Injury Proportion Ratios Research Articles

Epidemiology of injuries in united states high school track and field jumping events from 2008 – 2019

ABSTRACT Objectives Reports of injury characteristics of high school track and field athletes participating in jumping events in the United States are limited. In this descriptive epidemiological study, we report injury rates and patterns in these athletes. Methods Injuries and athletic exposures (AE) from the National High School Sports Related Injury Surveillance System, and High School Reporting Information Online (RIO) from 2008-2019 were analyzed. Jumping events included high jump, long jump, triple jump, and pole vault. Injury rate ratios (IRR) and injury proportion ratios (IPR) were examined by sex. Results A total of 727 injuries related to jumping events during 5,486,279 AEs occurred with the highest frequency at the thigh (20.3%) followed by the ankle (18.2%), knee (16.1%), and lower leg (11.0%). The most common types of injuries were muscle strain (29.0%) and ligament sprain (21.2%). Most athletes returned to sport within 1 week (43.1%, n = 312) or 3 weeks (34.7%, n = 243). Few jumping-related injuries resulted in surgery (4.9%, n = 35) or medical disqualification (4.4%, n = 31). The jumping-related injury rate was 1.33 injuries/10,000 AEs from 2008 to 2019. The rate of jumping-related injuries was higher in competition than in practice (IRR = 2.63, 95% confidence interval [CI]: 2.25–3.06). Injury rates were significantly higher in practice for female athletes than for males (IRR = 1.51, 95% CI: 1.23–1.86). Compared to male athletes, female athletes sustained a higher proportion of ankle injuries (IPR = 1.63, 95% CI: 1.15–2.32) and ligament sprains (IPR = 1.55, 95% CI: 1.16–2.09). Conclusions This study describes injury characteristics of high school track and field jumping athletes from 2008 to 2019. We found an overall injury rate of 1.33 injuries per 10,000 AEs. Higher overall rates of jumping-related injuries occurred during competitions than in practice, and female athletes displayed a significantly higher rate of injuries during practices compared to male athletes.

Sex Differences Across Concussion Characteristics in US Service Academy Cadets: A CARE Consortium Study.

To describe sex differences in concussion characteristics in US Service Academy cadets. Descriptive epidemiology study. Four US service academies. 2209 cadets (n = 867 females, n = 1342 males). Sex. Injury proportion ratios (IPR) compared the proportion of injuries by sex (females referent) for injury situation, certainty of diagnosis, prolonged recovery, recurrent injuries, mental status alterations, loss of consciousness (LOC), posttraumatic amnesia (PTA), retrograde amnesia (RGA), motor impairments, delayed symptom presentation, and immediate reporting. Concussions from varsity/intercollegiate sports [IPR of 1.73, 95% confidence interval (CI) 1.43-2.10] and intramurals (IPR of 1.53, 95% CI 1.02-2.32) accounted for a larger proportion in males, whereas concussions outside of sport and military activities accounted for a smaller proportion among males (IPR of 0.70, 95% CI 0.58-0.85). The proportion of concussions with prolonged recovery was lower among males (IPR of 0.69, 95% CI 0.60-0.78), while concussions with altered mental status (IPR of 1.23, 95% CI 1.09-1.38), LOC (IPR of 1.67, 95% CI 1.17-2.37), PTA (IPR of 1.94, 95% CI 1.43-2.62), and RGA (IPR of 2.14, 95% CI 1.38-3.31) accounted for a larger proportion among males. A larger proportion of concussions that were immediately reported was observed in males (IPR of 1.15, 95% CI 1.00-2.31). Proportions of other characteristics (e.g., recurrent injuries) were not different between sexes. A higher proportion of concussions occurred outside of sport and military training for female cadets, who also displayed proportionally longer recovery times than males, despite males demonstrating a higher proportion of LOC, PTA, and RGA. Possible factors may include different mechanisms of injury outside of sport and military training, different biopsychosocial states associated with sex or injury context, and delayed injury reporting when outside of an observed environment, possibly secondary to perceived stigma about reporting injuries.

Body Checking Injuries in National Collegiate Athletic Association Men's Ice Hockey: Findings From the NCAA Injury Surveillance Program 2009/10 to 2019/20.

To describe the epidemiology of body checking injuries in the National Collegiate Athletic Association (NCAA) Men's Ice Hockey. Secondary data analysis of historical cohort data. A convenience sample of injuries in NCAA Men's Ice Hockey during the 2009/10 to 2019/20 academic years. NCAA student-athletes. Event type, season, time loss, body part, diagnosis, player position, and mechanism. This study examined injuries that occurred during practice or competition, regardless of time loss, reported to the NCAA Injury Surveillance Program. Injury counts, rates, and proportions were used. The injury rate and proportion ratios with 95% confidence intervals were also constructed. Three independent logistic regression models were constructed to examine differential odds of time loss (≥1 day; TL) injury and the 2 most common injuries, between body checking injuries and all other injuries. Overall, 1290 body checking injuries (rate = 1.59/1000 athlete-exposures) were reported during the study period. Most were attributed to the upper extremity (42%) or head/neck (27%). The competition injury rate generally decreased after 2012/13. After adjusting for covariates, odds of (1) a TL injury was lower and (2) an acromioclavicular sprain was higher among body checking injuries as compared with injuries attributed to all other activities. Odds of concussion was not associated with body checking injuries. Body checking injuries were frequently attributed to the head/neck and upper extremities, and the rate of these injuries during competition appeared to be decreasing. Still, improvements in helmet and shoulder pad technology may further improve health and safety.

Epidemiology of Hamstring Tears in National Collegiate Athletic Association Athletes: Findings From the National Collegiate Athletic Association Injury Surveillance Program Between 2014/2015 and 2018/2019.

To describe the epidemiology of hamstring tears in National Collegiate Athletic Association (NCAA) sports. Descriptive epidemiology study. Athletic trainers from NCAA schools reported injuries to the NCAA Injury Surveillance Program. A convenience sample of NCAA hamstring tear injuries during the 2014/2015 through 2018/2019 academic years. NCAA student-athletes. Sport, sex, event type, season segment, injury history, and activity at the time of injury. Injury counts, rates, and proportions were used. Two thousand ninety-six hamstring tears from 8 474 400 athlete-exposures (AEs) were reported (2.47 per 10 000 AEs). Rates were highest in Men's Soccer (5.97 per 10 000 AEs) and Women's Soccer (3.13 per 10 000 AEs), among all Men's and Women's sports, respectively. Competition-related rates in Men's and Women's sports were highest in 2015 to 2016 then followed a decreasing pattern across the remainder of the study period. Among sex-comparable sports, rates were higher in men's (compared with women's) Baseball/Softball, Soccer, and Track and Field. The prevalence of recurrent injuries was comparable among men's (14.8%) and women's (11.5%) sports. Time loss hamstring tears were more prevalent in Men's sports than Women's sports [injury proportion ratio = 1.33; 95% confidence interval, (1.21, 1.47)]. Overall, hamstring tear rates were higher across all Men's sports compared with Women's sports. Rates across event type were comparable in several sports; and so, adjustments to practice are needed considering that practice environments are more modifiable than competitions. Indeed, improving hamstring tear prevention programs to reduce the burden of this injury in NCAA athletes remains critical.

Epidemiology of injuries in U.S. high school track and field throwing events from 2008 to 2019.

Injury characteristics of high school track and field throwing athletes in the United States are not well studied. Understanding epidemiology of injuries is important to identify treatment and prevention strategies. To describe injury rates and patterns in U.S. high school track and field throwing events from a longitudinal national sports injury surveillance system. Descriptive epidemiology study. Data were provided by the National High School Sports Related Injury Surveillance System, High School RIO (Reporting Information Online). Athletic trainers reported injury and exposure data through the High School RIO website on a weekly basis. An athlete exposure (AE) was defined as one athlete participating in one school-sanctioned practice or competition. Throwing events of discus, shot put, and javelin were analyzed in this study. Injury rate, rate ratios (RR), injury proportion ratios (IPR). U.S. high school athletes. A total of 267 track and field throwing injuries occurred during 5,486,279 AEs. Overall, the rate of injuries in competition was higher than in practice (RR 1.35, 95% confidence interval [CI] 1.01-1.80). In practice, the rate of injuries was higher for girls than boys (RR 1.53, 95% CI 1.12-2.08). The most frequently injured body part was the shoulder (21.7%), followed by the ankle (16.5%) and knee (12.0%). The most common types of injury were muscle strains (26.14%) and ligament sprains (25%). Recurrent injuries accounted for a higher proportion of chronic injuries compared to new injuries (IPR 1.85, 95% CI 1.16-2.97). This study described injury characteristics of high school track and field throwing athletes from 2008 to 2019. Based on our results, injury prevention may be particularly important for female throwers with prior injury.

Epidemiology of injuries among snowboarding athletes in the talent transfer program: A prospective cohort study of 39,880 athlete-exposures.

Talent transfer (TT) program is an appropriate approach to address the talent gap evident in specific sports activities, while little is known about the injury characteristics of snowboarding athletes involved in the TT program. To determine the epidemiology of injuries among snowboarders involved in the TT program. A total of 244 athletes who were not previously engaged in winter sports were selected for training in snowboarding that lasted for 109 days. The injuries and at-risk exposures (A-Es) data were recorded by physicians. Injury rates (IRs), incidence rate ratios (IRRs), and injury proportion ratios (IPRs) were calculated and compared by sex and age groups. The overall and time loss (TL) IR were 32.4/1000 A-Es and 12.2/1000 A-Es respectively. The overall and non-time loss (NTL) IRR were higher for female athletes than for male athletes. Additionally, the overall IRR and TL-IRR for female athletes were higher in those athletes who aged ≤15 years old. Over 93% of TL injuries resulted in participation restriction time of ≤7 days (male athletes, 93.94%; female athletes, 94.10%). Trunk (28.43%), knee joints (21.33%), and hand/wrist (16.53%) were found as the common sites of injury in both female and male athletes. The most frequent type of injury was contusion (male athletes: 53.00%, female athletes: 59.10%) resulted from ground/apparatus contact (male athletes: 75.10%, female athletes: 75.20%). The risk injury among snowboarding athletes involved in the TT program during the first snow season training was found noticeable, especially for younger female athletes. The high incidence of ground/apparatus contact-related injuries suggested the necessity of specifically designed training programs and braces for snowboarding athletes involved in the TT program.

The Effects of Modified Game Schedules on Injury Rates in the National Hockey League (NHL).

Background Due to the COVID-19 pandemic, many professional sports leagues such as the National Hockey League (NHL) made significant changes to their schedules and operating procedures.Changes included a modified 2019-2020 playoff format, the removal of the 2020-2021 preseason, and condensed game schedules. Though these modifications were made in an effort to protect players from COVID-19, they resulted in decreased training time and preparation. The purpose of this study was to assess the impact of these changes on the rate of player injuries in the NHL both after the resumption of the midseason stoppage and during the subsequent seasons. Hypothesis/purpose Changes to the NHL schedule amid the COVID-19 pandemic resulted in a significant increase in player injury rates. Methods NHL injuries were obtained from an NHL injury database for the 2018-2019 through the 2021-2022 seasons. The date of injury, date of return, injury description, player age, and player position were recorded. Injury rates were calculated as the number of total athlete injuries per 1000 game exposures (GEs). The primary outcome was the injury proportion ratio (IPR) when comparing the injury rates of the post-COVID-19 season with baseline seasons. Secondary measures analyzed injuries based on age, anatomiclocation, month in the season, position, length of injury, season-ending injuries, and recurring injuries. Results A total of 4604 injuries were recorded between 2018 and 2022. The modified 2019-2020 playoffs had significantly higher rates of injury (IPR = 1.84, 95% confidence interval {CI} = 1.36-2.49) with more game exposures per week. The 2020-2021 season had significantly higher rates of overall player injury compared to baseline seasons (IPR = 1.19, 95% CI = 1.09-1.30) and also had a higher rate of season-ending injuries (IPR = 1.71, 95% CI = 1.38-2.11). Most injuries occurred in the first few months of the 2020-2021 season. There was no significant difference in injury rate based on age group and no significant difference in the average length of injury between seasons. Conclusion Increases in injury rates could be due to decreased offseason training between seasons, the elimination of preseason games, and increased game density. Decreasing typical training timelines and eliminating the preseason to rapidly return to normal competition after unexpected events (pandemics, lockdowns, etc.) may pose a risk to player safety in the NHL. These findings should be considered before future schedule changes in professional hockey.

Epidemiology of Anterior Cruciate Ligament Tears in National Collegiate Athletic Association Athletes: 2014/15 - 2018/19.

To describe the epidemiology of ACL tears in NCAA men's and women's sports. Injury and exposure data collected within the NCAA Injury Surveillance Program from 2014/15-2018/19 were analyzed. ACL tear frequencies, rates (IRs) and proportions were used to describe injury incidence by sport, event type, injury mechanism, and injury history. Injury rate ratios (IRRs) were utilized to examine differential injury rates, and injury proportion ratios (IPRs) were used to examine differential distributions. A total of 729 ACL tears were reported from 8,474,401 recorded athlete exposures (AEs) during the study period (IR = 0.86 per 10,000 AEs), and the competition-related ACL tear rate was higher than the practice-related rate (IRR = 5.52, 95% CI: [4.75, 6.39]). Among men's sports, the highest overall ACL tear rate was observed in men's football (IR = 1.44 per 10,000 AEs), while among women's sports, the highest overall rate was observed in women's soccer (IR = 2.60 per 10,000 AEs). Among sex-comparable sports, ACL tear rates were higher in women's basketball, softball, and soccer, as compared with their men's counterparts. ACL tears were more prevalently attributed to player-contact mechanisms in men's sports than women's sports (IPR = 1.73, 95% CI: [1.37, 2.19]), while more prevalently attributed to non-contact mechanisms in women's sports than men's sports (IPR = 1.17, 95% CI: [1.01, 1.35]). ACL tear risk in women's sports continues to warrant attention and prevention efforts. Given the differential rates by event type, future research efforts may also evaluate initiatives to reduce competition-related injury burden in NCAA sports.

Epidemiology of Lateral Ligament Complex Tears of the Ankle in National Collegiate Athletic Association (NCAA) Sports: 2014-15 Through 2018-19

Background: Epidemiological studies of lateral ankle sprains in NCAA sports are important in appraising the burden of this injury and informing prevention efforts. Purpose: To describe the epidemiology of lateral ankle sprains in NCAA sports during the 2014-15 through 2018-19 seasons. Study Design: Descriptive epidemiology study. Methods: Injury and exposure information collected within the NCAA Injury Surveillance Program (ISP) were examined. Counts, rates, and proportions of lateral ankle sprains were used to describe injury incidence by sport, event type (practices, competitions), season segment (preseason, regular season, postseason), injury mechanism (player contact, noncontact, and surface contact, injury history (new, recurrent), and time loss (time loss [≥1 day], non–time loss). 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 3910 lateral ankle sprains were reported (4.61 per 10,000 athlete exposures) during the study period, and the overall rate was highest in men’s basketball (11.82 per 10,000 athlete exposures). The competition-related injury rate was higher than the practice-related rate (IRR, 3.24; 95% CI, 3.04-3.45), and across season segments, the overall rate was highest in preseason (4.99 per 10,000 athlete exposures). Lateral ankle sprains were most often attributed to player-contact mechanisms in men’s (43.2%) and women’s sports (35.1%), although injuries were more prevalently attributed to player contact in men’s than in women’s sports (IPR, 1.23; 95% CI, 1.13-1.34). Overall, 49.7% of all lateral ankle sprains were time loss injuries. Conclusions: The findings of this study are consistent with previous epidemiological investigations of lateral ankle sprains among NCAA athletes. Results offer additional context on differential injury mechanisms between men’s and women’s sports and on injury risk across the competitive season. Future research may examine the effectiveness of deploying injury prevention programs before the start of a season.

Epidemiology of Sports-Related Clavicle Fractures in the United States: Injuries From 2015 to 2019.

Background:Clavicle fractures are common orthopaedic injuries that frequently occur during sports and recreational activity.Purpose:To (1) determine the incidence rate of sports-related clavicle fractures among patients evaluated in emergency departments in the United States over a 5-year period, (2) determine the most common sports and risks associated with clavicle fractures, and (3) update the literature by comparing past and present injury trends.Study Design:Descriptive epidemiology study.Methods:The National Electronic Injury Surveillance System (NEISS) database was queried for patients evaluated with clavicle fractures in US emergency departments from 2015 to 2019. The authors evaluated the data by age, sex, race, and sport/recreational activity. Injuries were characterized based on sports-specific mechanism of injury. Using the NEISS weighted multiplier, the authors estimated annual incidence rates based on US Census data. Contingency table comparisons of categorical variables (ie, age groups vs sex distributions) were analyzed using either chi-square or Fisher exact tests as appropriate for the population size, while continuous variable comparisons were performed using 1-way analysis of variance statistical testing.Results:A total of 2386 athletic-related clavicle fractures were evaluated at participating emergency departments, translating to 304,211 clavicle fractures, with an annual per-year injury rate of 18.72 clavicle fractures per 100,000 persons at risk (95% CI, 15.28-23.67). Male athletes had disproportionately higher injury rates than female athletes (P < .001) for every year of the study and demonstrated a higher incidence of fractures compared with female athletes (injury proportion ratio, 5.54). Patients aged 10 to 19 years accounted for the highest overall incidence of injury (64.5%). The annual incidence rate of athletic-related clavicle fractures was not significantly different during the study period (P = .24). The most common mechanisms of injury were participation in football (26.87%), soccer (15.76%), snowboarding (5.03%), bicycling (3.77%), wrestling (3.65%), and snow skiing (3.52%).Conclusion:Study findings indicated that clavicle fractures sustained during sports and recreational activity disproportionately affect male athletes. Adolescent populations (10-19 years of age) had the highest overall incidence of injury, and the most common activities associated with clavicle fractures were football and soccer.

Effect of a Condensed NBA Season on Injury Risk: An Analysis of the 2020 Season and Player Safety.

Background:Health and safety concerns surrounding the coronavirus 2019 (COVID-19) pandemic led the National Basketball Association (NBA) to condense and accelerate the 2020 season. Although prior literature has suggested that inadequate rest may lead to an increased injury risk, the unique circumstances surrounding this season offer a unique opportunity to evaluate player safety in the setting of reduced interval rest.Hypothesis:We hypothesized that the condensed 2020 NBA season resulted in an increased overall injury risk as compared with the 2015 to 2018 seasons.Study Design:Descriptive epidemiology study.Methods:A publicly available database, Pro Sports Transactions, was queried for injuries that forced players to miss ≥1 game between the 2015 and 2020 seasons. Data from the 2019 season were omitted given the abrupt suspension of the league year. All injury incidences were calculated per 1000 game-exposures (GEs). The primary outcome was the overall injury proportion ratio (IPR) between the 2020 season and previous seasons. Secondary measures included injury incidences stratified by type, severity, age, position, and minutes per game.Results:A total of 4346 injuries occurred over a 5-season span among 2572 unique player-seasons. The overall incidence of injury during the 2020 season was 48.20 per 1000 GEs but decreased to 39.97 per 1000 GEs when excluding COVID-19. Despite this exclusion, the overall injury rate in 2020 remained significantly greater (IPR, 1.42 [95% CI, 1.32-1.52]) than that of the 2015 to 2018 seasons (28.20 per 1000 GEs). On closer evaluation, the most notable increases seen in the 2020 season occurred within minor injuries requiring only a 1-game absence (IPR, 1.53 [95% CI, 1.37-1.70]) and in players who were aged 25 to 29 years (IPR, 1.57 [95% CI, 1.40-2.63]), averaging ≥30.0 minutes per game (IPR, 1.67 [95% CI, 1.47-1.90]), and playing the point guard position (IPR, 1.67 [95% 1.44-1.95]).Conclusion:Players in the condensed 2020 NBA season had a significantly higher incidence of injuries when compared with the prior 4 seasons, even when excluding COVID-19–related absences. This rise is consistent with the other congested NBA seasons of 1998 and 2011. These findings suggest that condensing the NBA schedule is associated with an increased risk to player health and safety.

Epidemiology of Emergency Medical Services Activations for Sport-Related Injuries in the United States

BackgroundLiterature examining emergency medical services (EMS) activations for sport-related injuries is limited to the pediatric, high school, and collegiate student-athlete populations, excluding older individuals and recreational athletes. The purpose of this study was to examine EMS activations for sport-related injuries using the National EMS Information System Database from 2017-2018.MethodsData were obtained using the National EMS Information System Database from 2017-2018. EMS activations were limited to 9-1-1 responses for individuals aged 3-99 who sustained a sports-related injury. Independent variables included patient age group: pediatric (<18 years old) vs. adult (≥18 years old). Dependent variables were patient age, gender, and chief complaint anatomic location. Frequencies and proportions were calculated for each variable. Injury proportion ratios (IPRs) with 95% confidence intervals were calculated to compare chief complaint anatomic location by age group.ResultsThere were 71,322 sport-related injuries. Patients were 36.6±22.9 years and most (58.1%, n=41,132) were male. Adults had higher proportions of injuries affecting the abdomen (IPR: 2.05, 95%CI: 1.83, 2.31), chest (IPR: 1.90, 95%CI: 1.75, 2.05), general/global (IPR: 1.54, 95%CI: 1.50, 1.58), and genitalia (IPR: 2.40, 95%CI: 1.39, 4.15), and lower proportions of injuries affecting the back (IPR: 0.55, 95%CI: 0.50, 0.60), lower extremity (IPR: 0.63, 95%CI: 0.60, 0.65), upper extremity (IPR: 0.50, 95%CI: 0.47, 0.53), head (IPR: 0.73, 95%CI: 0.70, 0.77), and neck (IPR: 0.18, 95%CI: 0.16, 0.20) compared to pediatric patients.ConclusionInjuries sustained differed between adult and pediatric patients, indicating sport-related emergencies may change across the lifespan. General/global chief complaints likely indicate sport-related injuries affecting multiple anatomic locations and organ systems. Stakeholders planning large or high-risk athletic events should consider arranging standby or dedicated advanced life support units for their events.

Poster 190: Epidemiology of Hamstring Tears in NCAA Sports: 2014/15-2018/19

Objectives:Hamstring tears are one of the most common muscular injuries seen in athletes [1]. These injuries are especially prevalent in sports associated with sprinting or jumping, with previous literature indicating that football, soccer, and track athletes are most at risk [1]. Hamstring injuries are classified into strains (Grade I), partial tears (Grades 2) and full thickness tears (Grade 3). Previous literature has described the epidemiology of hamstring strains/tears in NCAA athletes from 2009-2014 [1]. The aim of this study was to describe the epidemiology of hamstring tears in NCAA sports during 2014/15-2018/19.Methods:This study utilized NCAA Injury Surveillance Program (ISP) exposure and injury data submitted by athletic trainers (ATs) at participating institutions (via their respective Electronic Medical Records system) during the 2014/15-2018/19 academic years. Hamstring Tear (Partial or Complete) rates (stratified by sport, event type, and sex) per 10,000 athlete-exposures (AEs) and rate profile plots by event type stratified by sex were constructed. The distribution of injuries by history (new, recurrent) and timeloss (>1 day [TL]; non-timeloss [NTL]) was also examined. Injury Rate Ratios (IRRs) were constructed to evaluate differential injury rates by event type (practice, competition) and sex (male, female [for sex-comparable sports]) and injury proportion ratios (IPRs) were used to evaluate differential proportions by injury history (new, recurrent) and timeloss (TL, NTL); effect estimates with 95% CIs excluding 1.00 were considered statistically significant.Results:Across the study period, 2,096 hamstring tears from 8,474,400 AEs (2.47 per 10,000 AEs) were reported to the NCAA ISP. Amongst men’s sports, overall injury rates were highest in soccer (5.97 per 10,000 AEs), football (4.35 per 10,000 AEs), and track & field (3.57 per 10,000 AEs). In women’s sports, overall injury rates were highest in soccer (3.13 per 10,000 AEs), field hockey (2.09 per 10,000 AEs), and track & field (1.98 per 10,000 AEs). The rate of hamstring tear injuries in men’s/women’s competitions increased between 2014/15 and 2015/16, then decreased across the study period. Whereas the rate of hamstring tear injuries in men’s/women’s practice remained stable across the study period. Recurrent hamstring tears accounted for comparable proportions of all hamstring tears in men’s (14.8%) and women’s (11.5%) sports. A greater proportion of injuries in men’s sports (as compared with women’s sports) resulted in TL (IPR=1.33; 95% CI=1.21, 1.47). Among sex-comparable sports, injury rates were higher in the following men’s sports (as compared with respective women’s sports): baseball (IRR= 1.79; 95% CI=1.31, 2.44) [compared to women’s softball], soccer (IRR= 1.91; 95% CI=1.54, 2.37), and track & field (IRR= 1.80; 95% CI= 1.43, 2.27).Conclusions:Across all NCAA sports, hamstring strain incidence was highest in men’s soccer, men’s football, and men’s track & field. Hamstring tear incidence was higher among men’s baseball, soccer, and track & field compared to women’s comparable sports. Elucidating contributory factors that explain higher hamstring tear incidence in men’s sports (compared to sex-comparable women’s sports) warrants further attention. The development and improvement of hamstring tear injury prevention programs to reduce the burden of this injuries in all NCAA athletes remains critical.In evaluating the temporal patterns in hamstring tear incidence in NCAA sports by event type and stratified by gender, the competition-related injury rate in men’s and women’s sports followed a similar pattern and was lower in 2018/19 compared to 2014/15.A greater proportion of hamstring tears in Men’s sports resulted in time loss of >1 day as compared with hamstring tears in women’s sports. Compared to the previous study period (2009/10-2013/14), a higher proportion of all injuries in the present study were recurrent hamstring tears and a higher proportion of all injuries in this study resulted in time loss of >1 day. [1]In sum, this information can aid sports medicine professionals in identifying athletes who may be at risk for injury and may be valuable in counseling patients with regards to rehabilitative treatment timeline expectations. In order to decrease risk of hamstring tear incidence, sport and athlete specific preventative rehabilitation techniques isolating and targeting the hamstring muscles may be beneficial.Disclosures and funding sources:The NCAA Injury Surveillance Program was funded by the NCAA. The Datalys Center is an independent nonprofit organization that manages the operations of the NCAA ISP. The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of the funding organization. We thank the many ATs who have volunteered their time and efforts to submit data to the NCAA ISP. Their efforts are greatly appreciated and have had a tremendously positive effect on the safety of high school and collegiate student-athletes.

The Problem of Recurrent Injuries in Collegiate Track and Field.

BackgroundAs with most sports, participating in Track and Field (T&F) has inherent injury risks and a previous injury often predisposes athletes to a greater future injury risk. However, the frequency and burden of recurrent injuries in collegiate T&F have not been closely examined.PurposeThe purpose of this study was to describe the frequency and burden of recurrent injuries in collegiate T&F and compare differences in the time loss associated with initial and recurrent injuries by sex and T&F discipline.Study DesignDescriptive Epidemiology StudyMethodsData from the NCAA Injury Surveillance Program were analyzed to describe the frequency and burden of recurrent injuries in collegiate T&F between 2009 and 2014. Comparisons of recurrent injury proportions by T&F discipline were made using Injury Proportion Ratios (IPR) and injury-associated time loss comparisons by injury type and sex were made using Negative Binomial Regression.ResultsFour hundred and seventy-four injuries were reported, 13.1% of which were classified as recurrent injuries. T&F athletes who competed in jumps experienced a lower proportion of recurrent injuries (6.1%) than runners (14.6%) and throwers (19.2%) (Recurrent IPR 0.40, 95% CI 0.18-0.88, p<0.05). When controlling for sex and injury diagnosis, T&F athletes experienced 50% greater time loss from sport following a recurrent injury than an initial injury (95% CI 17%-107%, p<0.01).ConclusionsRecurrent injuries in T&F athletes account for greater time loss than initial injuries, despite sex or injury diagnosis. The current study indicates a need for further research to assess factors contributing to time loss.Level of EvidenceLevel 3

Sentinel surveillance of substance-related self-harm in Canadian emergency departments, 2011 − 19

IntroductionSelf-harm is a public health concern that can result in serious injury or death. This study provides an overview of emergency department (ED) visits for patients presenting with substance-related self-harm.MethodsCases of self-harm in the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) database were extracted (April 2011 to September 2019; N = 15,682), using various search strategies to identify substance-related self-harm cases for patients 10 years and older. Cases involving alcohol, cannabis, illicit drugs, or medications (or any combinations of these) were included. Additional variables, including age and sex, location and the severity of injury (hospital admission) were examined. Proportionate injury ratios (PIR) were used to compare emergency department outcomes of self-harm and unintentional injuries involving substance use. Time trends were quantified using Joinpoint regression. For cases requiring hospital admission, text fields were analyzed for contextual factors.ResultsA total of 9470 substance-related self-harm cases were reported (28.1% of all intentional injury cases), representing 820.0 records per 100,000 eCHIRPP records. While age patterns for both sexes were similar, the number of cases for females was significantly higher among 15-19 year olds. Over half (55%) of cases that identified substance type involved medications, followed by multi-type substance use (19.8%). In the ED, there were proportionally more treatments, observations, and admissions presenting with substance-related self-harm compared to substance-related unintentional injury cases. Among those aged 20+ years, a statistically significant increasing trend of 15.9% per year was observed, while among those aged 10-19 years a significant annual percent change of 16.9% was noted (2011 to 2019). Text field analysis demonstrated suicide attempt or ideation was a reoccurring theme among all age groups. Poor mental health status or conflict with family or an intimate partner were reported stressors, depending on age group. Additional self-harming injuries, such as cutting, were reported among all age groups.ConclusionOur study found that hospital admission for substance-related self-harm was highest for patients aged 15-19 years, especially females, and that they were more likely to use medications. The statistically significant increasing trend of cases found between 2011 and 2019 is notable. Patients showed multiple types of adversities, demonstrating the complexity of this issue.

Epidemiological Comparison of ACL Injuries on Different Playing Surfaces in High School Football and Soccer.

Background:Anterior cruciate ligament (ACL) injuries are among the most common serious injuries to athletes in the United States. Among high school sports, the highest rates of ACL injury occur in soccer and football.Purpose:To compare ACL injuries on artificial turf and natural grass using a nationally representative sample of high school athletes participating in football and boys’ and girls’ soccer.Study Design:Descriptive epidemiology study.Methods:ACL injuries among high school athletes participating in football and soccer were obtained from the High School Reporting Information Online surveillance system during the 2007-08 through 2018-19 school years. National estimates and injury proportion ratios (IPRs) with 95% CIs were calculated for ACL injuries that occurred on artificial turf versus natural grass.Results:A total of 1039 ACL injuries were reported, which represented an estimated 389,320 (95% CI, 358,010-420,630) injuries nationally. There were 74,620 estimated football-related ACL injuries on artificial turf and 122,654 on natural grass. Likewise, 71,877 of the estimated soccer-related ACL injuries occurred on artificial turf and 104,028 on natural grass. A contact-injury mechanism accounted for 50.2% of football-related ACL injuries on artificial turf and 60.8% on natural grass. For soccer-related ACL injuries, a noncontact mechanism predominated on artificial turf (61.5%) and natural grass (66.4%). Among all injuries, ACL injuries were more likely to occur on artificial turf than natural grass in both football (IPR, 1.23 [95% CI, 1.03-1.47]) and girls’ soccer (IPR, 1.53 [95% CI, 1.08-2.16]); however, no significant association was found in boys’ soccer (IPR, 1.65 [95% CI, 0.99-2.75]). Among lower extremity injuries, ACL injuries were more likely to occur on artificial turf than natural grass in both boys’ soccer (IPR, 1.72 [95% CI, 1.03-2.85]) and girls’ soccer (IPR, 1.61 [95% CI, 1.14-2.26]); however, the association was not significant in football (IPR, 1.17 [95% CI, 0.98-1.39]).Conclusion:ACL injuries were more likely to occur (ie, had larger IPRs) on artificial turf than natural grass; however, this relationship was not statistically significant for all sports.

In National Collegiate Athletic Association Men’s and Women’s Soccer Athletes There Is a Low Rate of Lumbar Spine Injury, Women Suffer More Recurrent Injuries than Men, and Most Injuries Occur in the Preseason

PurposeTo use the National Collegiate Athletic Association Injury Surveillance Program (NCAA-ISP) from the 2009-2010 through the 2014-2015 seasons to report lumbar spine injury rates, characteristics, and time lost from sport in soccer players.MethodsCharacteristics of lumbar spine injuries by season, competition/practice, and time lost from sport were determined using the NCAA-ISP database. Rates of injury were calculated as the number of injuries divided by the number of athlete exposures (AEs). AEs are any athlete participation in a competition or practice. Incidence rate ratios (IRRs) were calculated to compare rates between event types and time of season. Injury proportion ratios (IPRs) were used to evaluate differences in injury rates between men and women.ResultsThe NCAA-ISP estimated 4,464 LSIs over 5 years. The rate of LSI in men was 2.1/10,000 AEs and 3.0/10,000 AEs in women. Women were 1.43 times more likely to suffer an LSI compared to men. Women were 2.15 times as likely to suffer an LSI in competition compared to in practice while men were 1.10 times as likely. Women were 2.15 times as likely to be injured in the preseason compared to the regular season, while men were 3.76 times as likely. Non-contact injuries were the most common cause of lumbar spine injuries (LSIs) in men (35%); however, contact injuries were more common in women (33%). Most athletes both male (57%) and female (59%) returned to play within 24 hours.ConclusionThis study provides information on the characteristics of LSIs in NCAA soccer. The overall injury rate to the lumbar spine is relatively low. Injury rates are highest in the preseason and in competition. Women suffer from more recurrent LSI’s than men, and men acquired more injuries through non-contact mechanisms. More than one-half of athletes returned to sport within 24 hours.

Epidemiology of NCAA Track and Field Injuries From 2010 to 2014.

Background:Track and field (T&F) athletes compete in a variety of events that require different skills and training characteristics. Descriptive epidemiology studies often fail to describe event-specific injury patterns.Purpose:To describe the epidemiology of injuries in National Collegiate Athletic Association (NCAA) T&F by sex, setting (practice vs competition), and time of season (indoor vs outdoor) and to compare injury patterns by events within the sport.Study Design:Descriptive epidemiology study.Methods:Data were obtained from the NCAA Injury Surveillance Program for all indoor and outdoor T&F injuries during the academic years 2009-2010 to 2013-2014. Injury rates, injury rate ratios, and injury proportion ratios (IPRs) were reported and compared by sex, injury setting, season, and event. Analysis included time-loss as well as no-time loss injuries.Results:Over the 5 seasons, the overall injury rate was 3.99 injuries per 1000 athletic-exposures (95% CI, 3.79-4.20). After controlling for injury diagnoses, women’s T&F athletes experienced an 18% higher risk of injury (95% CI, 7% to 31%) and missed 41% more time after an injury (95% CI, 4% to 93%) when compared with men. Among all athletes, the injury risk during competition was 71% higher (95% CI, 50% to 95%) compared with practice and required 59% more time loss (95% CI, 7% to 135%). Distance running accounted for a significantly higher proportion of overuse injuries (IPR, 1.70; 95% CI, 1.40-2.05; P < .05) and required 168% more time loss (95% CI, 78% to 304%) than other events. The hip and thigh were the body regions most commonly injured; injury type, however, varied by T&F event. Sprinting accounted for the greatest proportion of hip and thigh injuries, distance running had the greatest proportion of lower leg injuries, and throwing reported the greatest proportion of spine and upper extremity injuries.Conclusion:Injury risk in NCAA T&F varied by sex, season, and setting. Higher injury rates were found in women versus men, indoor versus outdoor seasons, and competitions versus practices. The hip and thigh were the body regions most commonly injured; however, injury types varied by event. These findings may provide insight to programs aiming to reduce the risk of injury and associated time loss in collegiate T&F.

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.

Women and Men National Collegiate Athletic Association Ice Hockey Players Were Similarly Likely to Suffer Lumbar Spine Injuries

PurposeTo describe and compare the epidemiology of lumbar spine injuries (LSIs) in women’s and men’s ice hockey during the 2009-2010 to 2013-2014 academic years and to investigate sex-specific differences, using data from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) database.MethodsThe incidence and characteristics of LSIs were identified utilizing the NCAA ISP. Rates of injury were calculated as number of injuries divided by total number of athlete exposures (AEs). AEs were defined as any student participation in one NCAA-sanctioned practice or competition. Incidence rate ratios (IRRs) were calculated to compare rates of injury between season, event type, mechanism, injury recurrence, and time lost from sport, and injury proportion ratios (IPRs) were calculated to examine the differences in injury rates between men and women.ResultsThere were a total of 165 LSIs from an average of 10 and 19 women’s and men’s teams, respectively, calculated to 1,254 LSIs nationally. Women were 2.48 times more likely to suffer a noncontact injury than men (95% CI: 1.33-4.61), whereas men were more likely than women to suffer contact LSIs (IPR: .51 [95% CI: .28-.92]). In Divisions II and III, women were 6.64 (95% CI: 4.14-10.64) and 1.28 (95% CI: 1.12-1.46) times more likely to suffer LSIs than men, respectively.ConclusionsWomen and men were similarly likely to suffer an LSI, but sex-specific differences existed in a mechanism of injury and likelihood of injury within NCAA Divisions.