Injury Proportion Ratios Research Articles

Strengthening surveillance of consumer products in Canada: the vaping example.

The overall objective of this study was to demonstrate how information collected by the Consumer Product Safety Program ("the Program") can be used to identify emerging hazards. Specifically, this study characterized and quantified trends associated with vaping reports received by the Program over the past five years. Data collated by the Program were extracted for the period from 1 January, 2015 to 30 September, 2019. The data were summarized using descriptive statistics and trends were quantified for annual percent change. In order to compare characteristics of vaping reports, the proportionate injury ratios (PIRs) and corresponding 95% CIs were used to compare vaping-related injuries to all other reports received by the Program. A total of 71 vaping-related reports were received between 1 January, 2015 and 30 September, 2019. During this period, the annual percent change increase in the number of reports received was approximately 73% annually (p < .05). Among the reported injuries, 41% were burn injuries. Proportionally, there were more vaping reports involving males (PIR = 1.89; 95% CI: 1.51-2.36) and individuals between the ages of 15 and 19 years (PIR = 11.53; 95 % CI: 4.95-26.8) as compared to all other reports submitted to the Program. While the number of reports relating to vaping products is small, the results of this analysis suggest that certain groups, including males and youth, are more likely to be the subject of a vaping-related incident.

Fair Play as an Injury Prevention Intervention: Do Yellow Card Accumulation Policies Reduce High School Soccer Injuries?

Evaluate yellow card policies' (YCPs) effectiveness in reducing competition contact injuries (CCIs). Retrospective cohort. High schools. Soccer players from High School (HS) Reporting Information Online participating schools, 2005/06 to 2017/18. Athlete exposure (AE), CCIs from HS competitions collected from states with/without YCPs. Rate and rate ratio (RR) of athlete-athlete CCIs recorded by athletic trainers were compared between states with/without YCPs and pre-YCPs/post-YCPs among the states with YCPs using Poisson regressions. Proportions of severe athlete-athlete CCIs were also described in states with/without YCPs. Fifteen states implemented YCPs between 2005/06 and 2017/18; 901 athlete-athlete CCIs occurred during 352 775 competition AEs in states with YCPs, and 3525 injuries during 1 459 708 competition AEs in states without YCPs. There was no significant difference in injury rates between schools in states with/without YCPs (RR 1.07; 95% confidence interval [CI]: 0.97-1.17). Among state with YCPs, injury rates were not significantly different between pre-YCP and post-YCP implementation (RR 1.15; 95% CI: 0.98-1.34). Although a significantly lower proportion of injuries resulting in >3 weeks' time loss (TL) occurred in states with YCPs (injury proportion ratio 0.81; 95% CI: 0.66-0.997), no significant differences were observed in proportions of other severe athlete-athlete CCIs between states with/without YCPs. Yellow card policies were ineffective in lowering HS soccer athlete-athlete CCI rates, although injuries resulting in >3 weeks' TL were less prevalent in states with YCPs. Implementation of YCPs alone, without proper enforcement, may not be a sufficient injury prevention strategy.

Sex-Based Differences in Anterior Cruciate Ligament Injuries Among United States High School Soccer Players: An Epidemiological Study.

Background:Anterior cruciate ligament (ACL) tears are common among high school athletes, with sex-based differences accounting for higher injury rates in girls. Previous epidemiological studies on ACL injuries focusing on adolescent athletes have looked at injuries across multiple sports, but few have analyzed ACL tears in solely high school soccer athletes.Purpose:To examine sex-based differences in the epidemiology of ACL injuries among high school soccer players in the United States (US).Study Design:Descriptive epidemiological study.Methods:ACL injury data for US high school soccer players were obtained from the internet-based National High School Sports-Related Injury Surveillance Study’s High School RIO (Reporting Information Online) system. Athletic trainers from a random sample of 100 high schools from 8 strata based on US Census geographic region reported data for athlete-exposures (AEs) (practice or competition) and ACL injuries from 2007 through 2017. Injury rates were calculated as the number of ACL injuries per 100,000 AEs. Subgroup differences were evaluated with rate ratios (RRs) or injury proportion ratios (IPRs) and 95% CIs. Statistical differences in demographics between groups were examined using independent t tests. Comparisons of categorical data (ie, level of play) were performed using the Wald chi-square test.Results:The reported number of ACL injuries corresponded to weighted national estimates of 41,025 (95% CI, 33,321-48,730) ACL injuries in boys’ soccer and 110,028 (95% CI, 95,349-124,709) in girls’ soccer during the study period. The rate of injuries was higher in girls’ soccer (13.23/100,000 AEs) than boys’ soccer (4.35/100,000 AEs) (RR, 3.04 [95% CI, 2.35-3.98]). The rate of ACL injuries was higher in competition compared with practice for girls (RR, 14.77 [95% CI, 9.85-22.15]) and boys (RR, 8.69 [95% CI, 5.01-15.08]). Overall, a smaller proportion of ACL injuries were caused by player-player contact for girls (30.1%) compared with boys (48.6%) (IPR, 0.62 [95% CI, 0.41-0.93]).Conclusion:ACL injury rates and patterns in high school soccer players differed between sex, type of exposure (practice vs competition), and mechanism of injury.

TRENDS IN US HIGH SCHOOL AND CLUB CHEER PRACTICE CONCUSSION REPORTING FROM 2012-2017

Background:Sport-related concussion (SRC) is one of the leading injuries among the 3.24 to 4.03 million athletes participating in cheerleading from 2012-2017. The purpose of this study was to provide a descriptive epidemiology of SRC in the school and club cheerleading practice setting from the 2012 to 2017 calendar years.Methods:Female cheerleading athletes, ages 12 to 18 participating in school or club cheer from 2012 to 2017 were included in the current study. Injury and exposure data from school and club cheerleading practices from the Rank One Health Injury Surveillance Database (ROH ISD) were analyzed. SRC counts, percentages, rates per 10,000 athletic exposures (AEs), rate ratios (RRs), and injury proportion ratios (IPRs) were reported with 95% confidence intervals (CIs). Any RR or IPR with a 95% CI not containing 1.0 were considered statistically significant.Results:From 2012-2017, 951 SRCs were recorded from a sample of 51,812 females participating in school cheerleading and 12,643 females participating in club cheerleading. Cheerleading SRCs accounted for 0.40% of all injuries in sports from 2012-2017. The total SRC rate in school cheerleading was 6.02/10,000 AEs (95% CI = 5.87, 6.17). The total SRC rate in club cheerleading was 11.98/10,000 AEs (95% CI = 11.74, 12.22). The SRC rate was higher in club practices than in school practices (RR = 1.99; 95% CI = 1.89, 2.09). More SRCs occurred at school cheerleading practices (65.62%) than club practices (34.48%). The proportion of SRCs from falls onto hardwood surfaces was higher in club cheerleading practices than school cheerleading practices (IPR = 1.69; 95% CI = 1.61, 1.77) while the proportion of falls onto padded surfaces was higher in school cheerleading practices than club cheerleading practices (IPR = 2.26; 95% CI = 2.18, 2.34).Conclusions:The findings from this study provide the largest SRC incidence rates for school and club cheerleading practices to date and reveal evidence of differences in the club and school practice settings. Club cheerleading practice SRCs occurred at a higher rate than school cheerleading practice SRCs and appear to be significantly reduced by practicing on padded surfaces. These findings should be considered when educating cheerleading coaches, parents, and athletes regrading concussion injury risks as well as identifying potential areas of injury prevention. Further research is warranted to identify potential causes for injury trends observed in the current study.

FAIR PLAY AS AN INJURY PREVENTION INTERVENTION: DO YELLOW CARD ACCUMULATION POLICIES REDUCE HIGH SCHOOL SOCCER INJURIES?

Background:Pediatric sports-related injuries are common, yet prevention efforts too often go unevaluated. Collins et al. studied nine U.S. high school (HS) sports during 2005/06-2006/07, finding boys’ and girls’ soccer had the highest injury rates related to illegal activity. Several states have implemented yellow card accumulation policies (YCPs) in an effort to prevent injuries.Hypothesis/Purpose:Purpose: Evaluate the effectiveness of YCPs in reducing HS soccer competition injuries by comparing injury rates and patterns in states with and without YCPs. Hypotheses: Athlete-athlete contact injury rates are lower in states with YCPsSevere injuries (concussion, fracture, ACL, injury requiring surgery, injury resulting in > 3 weeks’ time loss) are less prevalent in states with YCPsGender differences influence the effectiveness of YCPs Methods:Retrospective cohort study of NHFS member state association HS soccer players injured during competition in 2005/06-2017/18. Athlete exposure (AEs) and injury data collected from a national sports injury surveillance system, High School RIO. Poisson regression assessed the effects of YCPs on injury rates and patterns.Results:Of 50 NFHS member states associations, high schools from 47 were represented. Overall, 901 athlete-athlete contact injuries occurred during 352,775 competition AEs in states with YCPs and 3,525 during 1,459,708 AEs in states without YCPs. There was no significant difference in overall contact injury rates (rate ratio [RR] 1.06; 95% confidence interval [CI]: 0.98-1.14) between schools in states with and without YCPs. A small, significant increase in overall contact injury rates was discernable after states’ adoption of YCPs (RR 1.17; 95% CI: 1.03, 1.34), particularly in boys’ soccer (RR 1.32; 95% CI 1.08-1.62). A significantly lower proportion of injuries resulting in > 3 weeks’ time loss occurred in states with YCPs (injury proportion ratio [IPR] 0.81; p=0.047), while other severe injuries did not differ. There were no significant differences in YCPs’ effect by gender (p=0.319).Conclusion:Among HS boys’ and girls’ soccer players, playing in states with YCPs did not lower athlete-athlete contact injury rates, although injuries resulting in > 3 weeks’ time loss were less prevalent in states with YCPs. Athlete-athlete contact injury rates were slightly higher in states following adoption of YCPs, particularly in boys’ soccer. Enactment of YCPs alone, without proper enforcement, may not be a sufficient injury prevention strategy. Further studies assessing the impact of HS soccer YCPs need to consider the effects of state level YCP enforcement, documented illegal activity/foul play, and Fair Play education.Tables/Figures:Table 1.Rate of Athlete-Athlete Contact Injuries Sustained During Soccer Competition in High Schools in States with and without Yellow Card Policies, National High School Sports-Related Injury Surveillance Study, USA, 2005/06-2017/18 # Injuries# Competition AEsRate per 10,000 AERR (95% CI) a Overall With YCP90135277525.51.06 (0.98, 1.14)Without YCP3525145970824.1RefBoys’ Soccer With YCP43018862622.81.10 (0.99, 1.22)Without YCP162578385120.7RefGirls’ Soccer With YCP47116414928.71.02 (0.92, 1.13)Without YCP190067585728.1Ref aRate Ratio (RR) is the ratio of total injury rate in YCP schools to total injury rate in No YCP schools.Table 2.Rate of Athlete-Athlete Contact Injuries Sustained During Soccer Competition in High Schools in states with Yellow Card Policies Pre- and Post- Policy Enactment, National High School Sports-Related Injury Surveillance Study, USA, 2005/06-2017/18 # Injuries# Competition AEsRate per 10,000 AERR (95% CI) a Overall Post-YCP90135277525.51.17 (1.03, 1.34)Pre-YCP28513068621.8RefBoys’ Soccer Post-YCP43018862622.81.32 (1.08, 1.62)Pre-YCP1186826217.3RefGirls’ Soccer Post-YCP47116414928.71.07 (0.90, 1.28)Pre-YCP1676242426.8Ref aRate Ratio (RR) is the ratio of total injury rate in Post YCP enactment to total injury rate in Pre YCP enactment.Table 3.Severe Athlete-Athlete Contact Injuries Sustained During Soccer Competition in High Schools in states with and without Yellow Card Policies, National High School Sports-Related Injury Surveillance Study, USA, 2005/06-2017/18InjuryYCP# (%)b No YCP# (%)IPR (95% CI)a Concussion247 (27.4)945 (26.8)1.03 (0.88,1.22)Fracture72 (8.0)321 (9.1)0.87 (0.66,1.13)ACL34 (3.8)120 (3.4)1.11 (0.76,1.64)Injury required surgical intervention51 (5.7)199 (5.7)1.00 (0.73,1.38)Injury resulting in >3 weeks’ time lossc 124 (13.8)581 (16.5)0.81 (0.66, 1.00)d aInjury Proportion Ratios (IPRs). For all IPRs, No YCP is the referent category. bFor each category of injury above, % indicates what proportion of all athlete-athlete contact injuries sustained during soccer competition were accounted for by the specific injury category. cInjury resulting in >3 weeks’ time loss includes the following categories: “Returned to activity in 22 days or more,” “medical disqualification for season,” or “medical disqualification for career.” dAn upper limit of 95% CI equals 0.997, which is less than 1.00.

Epidemiology of lacrosse injuries treated at the United States emergency departments between 1997 and 2015

ABSTRACT Lacrosse has gained substantial popularity across age groups in the past few decades, but epidemiologic sex differences of lacrosse injuries in emergency settings have not been well described. We characterized and described lacrosse-related injuries presenting to United States Emergency Departments (US EDs) using data from the National Electronic Injury Surveillance System (NEISS). From 1997 to 2015, 7,587 lacrosse-related injuries were treated at US EDs (national estimate of 256,358 injuries). Males accounted for 75.5% of injuries. Average age was 16.0 ± 5.0 (range 5–71) years. Sprains/strains (25.4%), contusions/abrasions (23.9%), and fractures (18.7%) were the most common diagnoses. Females sustained a higher proportion of sprains/strains (36.0%) than males (21.9%) (p< 0.01), while males sustained a higher proportion of fractures (injury proportion ratios [IPR]; 21.3% vs. 10.8%, p< 0.01). Similar proportions of concussions were observed (IPR; 6.1% in males, 6.2% among females). Differences in injury patterns may be secondary to differences in rules and equipment between the two sports.

Relationship of Overuse Injuries and Extrascholastic Sport Participation in High School Athletes 2009-2010 through 2015-2016.

Overuse injuries (injuries due to repetitive loads with inadequate rest) can negatively affect high school athletes, but limited data exist on the effect of sports participation outside of the school-sanctioned season on the development of overuse injuries. Compare overuse injury patterns among high school athletes who participate in extrascholastic athletics to those participating only in scholastic sports. Descriptive cross-sectional, secondary analysis of injury data collected on high school athletes across 22 sports over the 2009-2010 through 2015-2016 academic years. Deidentified data collected as part of the High School Reporting Information Online study (HS RIO). High school athletes from a large convenience sample of U.S. high schools. Injury proportion ratios (IPRs) were computed overall and for individual sports to compare the proportion of overuse injuries in athletes competing in extrascholastic sports to athletes participating only in scholastic athletics. Overall, extrascholastic athletes experienced a higher proportion of overuse injuries compared to scholastic-only athletes (IPR = 1.21, 95% confidence interval [CI] 1.13-1.30), but this association varied by sport. Among extrascholastic athletes, a higher proportion of overuse injuries occurred in those simultaneously playing the same sport outside the school setting (IPR = 1.32, 95% CI 1.11-1.57) as well as having experienced an injury within the past year (IPR = 1.63, 95% CI 1.36-1.95) compared to those sustaining non-overuse injuries. Overuse injuries were associated with extrascholastic athletics and occurred in higher proportion in extrascholastic athletes who were playing the same sport in more than one league.

The rural-urban gap: differences in injury characteristics.

Injuries are among the top 10 leading causes of death in Canada. However, the types and rates of injuries vary between rural versus urban settings. Injury rates increase with rurality, particularly those related to motor vehicle collisions. Factors such as type of work, hazardous environments and longer driving distances contribute to the difference in rural and urban injury rates. Further examination of injuries comparing rural and urban settings with increased granularity in the nature of injuries and severity is needed. The study population consisted of records from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) from between 2011 and July 2017. Rural and urban status was determined based on postal codes as defined by Canada Post. Proportionate injury ratios (PIRs) were calculated to compare rural and urban injury rates by nature and severity of injury and sex, among other factors. Rural injuries were more likely to involve multiple injuries (PIR = 1.66 for 3 injuries) and crush injuries (PIR = 1.72). More modestly elevated PIRs for rural settings were found for animal bites (1.14), burns (1.22), eye injuries (1.32), fractures (1.20) and muscle or soft tissue injuries (1.11). Injuries in rural areas were more severe, with a higher likelihood of cases being admitted to hospital (1.97), and they were more likely to be due to a motor vehicle collision (2.12). The nature of injuries in rural settings differ from those in urban settings. This suggests a need to evaluate current injury prevention efforts in rural settings with the aim to close the gap between rural and urban injury rates.

Concussion Incidence and Trends in 20 High School Sports.

Ongoing monitoring of concussion rates and distributions is important in assessing temporal patterns. Examinations of high school sport-related concussions need to be updated. This study describes the epidemiology of concussions in 20 high school sports during the 2013-2014 to 2017-2018 school years. In this descriptive epidemiology study, a convenience sample of high school athletic trainers provided injury and athlete exposure (AE) data to the National High School Sports-Related Injury Surveillance Study (High School Reporting Information Online). Concussion rates per 10 000 AEs with 95% confidence intervals (CIs) and distributions were calculated. Injury rate ratios and injury proportion ratios examined sex differences in sex-comparable sports (soccer, basketball, baseball and softball, cross country, track, and swimming). We also assessed temporal trends across the study period. Overall, 9542 concussions were reported for an overall rate of 4.17 per 10 000 AEs (95% CI: 4.09 to 4.26). Football had the highest concussion rate (10.40 per 10 000 AEs). Across the study period, football competition-related concussion rates increased (33.19 to 39.07 per 10 000 AEs); practice-related concussion rates decreased (5.47 to 4.44 per 10 000 AEs). In all sports, recurrent concussion rates decreased (0.47 to 0.28 per 10 000 AEs). Among sex-comparable sports, concussion rates were higher in girls than in boys (3.35 vs 1.51 per 10 000 AEs; injury rate ratio = 2.22; 95% CI: 2.07 to 2.39). Also, among sex-comparable sports, girls had larger proportions of concussions that were recurrent than boys did (9.3% vs 6.4%; injury proportion ratio = 1.44; 95% CI: 1.11 to 1.88). Rates of football practice-related concussions and recurrent concussions across all sports decreased. Changes in concussion rates may be associated with changes in concussion incidence, diagnosis, and management. Future research should continue to monitor trends and examine the effect of prevention strategies.

Statistical Methods for Handling Observation Clustering in Sports Injury Surveillance.

Advances in sports injury-surveillance methods have made it possible to accommodate non-time-loss (NTL) injury reporting; however, the analysis of surveillance data now requires careful consideration of the nuances of NTL injury records. Injury-surveillance mechanisms that record NTL injuries are more likely to contain multiple injury records per athlete. These must be handled appropriately in statistical analyses to make methodologically sound inferences. We simulated datasets of NTL injuries using varying degrees of observation clustering and compared the inferences made using traditional techniques with those made after accounting for clustering in computations of injury proportion ratios. Inappropriate handling of even moderate clustering resulted in flawed inferences in 10% to 12% of our simulations. We observed greater bias in our estimates as the degree of clustering increased. We urge investigators to carefully consider observation clustering and adapt analytical methods to accommodate the evolving sophistication of surveillance.

Soccer-related head injuries-analysis of sentinel surveillance data collected by the electronic Canadian Hospitals Injury Reporting and Prevention Program.

Participating in sports is a great way to gain physical, psychological, and social benefits. However, it also carries the risk of injury. Soccer is one of the most popular sports worldwide, and in recent years, there have been concerns about potential vulnerabilities to head injuries. To investigate soccer-related head injuries (SRHIs), using data from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) surveillance system. Specifically, we aim to compare characteristics of SRHI cases to all head injury cases within the eCHIRPP database. Descriptive analyses of emergency department (ED) injury surveillance data (2011 to 2017) for individuals aged 5 to 29 years from all participating eCHIRPP sites. Computation of proportionate injury ratios (PIR) comparing SRHIs to all head injuries reported to eCHIRPP, and 95% confidence intervals (CI). A total of 3,970 SRHIs were reported to eCHIRPP. Injuries were from contact with another player, the ball, ground, goal-post, and other causes. Of the injuries caused by contact with the ball, 9% were from purposely directing the ball with the head (heading). A higher proportion of concussions (PIR=1.32, 95% confidence interval [CI]: 1.27 to 1.37) and minor closed head injuries (PIR=1.20, 95% CI: 1.15 to 1.26) were observed in soccer players. Higher proportions of head injuries occurred in organized soccer and soccer played outdoors. However, admission to the ED for a SRHI was rare (PIR=0.40, 95% CI: 0.30 to 0.55). Overall, elevated proportions of brain injuries were observed among soccer players, however, these injuries were unlikely to result in a hospital admission. Moreover, purposely heading the ball contributed to few ED visits.

Ten-Year Epidemiology of Ankle Injuries in Men's and Women's Collegiate Soccer Players.

Data from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) have indicated that ankle injuries are the most common injuries among NCAA soccer players. To review 10 years of NCAA-ISP data for soccer players' ankle injuries to understand how the time period (2004-2005 through 2008-2009 versus 2009-2010 through 2013-2014), anatomical structure injured, and sex of the athlete affected the injury rate, mechanism, and prognosis. Descriptive epidemiology study. Online injury surveillance. The NCAA-ISP was queried for men's and women's soccer ankle data from 2004 to 2014. Ankle-injury rates were calculated on the basis of injuries per 1000 athlete-exposures. Rate ratios (RRs) were used to compare injury rates. Injury proportion ratios (IPRs) were used to compare injury characteristics. When compared with the 2004-2005 through 2008-2009 seasons, the 2009-2010 through 2013-2014 seasons showed a similar rate of injuries (RR = 0.94, 95% confidence interval [CI] = 0.85, 1.04) but fewer days missed (P < .001) and fewer recurrent injuries (IPR = 0.55, 95% CI = 0.41, 0.74). The 4 most common ankle injuries, which accounted for 95% of ankle injuries, were lateral ligament complex tears (65.67%), tibiofibular ligament (high ankle) sprains (10.3%), contusions (10.1%), and medial (deltoid) ligament tears (9.77%). Of these injuries, high ankle sprains were most likely to cause athletes to miss ≥30 days (IPR = 1.9, 95% CI = 1.24, 2.90). Men and women had similar injury rates (RR = 1.02, 95% CI = 0.94, 1.11). Men had more contact injuries (IPR = 1.28, 95% CI = 1.16, 1.41) and contusion injuries (IPR = 1.34, CI = 1.03, 1.73) but fewer noncontact injuries (IPR = 0.86, 95% CI = 0.78, 0.95) and lateral ligamentous complex injuries (IPR = 0.92, 95% CI = 0.86, 0.98). Although the rate of ankle injuries did not change between the 2004-2005 through 2008-2009 seasons and the 2009-2010 through 2013-2014 seasons, the prognoses improved. Among the 4 most common ankle injuries, high ankle sprains resulted in the worst prognosis. Overall, male and female NCAA soccer players injured their ankles at similar rates; however, men were more likely to sustain contact injuries.

Epidemiology of Foot and Ankle Injuries in National Collegiate Athletic Association Men's and Women's Ice Hockey.

Background:Ice hockey is a high-speed contact sport in which athletes are prone to many different injuries. While past studies have examined overall injury rates in ice hockey, foot and ankle injuries among collegiate ice hockey players have yet to be analyzed.Purpose/Hypothesis:The purpose of this study was to elucidate the epidemiology of foot and ankle injuries among collegiate ice hockey players utilizing data from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program. We hypothesized that male ice hockey players would sustain more injuries compared with female ice hockey players and that the injuries sustained would be more severe.Study Design:Descriptive epidemiology study.Methods:Data on all foot and ankle injuries sustained during the academic years 2004 through 2014 were obtained from the NCAA Injury Surveillance Program. Injury rates, rate ratios (RRs), and injury proportion ratios were reported with 95% CIs.Results:Over the study period, the overall rate of foot and ankle injuries for men was higher than that for women (413 vs 103 injuries, respectively; RR, 4.01 [95% CI, 3.23-4.97]). Injury rates were highest during the regular season for both men (358 injuries; RR, 64.78 [95% CI, 58.07-71.49]) and women (89 injuries; RR, 38.37 [95% CI, 30.40-46.35]) compared with the preseason or postseason. The most common injury in men was a foot and/or toe contusion (22.5%), while women most commonly sustained a low ankle sprain (31.1%). For men, foot and/or toe contusions accounted for the most non–time loss (≤24 hours ) and moderate time-loss (2-13 days) injuries, while high ankle sprains accounted for the most severe time-loss (≥14 days) injuries. For women, foot and/or toe contusions accounted for the most non–time loss injuries, low ankle sprains accounted for the most moderate time-loss injuries, and high ankle sprains accounted for the most severe time-loss injuries.Conclusion:Foot and ankle injuries were frequent among collegiate ice hockey players during the period studied. For men, contusions were the most commonly diagnosed injury, although high ankle sprains resulted in the most significant time lost. For women, low ankle sprains were the most common and resulted in the most moderate time lost. These findings may direct future injury prevention and guide improvements in ice skate design.

Elbow Injuries in National Collegiate Athletic Association Athletes: A 5-Season Epidemiological Study.

Background:Little research has focused on the rates and patterns of elbow injuries in National Collegiate Athletic Association (NCAA) student-athletes.Purpose:To describe the epidemiological patterns of elbow injuries in NCAA athletes during 5 seasons over the academic years 2009 through 2014 using the NCAA Injury Surveillance Program (NCAA-ISP) database.Study Design:Descriptive epidemiology study.Methods:A voluntary convenience sample of NCAA varsity teams from 11 sports was examined to determine the rates and patterns of elbow injuries. Rates and distributions of elbow injuries were identified within the context of sport, event type, time in season, mechanism, time lost from sport, surgical treatment, and injury type. Rates of injury were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). An AE was defined as any student participation in 1 NCAA-sanctioned practice or competition with an inherent risk of exposure to potential injury. Injury rate ratios (IRRs) and injury proportion ratios (IPRs) were then calculated to compare the rates within and between sports by event type, season, sex, mechanism, surgical treatment, and time lost from sport. Comparisons between sexes were made using only sports data that had both male and female samples.Results:Overall, 373 elbow injuries were reported in the NCAA-ISP data set during the 2009-2010 through 2013-2014 academic years among 11 varsity sports. The overall rate of injury was 1.76 per 10,000 AEs. The rate of elbow injuries in men was 0.74 per 10,000 AEs, while women experienced injuries at a rate of 0.63 per 10,000 AEs. In sex-comparable sports, men were 1.17 times more likely to experience an elbow injury compared with women. Men’s wrestling (6.00/10,000 AEs) and women’s tennis (1.86/10,000 AEs) were the sports with the highest rates of elbow injuries by sex, respectively. The top 3 highest injury rates overall occurred in men’s wrestling, baseball, and tennis. Elbow injuries were 3.5 times more likely to occur during competition compared with practice. Athletes were 0.76 times less likely to sustain an elbow injury during the preseason compared with in-season. Contact events were the most common mechanism of injury (67%). For sex-comparable sports, men were 2.41 times more likely than women to have contact as their injury mechanism (95% CI, 0.78-7.38). The majority of athletes missed less than 24 hours of participation time (67%), and only a minority (3%) of patients with elbow injuries went on to have surgical intervention. Elbow ulnar collateral ligament injuries were most common (26% of total injuries).Conclusion:Analysis of the study data demonstrated a significant rate of elbow injuries, 1.76 injuries per 10,000 AEs in NCAA collegiate athletes. Higher injury rates can be expected in males within sex-comparable sports. Elbow injuries are most common in the setting of competitions and most commonly occur secondary to contact-type mechanisms. Injuries were more likely to occur during in-season play. The majority of injuries required less than 24 hours of time away from sport and did not require surgical intervention.

Epidemiology of Clavicle Fractures Among US High School Athletes, 2008-2009 Through 2016-2017.

Background:Little is known about the epidemiology of clavicle fractures in United States (US) high school athletes. Sports participation among high school students has increased steadily, placing increased numbers at risk of sports-related injury.Purpose:To describe the epidemiology of clavicle fractures among high school athletes, including injury rates by sex, sport, and type of play and trends in operative versus nonoperative treatment.Study Design:Descriptive epidemiology study.Methods:The study data set included all athlete-exposure (AE) and clavicle fracture data collected from 2008-2009 through 2016-2017 from a large sample of US high schools as part of the National High School Sports-Related Injury Surveillance Study for students participating in boys’ football, boys’/girls’ soccer, boys’/girls’ basketball, boys’/girls’ volleyball, boys’ wrestling, boys’ baseball, girls’ softball, girls’ field hockey, boys’ ice hockey, boys’/girls’ lacrosse, boys’/girls’ swimming and diving, boys’/girls’ track and field, girls’ gymnastics, girls’ cheerleading, boys’/girls’ tennis, and boys’/girls’ cross-country.Results:Overall, 567 clavicle fractures were reported during 31,520,765 AEs, an injury rate of 1.80 per 100,000 AEs. Injury rates varied by sport, with the highest rates in the boys’ full-contact sports of ice hockey (5.27), lacrosse (5.26), football (4.98), and wrestling (2.21). Among girls’ sports, the highest rates were in soccer (0.92), lacrosse (0.26), and basketball (0.25). In sex-comparable sports, injury rates were still significantly higher among boys (1.03) than girls (0.35) (rate ratio, 2.91; 95% CI, 1.97-4.30). Injury rates were significantly higher in competition (4.58) as compared with practice (0.87) (rate ratio, 5.27; 95% CI, 4.44-6.26). Most injuries were treated conservatively (82.7%) rather than operatively (17.3%). Time to return to sports varied, with a greater proportion of medical disqualifications among those treated operatively (40.0%) as compared with those treated conservatively (22.6%) (injury proportion ratio, 1.77; 95% CI, 1.31-2.39).Conclusion:Although clavicle fracture rates are relatively low, they vary by sport, sex, and activity. Understanding such differences should drive more effective, targeted injury prevention efforts. Increased time loss from sports with surgical versus conservative treatment may have been influenced by factors including injury severity and its timing relative to the season’s progress.

Trends in US High School Football Concussion Reporting, 2012-2017

Objectives: Football has been a sport with high concussion rates when examined independently (Rosenthal et al., 2014). Accurately describing injury trends in high school sports is necessary to identify student-athletes at the greatest risk of injury and where potential injury reduction interventions should be focused. With increased reported high school concussion injuries and associated state legislative requirements, increased incidence rates are needed. The purpose of this study was to provide updated high-school football concussion incidence rates. Methods: Data Source and Study Period This study used data from the Rank One Health Injury Surveillance Database (ROH ISD). Data for the current study were analyzed across 6 calendar years (2012 through 2017) from 1,999 high schools. Data from the current study examined high school football concussion data in males ages 14 to 18. The ROH ISD consists of a convenience sample of participating schools from 2012 to 2017. Exposure and injury data represent a convenience sample of US high schools. For the current study, only data provided across all 1,999 high schools were included. All 1,999 high schools included in the current study logged practice and game participation events for each individual athlete participating in football at the respective high school and athletic exposures (AEs) are an accurate representation of rostered athletes participating in either practices or games by age and calendar year. The ROH ISD was deemed Category 4 IRB exempt. Statistical Analysis Injury counts, practice exposures, game exposures, and distributions by event type (practice or game), age, and injury mechanism were examined. Injury rates per 1,000 AEs and injury rate ratios (IRRs) were calculated by event type. Injury proportion ratios (IPRs) were used to examine differences by calendar year. Risk ratios (RRs) were calculated to compare event type by calendar year. All 95% confidence intervals (CIs) not containing 1.0 were considered statistically significant. Results: 997,308 male student-athletes participated in high school football. ATs recorded a total of 14,103 concussions in high school football from a total of 235,134 total injuries across all high school sports. High school football concussions accounted for 6% of all injuries in high school sports from 2012-2017. More concussions occurred in games (51.8%) than practices (48.2%). Decreases were found in annual injury rates for practices in high school football student-athletes from 2012 to 2016 with an increase in 2017. Decreases were found in annual injury rates for games from 2012 to 2016 with an increase in 2017. IPR decreased by year from 2012 to 2016 (with an increase in 2017. IRR and RR comparisons for games versus practices were significant from 2012 to 2017 (Table 1). Conclusion: This study marks the largest epidemiological high school football concussion incidence investigation to date. The findings from this study provide updated high school football concussion incidence rates and provide further evidence of differences in injury rates when comparing practices and games. The higher rates of concussions occurring in games relative to practices emphasize prior trends of injury risk relative to the level of competition. Overall, results highlight a decline in injury rates over time and lower rates of injury compared to prior high school football epidemiological concussion studies. [Table: see text]

EPIDEMIOLOGY of NECK INJURIES ACCOMPANYING SPORT CONCUSSIONS in YOUTH OVER a 13-YEAR PERIOD IN a COMMUNITY-BASED HEALTHCARE SYSTEM.

The same trauma that produces concussion may also produce neck injury. The signs of concussion and neck injury are similar, and symptoms after acceleration-deceleration trauma to the head-neck complex do not accurately discriminate between them. Research on the epidemiology of neck injury among sport-concussed youth is sparse. The purpose of this study was to investigate the epidemiology of diagnosed neck injury in non-sport-related concussion (Non-SRC) versus sport-related concussion (SRC) in youth by age, sex, and sport. Cross-sectional epidemiologic study. De-identified data from community-based electronic health records over 13 years were extracted to analyze rates and characteristics of neck injuries among non-SRCs and SRCs in youth aged five to 21. Neck injury diagnosis prevalence rates and odds ratios were calculated to estimate risk of neck injury among concussed youth, comparing non-SRCs to SRCs by age and sex. Sixteen thousand, eight hundred eighty-five concussion records were extracted, of which 3,040 SRCs and 2,775 non-SRCs in youth aged five to 21 were identified by cross-filtering sport-related keywords (e.g., football, basketball, soccer, running, swimming, batting, horseback riding, skiing, etc.) with all ICD-9 and ICD-10 concussion codes. The prevalence of neck injuries diagnosed among SRCs (7.2%) was significantly different than the prevalence of neck injuries diagnosed among non-SRCs (12.1%, p < 0.000). Neck injury diagnoses were significantly more prevalent in females overall (p < 0.000) and among non-SRCs (p < 0.000). The prevalence of neck injury diagnoses was not significantly higher in concussed females versus concussed males with SRC (p = 0.164).Among youth aged five to 21 exposed to concussions, non-SRCs were more likely to be accompanied by a neck injury diagnosis than SRCs (OR 1.66; 95% CI 1.39 to 1.98; p < 0.000). Similarly, female-to-male neck injury proportion ratios were significantly higher in females in non-SRCs compared to SRCs (IPR 1.90, 95% CI 1.60 to 2.25, p < 0.000).Sports with highest prevalence of concussion differ from sports with highest prevalence of concussion-related neck injury in both sexes. The overall prevalence of diagnosed neck injuries in youth was higher in non-SRCs compared to SRCs (12.1 vs. 7.2%, p < 0.001), with the highest prevalence at age 14 in both sexes. The risk of neck injury diagnosis accompanying concussion was significantly higher in females compared to males (6.1% difference; p < 0.000).

Epidemiological Patterns of Patellofemoral Injuries in Collegiate Athletes in the United States From 2009 to 2014.

Background:As many as 30% of patients with knee pain seen in sports medicine clinics have complaints related to the patellofemoral joint. There is a paucity of research available regarding patellofemoral injuries, mechanism of injury, and playing time lost in collegiate athletes.Purpose:To describe the rates, mechanisms, severity, and potential sex-based differences of patellofemoral injuries in collegiate athletes across 25 National Collegiate Athletic Association (NCAA) sports.Study Design:Descriptive epidemiology study.Methods:Data from the 2009-2010 through the 2013-2014 academic years were obtained from the NCAA Injury Surveillance Program and were analyzed to calculate patellofemoral injury rates, mechanisms of injury, time lost, and need for surgery. Rate ratios and injury proportion ratios were used to quantify discernible differences between sex-comparable sports and timing of injury (ie, practice vs competition), respectively.Results:The overall patellofemoral injury incidence rate was 16.10 per 100,000 athlete-exposures (AEs). Women’s volleyball had the highest incidence of all sports (39.57 per 100,000 AEs). Injuries were 66% more likely to occur in competition than during practice. Female athletes experienced significantly more patellofemoral injuries than males in similar sports. Patellar tendinitis accounted for 49.2% of all patellofemoral injuries and was the most common injury in 20 of 25 studied sports. Patellar subluxation accounted for the most total days missed, and patellar dislocation had the highest mean days missed per injury (11.42 days). Patella fracture was the most likely injury to require surgery (80%).Conclusion:Patellofemoral injuries were most common in sports that require jumping and quick changes of direction, specifically women’s volleyball, men’s and women’s basketball, and women’s soccer. The majority of patellofemoral injuries in this cohort were classified as patellar tendinitis caused by overuse. Most injuries resulted in no competition or practice time lost. This information may contribute to the development of prevention programs aimed at addressing the most prevalent types and mechanisms of injury in each sport to reduce the incidence of patellofemoral injury in these athletes.

Epidemiology of Elbow Ulnar Collateral Ligament Injuries in Throwing Versus Contact Athletes of the National Collegiate Athletic Association: Analysis of the 2009-2010 to 2013-2014 Seasons.

Background:The management and outcomes of elbow ulnar collateral ligament (UCL) injuries in throwing athletes have been well investigated. However, less is known regarding the management, severity, and outcomes of such injuries in contact athletes.Purpose:To compare the incidence, severity, and outcomes of elbow UCL injuries between throwing and contact athletes in collegiate sports.Study Design:Descriptive epidemiology study.Methods:Elbow UCL injuries were queried from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program between the seasons of 2009-2010 and 2013-2014 in 25 varsity sports. The rates and distribution of injuries by mechanism, participation restriction time, and outcomes (eg, season-ending injury, surgery) were examined. A severe injury was defined as loss of ≥21 days from participation, a season-ending injury, or requiring a surgical intervention. The injury frequency, incidence per 10,000 athlete-exposures (AEs), and injury proportion ratio comparing throwing and contact athletes were calculated with 95% CIs.Results:Over the course of 5 seasons, 109 UCL injuries were recorded, for an overall injury rate of 0.29 per 10,000 AEs. Of these injuries, 83 (76.1%) were a result of contact and 26 (23.9%) from throwing. Men’s wrestling (1.78 per 10,000 AEs) and men’s baseball (1.12 per 10,000 AEs) sustained the highest injury rates. A larger proportion of throwing (n = 8; 36.4%) compared with contact (n = –7; 9.1%) (P < 0.01) injuries results in >21 days of time loss. Additionally, more throwing-related UCL injuries required surgery (n = 2; 11.1%) compared with contact-related injuries (n = 1; 1.3%) (P < 0.01). As a result, throwing athletes demonstrated a significantly higher proportion of severe injuries than contact athletes (injury proportion ratio, 4.62 [95% CI, 1.72-12.40]).Conclusion:The evaluation of athletes in 25 collegiate varsity sports across 5 seasons found over 3 times more elbow UCL injuries in contact versus throwing athletes. However, the number of severe injuries in throwing athletes was significantly higher than in contact athletes. These findings demonstrate that although elbow UCL injuries are prone to occur in both contact and throwing athletes, their prevention, management, and outcomes must be framed on a sport-by-sport basis.

SEX DIFFERENCES IN ANTERIOR CRUCIATE LIGAMENT INJURIES AMONG US HIGH SCHOOL SOCCER PLAYERS: AN EPIDEMIOLOGIC STUDY

BACKGROUND Anterior cruciate ligament (ACL) injuries are common among adolescent athletes, with soccer being the sport most frequently implicated in girls’ ACL injuries. The current literature on ACL injuries, while extensive, lacks a comprehensive study of ACL injuries in United States (US) high school soccer players. The objective of this study was to describe the epidemiology of ACL injuries among US high school soccer players. METHODS ACL injury and athlete exposure (AE) data for US high school soccer players were obtained from the internet-based National High School Sports-Related Injury Surveillance System, High School RIO (Reporting Information Online) dataset collected from school years 2007-2008 through 2016-2017. Injury rates were calculated as the number of ACL injuries per 100,000 AEs. Subgroup differences were evaluated with rate ratios (RRs) or injury proportion ratios (IPRs) and 95% Confidence Intervals (CIs). Subgroup differences were examined with independent t-tests. Comparisons of categorical data (i.e., mechanism of injury) were performed using Pearson’s?2 tests. RESULTS The number of ACL injuries reported to High School RIO corresponded to weighted national estimates of 41,205 (95% CI = 33,321 – 48,730) ACL injuries in boys’ soccer and 110,029 (95% CI = 95,349 – 124,709) in girls’ soccer during the study period. ACL injury rates were significantly higher in girls’ soccer (13.23 per 100,000 AEs) than boys’ soccer (4.35 per 100,000 AEs) (RR = 3.04, 95% CI = 2.35 – 3.98) and were significantly higher in competition compared to practice for both girls (RR = 14.77, 95% CI = 9.85 – 22.15) and boys (RR = 8.69, 95% CI = 5.01 – 15.08). A greater proportion of ACL injuries were due to player-player contact in boys (48.6%) compared to girls (30.1%) (IPR = 1.62, 95% CI = 1.08 – 2.42). There was no statistical difference in the proportion of ACL injuries managed surgically in boys and girls (84% vs. 78%, respectively). CONCLUSIONS There are sex-based differences in mechanism of injury and ACL injury rate in high school soccer players. In addition, boys and girls showed higher rates of injury during competition. This study suggests several areas for targeted evidence-based ACL injury prevention strategies in US high school soccer players.