Cost of injuries from a prospective cohort study of North Carolina high school athletes.

OBJECTIVE: To estimate the economic cost of injuries in a population of US high school varsity athletes. DESIGN AND SETTING: The North Carolina High School Athletic Injury Study, conducted from 1996 to 1999, was a prospective cohort study of injury incidence and severity. A two-stage cluster sampling technique was used to select athletic teams from 100 high schools in North Carolina. An injury cost model was used to estimate the economic cost of injury. PARTICIPANTS: Varsity athletes from 12 sports: football, girls' and boy's soccer, girls' and boys' track, girls' and boy's basketball, baseball, softball, wrestling, volleyball, and cheerleading. MAIN OUTCOME MEASURES: Descriptive data were collected at the time of injury. Three types of costs were estimated: medical, human capital (medical costs plus loss of future earnings), and comprehensive (human capital costs plus lost quality of life). RESULTS: The annual statewide estimates were $9.9 million in medical costs, $44.7 million in human capital costs, and $144.6 million in comprehensive costs. The mean medical cost was $709 per injury (95% CI $542 to $927), $2223 per injury (95% CI $1709 to $2893) in human capital costs, and $10,432 per injury (95% CI $8062 to $13,449) in comprehensive costs. Sport and competition division were significant predictors of injury costs. CONCLUSIONS: Injuries among high school athletes represent a significant economic cost to society. Further research should estimate costs in additional populations to begin to develop cost-effective sports injury prevention programs.

Catastrophic injuries in pole-vaulters.

Pole vaulting is a unique sport in that athletes often land from heights ranging from 10 to 20 feet. We retrospectively reviewed 32 catastrophic pole-vault injuries that were reported to the National Center for Catastrophic Sports Injury Research between 1982 and 1998. The purpose of this study was to determine the mechanisms of injury so that preventive strategies can be implemented. Information was obtained by means of a telephone interview with someone familiar with the accident. All injuries occurred in male athletes at an average age of 17.5 years; 31 were catastrophic head injuries and 1 was a thoracic spine fracture that resulted in paraplegia. Three common mechanisms were identified: 17 (53%) athletes landed with their body on the landing pad and their head on the surrounding hard ground, 8 (25%) landed in the vault box after being stranded at the height of the jump, and 5 (16%) completely missed the landing pad. The mechanism of injury in the remaining two athletes was unknown. The accident resulted in death in 16 (50%) athletes and in permanent disability in 6 (19%). Increasing the minimum landing pad size and enforcing the rule requiring soft surfaces adjacent to the landing pads are the primary recommendations for preventing injuries. The authors discuss other rule and equipment changes that may help reduce the occurrence of future injuries.

Injuries in little league baseball from 1987 through 1996: implications for prevention.

UNLABELLED: Baseball is a very popular team sport in the United States, but there has been concern with the number of injuries and fatalities. OBJECTIVE: This study describes the incidence of injuries to Little League Baseball, Inc, players from 5 to 12 years old from 1987 through 1996. METHODS: Descriptive statistical analyses of injuries derived from Little League Baseball, Inc, insurance data from 17,221,210 player-years of follow-up in the 10-year study period. An average of 1,722,121 children participated every year. RESULTS: During the study, there were 29,038 injuries and an injury rate of 1.69 injuries per 1,000 participants per season. Ball-related injuries totaled 15,266, and batters had the greatest number of ball injuries. There were 12,306 facial and teeth injuries, mostly in defensive players. Sliding was associated with 60% of the injuries to base runners. Approximately 25% of the injuries were considered severe (fractures, dislocations, and concussions), and 13 players died. CONCLUSION: Based on the data, youth baseball appears to be a very safe sport, but there are areas where injury prevention is possible. Data and additional attention are needed concerning face mask use for players in the field, modified balls for minimizing contact injuries, education on sliding technique, and use of safety bases for runners.

Catastrophic football injuries: 1977-1998.

The primary purpose of this study was to investigate the occurrence of catastrophic football head and spine injuries, in an attempt to reduce their frequency. We analyzed epidemiological and medical data from 1977 through 1998. Catastrophic football injuries are defined as football injuries that result in death, brain or spinal cord injury, or cranial or spinal fracture. All studied cord injuries involved the cervical region. During the period covered by this study, 118 athletes died as a direct result of participation in the skills of football, 200 football players received a permanent cervical cord injury, and 66 sustained a permanent cerebral injury. Most cervical injuries occurred to defensive players during the act of tackling. The axial loading mechanism of spinal cord injury was identified in 27% of tackling injuries. To further reduce catastrophic injuries, players must stop tackling with the head down and using the head as a battering ram; instead, players should use the shoulder for blocking and tackling. Other recommendations for reducing catastrophic injuries are presented.

The North Carolina High School Athletic Injury Study: design and methodology.

PURPOSE: Organized interscholastic athletics are an integral part of the educational program at almost every school level. With this growing popularity of sports and their inclusion in more public school programs, it becomes increasingly apparent that additional consideration must be given to the injury problem associated with sport. The North Carolina High School Athletic Injury Study (NCHSAIS) was undertaken to identify patterns of injury among male and female athletes in North Carolina high schools participating in any of 12 sports. Specific aims are to measure the incidence, severity and etiology of injuries; to determine the relationship of demographic factors and protective equipment, exposure to play, and school characteristics to injuries; to study the relationship of coaches' training and experience to injury occurrence; and to compare the incidence and severity of injury among female and male athletes in the same or comparable sports. METHODS: A two-stage cluster sample of 100 high schools in North Carolina was selected for this 4-yr prospective study. RESULTS: Participation by the initial sample or a random replacement was achieved for 91 of the 100 schools. Nonresponse occurred at multiple levels of the sample for this study, and the weekly participation form posed the greatest respondent burden. CONCLUSIONS: The NCHSIAS offers a successful methodology for addressing sports injuries. In this paper we describe the design, methodology, and implementation issues that emerge in conducting a large scale epidemiological study in a population of high school athletes.

Fatalities and catastrophic injuries in high school and college sports, 1982-1997 lessons for improving safety.

The prohibition of 'spearing' in football and the rules regarding water depth and the racing dive in swimming are examples of how data on deaths and catastrophic injuries can be used to help promote the safety of young athletes. Other preventive measures supported by research include anchoring movable soccer goals to prevent tipping, improved training for high school wrestling coaches, increased awareness of pathogenic weight control in wrestling and gymnastics, rules against pushing or checking from behind in ice hockey, protective helmets for batting-practice pitchers in baseball, and barriers around the discus circle in track and field.

Fatalities from head and cervical spine injuries occurring in tackle football: 50 years' experience.

Football head and cervical spine fatalities have been related to 84.9% of all football fatalities from 1945 through 1994. The decade from 1965 through 1974 was responsible for the greatest number and percentage of head and cervical spine fatalities, and the two decades from 1975 through 1994 were associated with the smallest number and percentage. The data reveal that most head and cervical spine fatalities are related to high school football players either tackling or being tackled in a game. Most head fatalities are subdural hematomas, and almost all of the cervical spine fatalities are fractures, dislocations, or fracture-dislocations. There has been a dramatic reduction in these types of fatalities during the last two decades, 1975 through 1994, and the preventive measures that have received most of the credit have been the 1976 rule change that prohibits initial contact with the head and face when blocking and tackling, the NOCSAE helmet standard that went into effect in colleges in 1978 and high schools in 1980, better coaching in the techniques of blocking and tackling, and improved medical care. There has been a reduction of head and cervical spine fatalities, but the analysis of data for the next decade, 1995 through 2004, will reveal the continued effects of the preventive measures discussed and continued research efforts. A number of researchers have stated that in order for the head and cervical spine fatalities to continue decreasing, there must be increased helmet research with an emphasis on concussions and neck injuries. Will the number of fatalities continue to decrease? Only time will tell.

Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles.

OBJECTIVE: To develop clinical, demographic, and pathological profiles of young competitive athletes who died suddenly. DESIGN: Systematic evaluation of clinical information and circumstances associated with sudden deaths; interviews with family members, witnesses, and coaches; and analyses of postmortem anatomic, microscopic, and toxicologic data. PARTICIPANTS AND SETTING: A total of 158 sudden deaths that occurred in trained athletes throughout the United States from 1985 through 1995 were analyzed. MAIN OUTCOME MEASURES--Characteristics and probable cause of death. RESULTS: Of 158 sudden deaths among athletes, 24 (15%) were explained by noncardiovascular causes. Among the 134 athletes who had cardiovascular causes of sudden death, the median age was 17 years (range, 12-40 years), 120 (90%) were male, 70 (52%) were white, and 59 (44%) were black. The most common competitive sports involved were basketball (47 cases) and football (45 cases), together accounting for 68% of sudden deaths. A total of 121 athletes (90%) collapsed during or immediately after a training session (78 cases) or a formal athletic contest (43 cases), with 80 deaths (63%) occurring between 3 PM and 9 PM. The most common structural cardiovascular diseases identified at autopsy as the primary cause of death were hypertrophic cardiomyopathy (48 athletes [36%]), which was disproportionately prevalent in black athletes compared with white athletes (48% vs 26% of deaths; P = .01), and malformations involving anomalous coronary artery origin (17 athletes [13%]). Of 115 athletes who had a standard preparticipation medical evaluation, only 4 (3%) were suspected of having cardiovascular disease, and the cardiovascular abnormality responsible for sudden death was correctly identified in only 1 athlete (0.9%). CONCLUSIONS: Sudden death in young competitive athletes usually is precipitated by physical activity and may be due to a heterogeneous spectrum of cardiovascular disease, most commonly hypertrophic cardiomyopathy. Preparticipation screening appeared to be of limited value in identification of underlying cardiovascular abnormalities.

Blunt impact to the chest leading to sudden death from cardiac arrest during sports activities.

BACKGROUND: Sudden death from cardiac arrest in a young person may occur during sports play after a blunt blow to the chest in the absence of structural cardiovascular disease or traumatic injury (cardiac concussion or commotio cordis). We studied the clinical features of this apparently uncommon but important phenomenon. METHODS: We identified cases from the registries of relevant agencies and organizations, as well as newsmedia accounts, and developed a clinical profile of 25 children and young adults, 3 to 19 years of age. RESULTS: Each victim collapsed with cardiac arrest immediately after an unexpected blow to the chest, which was usually inflicted by a projectile (such as a baseball or hockey puck). Incidents took place during organized competitive sports in 16 cases and in recreational settings at home, at school, or on the playground in 9. In each instance, the impact to the chest was not judged to be extraordinary for the sport involved and did not appear to have sufficient force to cause death. Twelve victims collapsed virtually instantaneously on impact, whereas 13 remained conscious and physically active for a brief time before cardiac arrest. Cardiopulmonary resuscitation was administered within about three minutes to 19 victims, but normal cardiac rhythm could be restored in only 2 (both incurred irreversible brain damage and died shortly thereafter). Seven victims (28 percent) were wearing some form of protective chest padding. CONCLUSIONS: We speculate that most sudden deaths related to impact to the chest (not associated with traumatic injury) are due to ventricular dysrhythmia induced by an abrupt, blunt precordial blow, presumably delivered at an electrically vulnerable phase of ventricular excitability. This profile of blunt chest impact leading to cardiac arrest adds to our understanding of the range of causes of sudden death on the athletic field and may help in the development of preventive measures.

Nontraumatic sports death in high school and college athletes.

Nontraumatic deaths occur each year in organized high school and college athletics, resulting in considerable public concern. We conducted a study of the frequency and causes of nontraumatic sports deaths in high school and college athletes in the USA through the National Center for Catastrophic Sports Injury Research to define the magnitude of this problem and its causes. Over a 10-yr period, July 1983-June 1993, nontraumatic sports deaths were reported in 126 high school athletes (115 males and 11 females) and 34 college athletes (31 males and 3 females). Estimated death rates in male athletes were fivefold higher than in female athletes (7.47 vs 1.33 per million athletes per year, P < 0.0001), and twofold higher in male college athletes than in male high school athletes (14.50 vs 6.60 per million athletes per year, P < 0.0001). Cardiovascular conditions were more common causes of death than noncardiovascular conditions. Hypertrophic cardiomyopathy and congenital coronary artery anomalies were the most common causes of death. In high school and college athletes, males are at increased risk for nontraumatic sports deaths compared with females even after adjustment for participation frequency; college males are at greater risk than high school males. In all groups the deaths were primarily due to cardiovascular conditions.

Catastrophic injuries and fatalities in high school and college sports, fall 1982-spring 1988.

Direct and indirect deaths and catastrophic injuries, defined as any injury incurred during participation in a high school/college sponsored sport in which there is permanent severe functional neurological disability (nonfatal) or transient but not permanent functional neurologic disability (serious), are presented for all sports during the period of fall 1982 to spring 1988. Football contributed the greatest numbers of catastrophic injuries but also had the largest number of participants. Ice hockey, gymnastics, and wrestling are the other sports where participants are at greatest risk of catastrophic injury or death. Mechanisms of injury in each sport and corrective actions are identified and discussed. While high school and college catastrophic injuries may never be totally eliminated, they can be dramatically reduced by reliable injury data collection and analysis.

Catastrophic spine injuries in football (1977-1989).

Funded by the National Collegiate Athletes Association, the purpose of the National Center for Catastrophic Sports Injury Research is to reduce catastrophic injuries of the head and neck by analyzing the epidemiologic and medical data, and then recommending appropriate rules, conditioning, and medical changes. Catastrophic cervical spine injuries are defined as those that result in spinal cord injury. All cases result in disability. Deaths are excluded from this report. A total of 128 players incurred permanent cervical cord injuries from 1977 through 1989. Defensive players are at greater risk for quadriplegia than offensive players are, and most are injured while tackling. To further reduce catastrophic spine injuries, players must stop using the head as a battering ram, and use the shoulder for blocking and tackling instead. Other recommendations for reducing catastrophic spine injuries are presented.

Catastrophic Spine Injuries in Football.

In brief: Catastrophic spine injuries among football players are decreasing, according to data furnished by the National Collegiate Athletic Association. A total of 105 players incurred permanent cervical cord injuries from 1977 through 1987, with 13 such injuries in 1980 and only seven in 1987. Defensive players are at greater risk for quadriplegia than offensive players, and most are injured while tackling. To further reduce catastrophic spine injuries, players must stop using the head as a battering ram and use the shoulder for blocking and tackling instead.

Fatalities from head and cervical spine injuries occurring in tackle football: 40 years' experience.

Football head and cervical spine fatalities have been related to 84.6 per cent of all football fatalities from 1945 through 1984. The decade from 1965 through 1974 was responsible for the greatest number and percentage of head and cervical spine fatalities, and the decade from 1975 through 1984 was associated with the smallest number and percentage. The data reveal that the majority of head and cervical spine fatalities are related to high-school football players either tackling or being tackled in a game. The majority of head fatalities are subdural hematomas, and almost all of the cervical spine fatalities are fractures, dislocations, or fracture-dislocations. There has been a dramatic reduction in these types of fatalities during the last decade, 1975 through 1984, and the preventive measures that have received most of the credit have been the 1976 rule change that prohibits initial contact with the head and face when blocking and tackling, the NOCSAE helmet standard that went into effect in colleges in 1978 and high schools in 1980, better coaching in the techniques of blocking and tackling, and improved medical care. There has been a reduction of head and cervical spine fatalities, but the analysis of data for the next decade, 1985 through 1994, will reveal the effects of the preventive measures discussed and continued research efforts.

An Update on Football Deaths and Catastrophic Injuries.

In brief: The latest data on football deaths and injuries at the college, high school, and youth league levels show that seven direct fatalities and seven permanent cervical cord injuries occurred in 1985, for an incidence in each category of 0.44 per 100,000 players. Direct fatalities have been in single digits for eight years, and the total for the 1975 to 1984 period was significantly lower than for the preceding decade (83 vs 204). Overall, the latest figures indicate a continued decline in football deaths and catastrophic injuries, which is credited to a ban on spearing and to a helmet standard, Guidelines for prevention of fatalities and catastrophic injuries are listed.

[An ophthalmological cautery (author's transl)]. / Ein ophthalmologischer Mikrokauter.

A microcautery specially developed for ophthalmological procedures--in contrast to the cauteries commonly used in ophthalmology--is described. It is a foot-operated unit controlled by the surgeon or his assistant. The power settings for the cautery tip are designed to permit easy selection of optimum current flow. The pre-selected cautery temperature is not affected by switching on and off or by the cautery tip becoming red-hot. There is a continuous audible signal as long as power is reaching the cautery tip. The device has been in use for three years without giving trouble.