Epidemiology of National Collegiate Athletic Association Women's Lacrosse Injuries, 2009-10 Through 2014-15.

CONTEXT: Participation in collegiate women's lacrosse has increased dramatically, but little recent epidemiological data exists regarding injuries. OBJECTIVE: Describe the epidemiology of National Collegiate Athletic Association (NCAA) women's lacrosse injuries during the 2009-10 through 2014-15 academic years. SETTING: Aggregate injury and exposure data collected from 40 women's lacrosse programs providing 83 team-seasons of data. PATIENTS OR OTHER PARTICIPANTS: Collegiate women's lacrosse student-athletes. INTERVENTION: Women's lacrosse data from the NCAA Injury Surveillance Program were analyzed. MAIN OUTCOME MEASURES: Injury rates; injury rate ratios; and injury proportions by body site, diagnosis, and injury mechanism were reported with 95% confidence intervals (CI). Time loss (TL) injuries resulted in participation restriction time of at least 24 hours. Nontime loss (NTL) injuries resulted in participation restriction time under 24 hours. RESULTS: There were 705 TL and NTL women's lacrosse injuries, resulting in an injury rate of 4.93/1000 athlete-exposures (AEs; 95% CI: 4.57-5.30). The TL and NTL injury rates were 2.18/1000 AE (95% CI: 1.93-2.42) and 2.64/1000 AE (95% CI: 2.37-2.90), respectively. Most injuries were to the lower extremity (competition: 64.4%; practice: 71.2%). Most injuries in competition were sprains (26.0%), contusions (19.6%), and strains (19.2%); most injuries in practice were strains (21.4%), sprains (18.1%), and inflammatory conditions (15.8%). Concussions comprised the highest proportion of head/face injuries (competition: 82.1%; practice: 54.5%). No eye injuries were reported. The highest proportion of injuries were player contact (27.4%) in competitions and noncontact (32.1%) in practices. Contact with the ball and stick comprised 21.5% of competition and 14.0% of practice injuries. CONCLUSIONS: This study is the most robust assessment of collegiate women's lacrosse injuries to date, utilizing surveillance data that includes both TL and NTL injuries. Over half of all injuries were NTL; inclusion of such injuries further highlights the breadth of injuries managed by team medical staff.

Collegiate ACL Injury Rates Across 15 Sports: National Collegiate Athletic Association Injury Surveillance System Data Update (2004-2005 Through 2012-2013).

OBJECTIVE: To present data on the rate of anterior cruciate ligament (ACL) injury in 15 collegiate sports from 2004 to 2005 through 2012 to 2013 updating the 1988-1989 to 2003-2004 data. DESIGN: Prospectively designed descriptive epidemiology study. SETTING: National Collegiate Athletic Association Schools. PARTICIPANTS: National Collegiate Athletic Association School athletes. MAIN OUTCOME MEASURE: Injury rate by year and sport. RESULTS: Most ACL injuries to women occurred by a noncontact mechanism (60%) versus a contact mechanism for men (59%). The highest average annual rate of ACL injury for men was found in football (0.17 per 1000 athlete-exposure [A-E]). The highest average annual rate of ACL injury for women was found in lacrosse (0.23 per 1000 A-E). There were statistically significant increases in average annual injury rate for men's (P = 0.04) and women's soccer (P = 0.01) and a statistically significant decrease in women's gymnastics over the 9 years (=0.009). Controlling for exposures, there were statistically significant increases in the average annual number of injuries for men's and women's basketball, ice hockey, field hockey, football, and volleyball and a decrease in the average annual number of injuries for baseball and women's gymnastics. Women continue to sustain ACL injuries at higher rates than men in the comparable sports of soccer, basketball, and lacrosse. CONCLUSIONS: Anterior cruciate ligament injury rates continue to rise in men's and women's soccer. Some sports have shown absolute increases in ACL rates, which persist even after exposure rates are taken into account. CLINICAL RELEVANCE: Despite extensive research and development of prevention programs before and during the time of this study, very few sports showed a reduction in ACL injury rates in this data set.

College Sports-Related Injuries - United States, 2009-10 Through 2013-14 Academic Years.

Sports-related injuries can have a substantial impact on the long-term health of student-athletes. The National Collegiate Athletic Association (NCAA) monitors injuries among college student-athletes at member schools. In academic year 2013-14, a total of 1,113 member schools fielded 19,334 teams with 478,869 participating student-athletes in NCAA championship sports (i.e., sports with NCAA championship competition) (1). External researchers and CDC used information reported to the NCAA Injury Surveillance Program (NCAA-ISP) by a sample of championship sports programs to summarize the estimated national cumulative and annual average numbers of injuries during the 5 academic years from 2009-10 through 2013-14. Analyses were restricted to injuries reported among student-athletes in 25 NCAA championship sports. During this period, 1,053,370 injuries were estimated to have occurred during an estimated 176.7 million athlete-exposures to potential injury (i.e., one athlete's participation in one competition or one practice). Injury incidence varied widely by sport. Among all sports, men's football accounted for the largest average annual estimated number of injuries (47,199) and the highest competition injury rate (39.9 per 1,000 athlete-exposures). Men's wrestling experienced the highest overall injury rate (13.1 per 1,000) and practice injury rate (10.2 per 1,000). Among women's sports, gymnastics had the highest overall injury rate (10.4 per 1,000) and practice injury rate (10.0 per 1,000), although soccer had the highest competition injury rate (17.2 per 1,000). More injuries were estimated to have occurred from practice than from competition for all sports, with the exception of men's ice hockey and baseball. However, injuries incurred during competition were somewhat more severe (e.g., requiring ≥7 days to return to full participation) than those acquired during practice. Multiple strategies are employed by NCAA and others to reduce the number of injuries in organized sports. These strategies include committees that recommend rule and policy changes based on surveillance data and education and awareness campaigns that target both athletes and coaches. Continued analysis of surveillance data will help to understand whether these strategies result in changes in the incidence and severity of college sports injuries.

Epidemiology of National Collegiate Athletic Association Women's Gymnastics Injuries, 2009-2010 Through 2013-2014.

CONTEXT: Recent injury-surveillance data for collegiate-level women's gymnastics are limited. In addition, researchers have not captured non-time-loss injuries (ie, injuries resulting in restriction of participation <1 day). OBJECTIVE: To describe the epidemiology of National Collegiate Athletic Association (NCAA) women's gymnastics injuries during the 2009-2010 through 2013-2014 academic years. DESIGN: Descriptive epidemiology study. SETTING: Aggregate injury and exposure data collected from 11 women's gymnastics programs providing 28 seasons of data. PATIENTS OR OTHER PARTICIPANTS: Collegiate student-athletes participating in women's gymnastics during the 2009-2010 through 2013-2014 academic years. INTERVENTION(S): Women's gymnastics data from the NCAA Injury Surveillance Program (ISP) during the 2009-2010 through 2013-2014 academic years were analyzed. MAIN OUTCOME MEASURE(S): Injury rates; injury rate ratios; injury proportions by body site, diagnosis, and apparatus; and injury proportion ratios were reported with 95% confidence intervals (CIs). RESULTS: The ISP captured 418 women's gymnastics injuries, a rate of 9.22/1000 athlete-exposures (AEs; 95% CI = 8.33, 10.10). The competition injury rate (14.49/1000 AEs) was 1.67 times the practice injury rate (8.69/1000 AEs; 95% CI = 1.27, 2.19). When considering time-loss injuries only, the injury rate during this study period (3.62/1000 AEs) was lower than rates reported in earlier NCAA ISP surveillance data. Commonly injured body sites were the ankle (17.9%, n = 75), lower leg/Achilles tendon (13.6%, n = 57), trunk (13.4%, n = 56), and foot (12.4%, n = 52). Common diagnoses were ligament sprain (20.3%, n = 85) and muscle/tendon strain (18.7%, n = 78). Overall, 12.4% (n = 52) of injuries resulted in time loss of more than 3 weeks. Of the 291 injuries reported while a student-athlete used an apparatus (69.6%), most occurred during the floor exercise (41.9%, n = 122) and on the uneven bars (28.2%, n = 82). CONCLUSIONS: We observed a lower time-loss injury rate for women's gymnastics than shown in earlier NCAA ISP surveillance data. Safety initiatives in women's gymnastics, such as "sting mats," padded equipment, and a redesigned vault table, may have contributed to minimizing the frequency and severity of injury.

National collegiate athletic association injury surveillance system: review of methods for 2004-2005 through 2013-2014 data collection.

BACKGROUND: Since 1982, the National Collegiate Athletic Association has used the Injury Surveillance System (ISS) to collect injury and athlete-exposure data from a representative sample of collegiate institutions and sports. At the start of the 2004-2005 academic year, a Web-based ISS replaced the paper-based platform previously used for reporting injuries and exposures. OBJECTIVE: To describe the methods of the Web-based National Collegiate Athletic Association ISS for data collection as implemented from the 2004-2005 to 2013-2014 academic years. DESCRIPTION: The Web-based ISS monitored National Collegiate Athletic Association-sanctioned practices and competitions, the number of participating student-athletes, and time-loss injuries during the preseason, regular season, and postseason in 25 collegiate sports. Starting in the 2009-2010 academic year, non-time-loss injuries were also tracked. Efforts were made to better integrate ISS data collection into the workflow of collegiate athletic trainers. Data for the 2004-2005 to 2013-2014 academic years are available to researchers through a standardized application process available at the Datalys Center Web site. CONCLUSIONS: As of February 2014, more than 1 dozen data sets have been provided to researchers. The Datalys Center encourages applications for access to the data.

Pathogeneses of sudden cardiac death in national collegiate athletic association athletes.

BACKGROUND: The pathogenesis of sudden cardiac death in college athletes has not been defined by systematic case identification. METHODS AND RESULTS: A total of 45 cases of sudden cardiac death were identified in National Collegiate Athletic Association (NCAA) athletes from 2004 to 2008 based on an internal reporting system and review of media reports. Autopsy reports were reviewed and adjudicated by a multidisciplinary panel. Cause of death could be reasonably determined in 36 cases; 3 athletes had no autopsy, 5 autopsy reports could not be obtained, and 1 autopsy had insufficient information to determine cause of death. The most common finding at death was a structurally normal heart or autopsy-negative sudden unexplained death (11, 31%), followed by coronary artery abnormalities (5, 14%), dilated cardiomyopathy (3, 8%), myocarditis related (3, 8%), aortic dissection (3, 8%), and idiopathic left ventricular hypertrophy/possible hypertrophic cardiomyopathy (HCM; 3, 8%). There was 1 case each (3%) of hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, long QT syndrome, commotio cordis, and Kawasaki disease. There was 1 case of death in a sickle cell positive athlete who also had left ventricular hypertrophy. The adjudicated diagnosis agreed with the official pathology report in only 59% of cases. CONCLUSIONS: Unexplained death with a structurally normal heart is the most common finding after suspected sudden cardiac death in NCAA athletes. Hypertrophic cardiomyopathy is infrequently seen, and conclusions in autopsy reports may not accurately reflect the pathological findings. Standardized protocols for cardiovascular autopsies in athletes are needed, including postmortem genetic testing, particularly in autopsy-negative cases.

Motor vehicle accidents: the leading cause of death in collegiate athletes.

OBJECTIVE: To report the leading cause of death in National Collegiate Athletic Association (NCAA) athletes. DESIGN: Retrospective analysis from January 2004 to December 2008. SETTING: NCAA institutions. PARTICIPANTS: Collegiate athletes. ASSESSMENT OF RISK FACTORS: NCAA divisions, sport, gender, and race. MAIN OUTCOME MEASURES: Mortality. RESULTS: During the 5-year period, there were 273 deaths and a total of 1 969 663 athlete participation-years. Of these 273 deaths, 145 (53%) were due to accidents or unintentional injury, 45 (16%) from cardiac arrest, 25 (9%) suicides, and 18 (6%) homicides. The rate of death due to accidents was 7.36/100 000 participants per year. Motor vehicle accidents accounted for 100 accidents (69%). There was no significant difference in accident rates between NCAA divisions. Accidents were twice as likely in men compared with women (P < 0.0001). There was no significant difference in the accident rates in white versus black athletes. Although accidents usually occurred more frequently in the general population (5-fold) compared with NCAA athletes, certain athlete subgroups (Division I wrestling, Divisions I and II basketball, and Divisions I and II football) seem to be high-risk populations with death rates that were no different than the general population. This suggests that these athletes may engage in higher risk behaviors compared with other sporting subgroups. CONCLUSIONS: Motor vehicle accidents are the most common cause of sudden death in athletes across NCAA divisions, gender, race, and sport. Medical teams and institutions should design (1) effective safety prevention programs, and (2) catastrophic incident plans that can be implemented in the event of such tragedies.

Sickle cell trait associated with a RR of death of 37 times in National Collegiate Athletic Association football athletes: a database with 2 million athlete-years as the denominator.

BACKGROUND: This study examines sickle cell trait (SCT) as a cause of sudden death in National Collegiate Athletic Association (NCAA) athletes and explores the cost-effectiveness of different screening models. METHODS: The authors reviewed the cause of all cases of sudden death in NCAA student-athletes from January 2004 through December 2008. The authors also explored the cost-effectiveness of screening for this condition in selected populations assuming that identifying athletes with SCT would prevent death. RESULTS: There were 273 deaths and a total of 1 969 663 athlete-participant-years. Five (2%) deaths were associated with SCT. In football athletes, there were 72 (26%) deaths. Of these, 52 (72%) were due to trauma unrelated to sports activity and 20 (28%) were due to medical causes; nine deaths were cardiac (45%), five were associated with SCT (25%). Thirteen of the 20 deaths due to medical causes occurred during exertion; cardiac (6, 46%) SCT associated (5, 39%), and heat stroke unrelated to SCT (2, 15%). All deaths associated with SCT occurred in black Division I football athletes. The risk of exertional death in Division I football players with SCT was 1:827 which was 37 times higher than in athletes without SCT. The cost per case identified varied widely depending on the population screened and the price of the screening test. CONCLUSIONS: Exertional death in athletes with SCT occurs at a higher rate than previously appreciated. More research is needed to (1) understand the pathophysiology of death in SCT-positive athletes and (2) determine whether screening high-risk populations reduces mortality.

Incidence of sudden cardiac death in National Collegiate Athletic Association athletes.

BACKGROUND: The true incidence of sudden cardiac death (SCD) in US athletes is unknown. Current estimates are based largely on case identification through public media reports and estimated participation rates. The purpose of this study was to more precisely estimate the incidence of SCD in National Collegiate Athletic Association (NCAA) student-athletes and assess the accuracy of traditional methods for collecting data on SCD. METHODS AND RESULTS: From January 2004 through December 2008, all cases of sudden death in NCAA student-athletes were identified by use of an NCAA database, weekly systematic search of public media reports, and catastrophic insurance claims. During the 5-year period, there were 273 deaths and a total of 1 969 663 athlete participant-years. Of these 273 deaths, 187 (68%) were due to nonmedical or traumatic causes, 80 (29%) to medical causes, and 6 (2%) to unknown causes. Cardiovascular-related sudden death was the leading cause of death in 45 (56%) of 80 medical cases, and represented 75% of sudden deaths during exertion. The incidence of SCD was 1:43 770 participants per year. Among NCAA Division I male basketball players, the rate of SCD was 1:3100 per year. Thirty-nine (87%) of the 45 cardiac cases were identified in the NCAA database, only 25 (56%) by use of public media reports, and 9 (20%) from catastrophic claims data. CONCLUSIONS: SCD is the leading medical cause of death and death during exercise in NCAA student-athletes. Current methods of data collection underestimate the risk of SCD. Accurate assessment of SCD incidence is necessary to shape appropriate health policy decisions and develop effective strategies for prevention.

NCAA rule change improves weight loss among national championship wrestlers.

PURPOSE: The present investigation was initiated to examine the weight management practices among wrestlers participating in the NCAA Division I, II, and III wrestling tournaments. Part 1 examined the efficacy of body composition assessment between preseason (PRE) and postseason (POST). Part 2 examined rapid weight loss (RWL) during the 20 h preceding the weigh-in and the rapid weight gained (RWG) during the first day's competition. METHODS: Subjects include 811 competitors from Divisions I, II, and III participating in the NCAA national championship tournaments between 1999 and 2004. Measurements included relative body fatness (% BF) and weight (WT) on the day preceding the tournament and the evening of the first day. Minimal weight (MW) was computed with 5% BF. Retrospectively, MW, % BF, and WT from the previous fall were obtained for comparisons from NCAA records. RESULTS: Part 1: WT and % BF decreased significantly PRE (WT 74.0 +/- 11.1 kg; % BF 12.3 +/- 3.4%) to POST (WT 71.5 +/- 10.4 kg; % BF 9.5 +/- 1.8%), but MW (PRE MW 68.0 +/- 9.2 kg, POST MW 67.9 +/- 9.1 kg) remained unchanged. Heavier wrestlers and Division I and II wrestlers showed the greatest changes in WT and % BF. Part 2: RWL averaged (+/- SD) 1.2 +/- 0.9 kg and relative to weight 1.7 +/- 1.2%. Division I and lighter wrestlers showed the greatest change. RWG averaged 0.9 +/- 0.8 kg, or 1.3 +/- 1.2%. RWG was greater among lighter and Division I and II wrestlers. CONCLUSIONS: Minimal weight estimates PRE appear valid compared with POST. RWL and RWG are reduced significantly over previous investigations with only mat-side weigh-ins. The NCAA weight management program appears effective in reducing unhealthy weight cutting behaviors and promoting competitive equity. Efforts to institute similar programs among younger wrestlers seem warranted.