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 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.

The epidemiology of new versus recurrent sports concussions among high school athletes, 2005-2010.

OBJECTIVES: To compare new versus recurrent concussions with respect to constellation of symptoms, symptom severity, symptom resolution; evaluate potential subset differences with respect to gender and sport; and to compare mechanisms and activities associated with new versus recurrent concussions. METHODS: Sports-related injury and exposure data were collected for nine sports from 2005 to 2010 from 100 nationally representative US high schools. RESULTS: Nationally, an estimated 732,805 concussions occurred. Of these reported concussions, 13.2% were recurrent. The rate of new concussions was 22.2 per 100,000 athletic exposures while the rate of recurrent concussions was 3.1 per 100,000 athletic exposures (RR 7.23, 95% CI 6.39 to 8.17, p<0.001). While 0.6% of new concussion symptoms took >1 month to resolve, 6.5% of recurrent concussion symptoms took >1 month to resolve (IPR 10.35; 95% CI 4.62 to 23.16; p<0.001). Loss of consciousness was reported more often with recurrent (7.7%) than new concussions (4.4%) (IPR 1.76; 95% CI 1.02 to 3.03; p=0.043). A greater proportion of athletes sustaining recurrent concussions returned to play in >3 weeks (7.5%) or were medically disqualified (16.2%) than athletes sustaining new concussions (3.8%; IPR 1.95; 95% CI 1.01 to 3.77; p=0.047 and 2.9%; IPR 5.58; 95% CI 3.50 to 8.88; p<0.001, respectively). The majority of new and recurrent concussions resulted from contact with another person (73.4% and 77.9%, respectively). CONCLUSIONS: Athletes sustaining recurrent concussions had longer symptom resolution times, were kept out of play longer and reported loss of consciousness more frequently than athletes sustaining new concussions. With the possibility of long-term impairment and other negative sequelae, proper management and prevention of concussions at the high school level is imperative.