wearing mouthguards were they were not required to (65.3 %) and that the athletes could not breathe or talk while wearing one (61.5 %). These reasons were consistent across sex and sport. Most athletes reported that their coaches (87.3 %) and parents (64.5 %) had never talked to them about wearing a mouthguard. Lower precaution adoption process model stage was significantly associated with higher impulsivity (p < 0.001) and higher delayed discounting (p = 0.016) after adjusting for school, sport, and sex. Voluntary mouthguard use among high school athletes playing basketball and baseball/softball remains low despite the risk of dental injury in these sports. Effective, evidence-based, targeted, and tailored interventions to improve adolescent athletes' use of mouthguards to prevent sports-related dental injuries should be based on the specific behavioral and social factors influencing each athlete's decision making regarding use of mouthguards.

An Evidence-Based Discussion of Heading the Ball and Concussions in High School Soccer.

IMPORTANCE: Soccer, originally introduced as a safer sport for children and adolescents, has seen a rapid increase in popularity in the United States over the past 3 decades. Recently, concerns have been raised regarding the safety of soccer ball heading (when an athlete attempts to play the ball in the air with his or her head) given the rise in concussion rates, with some calling for a ban on heading among soccer players younger than 14 years. OBJECTIVES: To evaluate trends over time in boys' and girls' soccer concussions, to identify injury mechanisms commonly leading to concussions, to delineate soccer-specific activities during which most concussions occur, to detail heading-related soccer concussion mechanisms, and to compare concussion symptom patterns by injury mechanism. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of longitudinal surveillance data collected from 2005-2006 through 2013-2014 in a large, nationally representative sample of US high schools. Participants were boys and girls who were high school soccer players. EXPOSURES: Concussions sustained during high school-sanctioned soccer games and practices. MAIN OUTCOMES AND MEASURES: Mechanism and sport-specific activity of concussion. RESULTS: Overall, 627 concussions were sustained during 1,393,753 athlete exposures (AEs) among girls (4.50 concussions per 10,000 AEs), and 442 concussions were sustained during 1,592,238 AEs among boys (2.78 concussions per 10,000 AEs). For boys (68.8%) and girls (51.3%), contact with another player was the most common concussion mechanism. Heading was the most common soccer-specific activity, responsible for 30.6% of boys' concussions and 25.3% of girls' concussions. Contact with another player was the most common mechanism of injury in heading-related concussions among boys (78.1%) and girls (61.9%). There were few differences in concussion symptom patterns by injury mechanism. CONCLUSIONS AND RELEVANCE: Although heading is the most common activity associated with concussions, the most frequent mechanism was athlete-athlete contact. Such information is needed to drive evidence-based, targeted prevention efforts to effectively reduce soccer-related concussions. Although banning heading from youth soccer would likely prevent some concussions, reducing athlete-athlete contact across all phases of play would likely be a more effective way to prevent concussions as well as other injuries.

Neck strength: a protective factor reducing risk for concussion in high school sports.

As the number of high school students participating in athletics continues to increase, so will the number of sports-related concussions unless effective concussion prevention programs are developed. We sought to develop and validate a cost-effective tool to measure neck strength in a high school setting, conduct a feasibility study to determine if the developed tool could be reliably applied by certified athletic trainers (ATs) in a high school setting, and conduct a pilot study to determine if anthropometric measurements captured by ATs can predict concussion risk. In the study's first phase, 16 adult subjects underwent repeated neck strength testing by a group of five ATs to validate the developed hand-held tension scale, a cost effective alternative to a hand-held dynamometer. In the second phase, during the 2010 and 2011 academic years, ATs from 51 high schools in 25 states captured pre-season anthropometric measurements for 6,704 high school athletes in boys' and girls' soccer, basketball, and lacrosse, as well as reported concussion incidence and athletic exposure data. We found high correlations between neck strength measurements taken with the developed tool and a hand-held dynamometer and the measurements taken by five ATs. Smaller mean neck circumference, smaller mean neck to head circumference ratio, and weaker mean overall neck strength were significantly associated with concussion. Overall neck strength (p < 0.001), gender (p < 0.001), and sport (p = 0.007) were significant predictors of concussions in unadjusted models. After adjusting for gender and sport, overall neck strength remained a significant predictor of concussion (p = 0.004). For every one pound increase in neck strength, odds of concussion decreased by 5 % (OR = 0.95, 95 % CI 0.92-0.98). We conclude that identifying differences in overall neck strength may be useful in developing a screening tool to determine which high school athletes are at higher risk of concussion. Once identified, these athletes could be targeted for concussion prevention programs.

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.

Epidemiology of U.S. high school sports-related ligamentous ankle injuries, 2005/06-2010/11.

OBJECTIVE: Describe ankle injury epidemiology among US high school athletes in 20 sports. DESIGN: Descriptive prospective epidemiology study. SETTING: Sports injury data for the 2005/06 to 2010/11 academic years were collected using an Internet-based injury surveillance system, Reporting Information Online. PARTICIPANTS: A nationwide convenience sample of US high schools. ASSESSMENT OF RISK FACTORS: Injuries sustained as a function of sport and gender. MAIN OUTCOME MEASURES: Ankle sprain rates and patterns, outcomes, and mechanisms. RESULTS: From 2005/06 to 2010/11, certified athletic trainers reported 5373 ankle sprains in 17,172,376 athlete exposures (AEs), for a rate of 3.13 ankle sprains per 10,000 AEs. Rates were higher for girls than for boys (rate ratio [RR], 1.25; 95% confidence interval [CI], 1.17-1.34) in gender-comparable sports and higher in competition than practice for boys (RR, 3.42; 95% CI, 3.20-3.66) and girls (RR, 2.71; 95% CI, 2.48-2.95). The anterior talofibular ligament was most commonly injured (involved in 85.3% of sprains). Overall, 49.7% of sprains resulted in loss of participation from 1 to 6 days. Although 0.5% of all ankle sprains required surgery, 6.6% of those involving the deltoid ligament also required surgery. The athletes were wearing ankle braces in 10.6% of all the sprains. The most common injury mechanism was contact with another person (42.4% of all ankle sprains). CONCLUSIONS: Ankle sprains are a serious problem in high school sports, with high rates of recurrent injury and loss of participation from sport.

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

PURPOSE: U.S. high school athletes sustain millions of injuries annually. Detailed patterns of knee injuries, among the most costly sports injuries, remain largely unknown. We hypothesize that patterns of knee injuries in U.S. high school sports differ by sport and sex. METHODS: U.S. high school sports-related injury data were collected for 20 sports using the National High School Sports-Related Injury Surveillance System, High School RIO™. Knee injury rates, rate ratios (RR), and injury proportion ratios were calculated. RESULTS: From 2005/2006 to 2010/2011, 5116 knee injuries occurred during 17,172,376 athlete exposures (AE) for an overall rate of 2.98 knee injuries per 10,000 AE. Knee injuries were more common in competition than in practice (rate ratio = 3.53, 95% confidence interval [CI] = 3.34-3.73). Football had the highest knee injury rate (6.29 per 10,000 AE) followed by girls' soccer (4.53) and girls' gymnastics (4.23). Girls had significantly higher knee injury rates than boys in sex-comparable sports (soccer, volleyball, basketball, baseball/softball, lacrosse, swimming and diving, and track and field; RR = 1.52, 95% CI = 1.39-1.65). The most commonly involved structure was the medial collateral ligament (reported in 36.1% of knee injuries), followed by the patella/patellar tendon (29.5%), anterior cruciate ligament (25.4%), meniscus (23.0%), lateral collateral ligament (7.9%), and posterior cruciate ligament (2.4%). Girls were significantly more likely to sustain anterior cruciate ligament injuries in sex-comparable sports (RR = 2.38, 95% CI = 1.91-2.95). Overall, 21.2% of knee injuries were treated with surgery; girls were more often treated with surgery than boys in sex-comparable sports (injury proportion ratio = 1.30, 95% CI = 1.11-1.53). CONCLUSIONS: Knee injury patterns differ by sport and sex. Continuing efforts to develop preventive interventions could reduce the burden of these injuries.

Epidemiology of 10,000 high school football injuries: patterns of injury by position played.

BACKGROUND: With more than 1.1 million high school athletes playing annually during the 2005-06 to 2009-10 academic years, football is the most popular boys' sport in the United States. METHODS: Using an internet-based data collection tool, RIO, certified athletic trainers (ATs) from 100 nationally representative US high schools reported athletic exposure and football injury data during the 2005-06 to 2009-10 academic years. RESULTS: Participating ATs reported 10,100 football injuries corresponding to an estimated 2,739,187 football-related injuries nationally. The injury rate was 4.08 per 1000 athlete-exposures (AEs) overall. Offensive lineman collectively (center, offensive guard, offensive tackle) sustained 18.3% of all injuries. Running backs (16.3%) sustained more injuries than any other position followed by linebackers (14.9%) and wide receivers (11.9%). The leading mechanism of injury was player-player contact (64.0%) followed by player-surface contact (13.4%). More specifically, injury occurred most commonly when players were being tackled (24.4%) and tackling (21.8%). CONCLUSIONS: Patterns of football injuries vary by position. Identifying such differences is important to drive development of evidence-based, targeted injury prevention efforts.

Epidemiology of United States high school sports-related fractures, 2008-09 to 2010-11.

BACKGROUND: High school athletes sustain millions of injuries annually, many of which are fractures. Fractures can severely affect athletes physically, emotionally, and financially and should be targeted with focused prevention methods. HYPOTHESIS: Patterns and primary mechanisms of fractures differ by sport and gender. STUDY DESIGN: Descriptive epidemiology study. METHODS: High school sports-related injury data were collected from academic years 2008-09 to 2010-11 for 18 sports and from 2009-10 to 2010-11 for 2 additional sports. We used linear regression to describe annual fracture rate trends and calculated fractures rates, rate ratios (RRs), and injury proportion ratios (IPRs). RESULTS: From 2008-09 to 2010-11, certified athletic trainers reported a total of 21,251 injuries during 11,544,455 athlete exposures (AEs), of which 2103 (9.9%) were fractures, with an overall rate of 1.82 fractures per 10,000 AEs. Fracture rates were highest in football (4.37 per 10,000 AE), boys' ice hockey (3.08), and boys' lacrosse (2.59). Boys sustained 79.1% of all fractures, and the overall rates of fractures were greater in boys' sports than in girls' sports for competition (RR, 2.82; 95% CI, 2.45-3.24) and practice (RR, 2.43; 95% CI, 2.07-2.86). The most commonly fractured body sites were the hand/finger (32.1%), lower leg (10.1%), and wrist (9.5%). Overall, 17.2% of fractures required surgery, which was higher than for all other injuries combined (IPR, 3.14; 95% CI, 2.81-3.52). The most common mechanism of fracture involved contact with another player (45.5%). Using linear regression, we found the proportion of all injuries that were fractures was inversely correlated with the athlete's age (P = .02) but was not correlated with the athletes' age- and gender-adjusted body mass index. CONCLUSION: Fractures are a significant problem for high school athletes. Targeted preventive interventions should be implemented to reduce the burdens these injuries cause the athletes.

Epidemiology of 6.6 million knee injuries presenting to United States emergency departments from 1999 through 2008.

BACKGROUND: While knee injuries are treated by a wide range of clinicians, patients with knee injuries frequently present to emergency departments (EDs). The knee is the most commonly injured joint by adolescent athletes with an estimated 2.5 million sports-related injuries presenting to EDs annually. OBJECTIVES: The objective was to examine the epidemiology of knee injuries presenting to EDs in the United States from 1999 through 2008. METHODS: The Consumer Product Safety Commission National Electronic Injury Surveillance System database (NEISS) was used to examine causes of knee injuries treated in U.S. EDs from 1999 through 2008. RESULTS: An estimated 6,664,324 knee injuries presented to U.S. EDs from 1999 through 2008, for a rate of 2.29 knee injuries per 1,000 population. Those 15 to 24 years of age had the highest injury rate (3.83), while children younger than 5 years had the lowest rate (0.55). The most common diagnoses were strains and sprains (42.1%), contusions and abrasions (27.1%), and lacerations and punctures (10.5%). The most common general product categories causing injury were sports and recreation (49.3%), home structures (30.2%), and home furnishings (13.6%). Several sex and age group differences were identified. For example, males sustained a higher proportion of basketball-related injuries (11.1%) than females (3.6%; injury proportion ratio [IPR] = 3.11, 95% confidence interval [CI] = 2.79 to 3.46, p < 0.001). Additionally, individuals 65 years and older sustained a higher proportion of injury due to stairs, ramps, landings, and floors (42.0%), compared to all other ages (20.1%; IPR = 2.09, 95% CI = 1.95 to 2.23, p < 0.001). CONCLUSIONS: Rates and patterns of knee injuries vary by sex and age. Although knee injuries will likely continue to occur most frequently among youth and young adult athletes, anticipating and responding to trends such as an increase in the incidence of knee injuries among adult and senior patients will enable clinicians to better anticipate caseloads, allocate resources, and determine best practices for diagnosis and treatment of knee injuries in different age groups.

Epidemiology of concussions among United States high school athletes in 20 sports.

BACKGROUND: In the United States (US), an estimated 300,000 sports-related concussions occur annually. Among individuals 15 to 24 years of age, sports are second only to motor vehicle crashes as the leading cause of concussions. PURPOSE: To investigate the epidemiology of concussions in high school athletes by comparing rates and patterns of concussion among 20 sports. STUDY DESIGN: Descriptive epidemiology study. METHODS: Using an Internet-based data collection tool, RIO, certified athletic trainers from a large, nationally disperse sample of US high schools reported athlete exposure and injury data for 20 sports during the 2008-2010 academic years. RESULTS: During the study period, 1936 concussions were reported during 7,780,064 athlete-exposures (AEs) for an overall injury rate of 2.5 per 10,000 AEs. The injury rate was higher in competition (6.4) than practice (1.1) (rate ratio [RR], 5.7; 95% confidence interval [CI], 5.2-6.3). The majority of concussions resulted from participation in football (47.1%, n = 912), followed by girls' soccer (8.2%, n = 159), boys' wrestling (5.8%, n = 112), and girls' basketball (5.5%, n = 107). Football had the highest concussion rate (6.4), followed by boys' ice hockey (5.4) and boys' lacrosse (4.0). Concussions represented a greater proportion of total injuries among boys' ice hockey (22.2%) than all other sports studied (13.0%) (injury proportion ratio [IPR], 1.7; 95% CI, 1.4-2.1; P < .01). In gender-comparable sports, girls had a higher concussion rate (1.7) than boys (1.0) (RR, 1.7; 95% CI, 1.4-2.0). The most common mechanisms of injury were player-player contact (70.3%) and player-playing surface contact (17.2%). In more than 40% of athletes in sports other than girls' swimming and girls' track, concussion symptoms resolved in 3 days or less. Athletes most commonly returned to play in 1 to 3 weeks (55.3%), with 22.8% returning in less than 1 week and 2.0% returning in less than 1 day. CONCLUSION: Although interest in sports-related concussions is usually focused on full-contact sports like football and ice hockey, concussions occur across a wide variety of high school sports. Concussion rates vary by sport, gender, and type of exposure. An understanding of concussion rates, patterns of injury, and risk factors can drive targeted preventive measures and help reduce the risk for concussion among high school athletes in all sports.