National Athletic Treatment , Injury And Outcomes Network Research Articles

Concussion Symptomology By Symptom Resolution Time in US High School Athletes: Findings From The National Athletic Treatment, Injury and Outcomes Network (NATION) High School Surveillance Program.

Concussions incurred during high school athletics are a significant health concern, and studies examining concussions with symptom resolution time (SRT) of 15-28 days have been limited. To compare concussions that had a SRT of 15-28 days with concussions that had a SRT of >28 days among US High School athletes. Descriptive epidemiology study. Secondary school athletic training clinics. Secondary school athletes. Concussion frequency, symptom number, and symptom prevalence. Among all 917 reported concussions (of which 50.8% had missing SRT), 88 had SRT recorded as 15-28 days and 29 had SRT recorded as >28 days. Greater frequencies of concussions with SRT >15 days were reported among boys' sports (n= 78) than girls' sports (n= 39). Boys' football (51.7%) and girls' basketball (11.5%) accounted for the largest proportions of all reported concussions with SRT of 15-28 days; boys' football (58.6%) accounted for the greatest proportion of concussions reported with SRT >28 days. The average number of symptoms in concussions with SRT of 15-28 days was 6.3±3.4 and 7.2±3.8 in those with SRT >28 days. The most frequently reported symptoms in concussions with both SRT of 15-28 days and >28 days were headache, dizziness, sensitivity to light, and difficulty concentrating. The prevalence of irritability was higher in concussions with SRT of 15-28 days as compared to concussions with SRT >28 days (26.1% vs. 13.8%); visual problems (48.3% vs. 35.2%) and hyperexcitability (24.1% vs. 15.9%) were more prevalent in concussion with SRT >28 days, although differences were not statistically significant. Symptom prevalence and total count were comparable between concussions with SRT of 15-28 days and >28 days with no statistically significant difference, suggesting symptom burden within these groups are more similar than they are different.

Prevalence of Acute Neck Pain Following Sports-Related Concussion in High School Athletes.

To explore the prevalence of acute neck pain in high school athletes following sports-related concussion (SRC) and to examine the role of acute neck pain in modifying or amplifying concurrent concussive symptoms. Retrospective observational. High school sporting events. High school athletes who suffered a sports-related concussion between the 2011 and 2019 academic years academic years from the National Athletic Treatment, Injury and Outcomes Network (NATION) Study. Not applicable. Prevalence of neck pain (yes/no) along with 33 other commonly reported concussion symptoms, number of symptoms reported, mechanism of injury (contact with person/surface or object), sport type (contact/noncontact), and injury history (first time/repeated injury). One hundred thirty-eight of 401 athletes (33.9%) indicated acute neck pain following SRC. Those with neck pain reported significantly more symptoms overall (M = 13.53, SD = 6.89) relative to their non-neck pain counterparts (M = 8.46, SD = 5.68; t [191.35] = 7.11, P < 0.001). Athletes with SRC due to contact with a surface were significantly less likely to report neck pain than those reported contact with a person. Neck pain, repeated injury, and female sex were significantly associated with a greater number of concussion symptoms in the acute phase. Our data suggest that acute neck pain is a frequent acute symptom following SRC and signals the necessity for additional screening to seek and identify comorbid cervical pathology. Prospective studies should seek to access the benefit of cervical therapy in the early stages in SRC patients with neck pain to reduce the risk of persistent postconcussion symptoms.

Epidemiology of Lower Leg Soft Tissue Injuries in High School Athletes.

BackgroundAnnually there are an estimated 4.5 million sports- and recreation-related injuries among children and young adults in the United States. The most common sports-related injuries are to the lower extremities, with two-thirds occurring among children and young adults (age range 5-24 years). The objective is to describe the epidemiology of lower leg injuries across 27 high school (HS) sports over a 3-year period.MethodsThe Datalys Center for Sports Injury Research and Prevention provided lower leg injury data for 27 sports in 147 high schools for 2011-2012 through 2013-2014 academic years from National Athletic Treatment, Injury and Outcomes Network (NATION) HS Surveillance Program.ResultsThe overall rate of lower leg injuries over this 3-year period was 1.70 per 10 000 acute events (AEs) (95% CI, 1.59-1.82). In men, the highest number of lower leg injuries was in football (n=181), but indoor track had the highest rate of injury at 2.80 per 10 000 AEs (95% CI, 2.14-3.58). In women, the highest number of lower leg injuries and the highest rate of injury were in cross-country (n=76) at 3.85 per 10 000 AEs (95% CI, 3.03-4.81). The practice injury rate was 0.91 times the competition injury rate (95% CI, 0.78-1.07).ConclusionAn improved understanding of the most common sports in which lower leg injuries are seen may help direct appropriate resource utilization. Our data would suggest efforts toward prevention of these overuse injuries, especially in football, track, and cross-country may have the greatest impact on the health of student athletes.Level of Evidence:Level IV, case series.

Non-Time-Loss and Time-Loss Softball Injuries in Secondary School Athletes: A Report From the National Athletic Treatment, Injury and Outcomes Network (NATION).

Most studies of injury trends associated with softball focus on injuries requiring at least 24 hours of missed participation time (time-loss [TL] injuries), with little focus on those that do not (non-time-loss [NTL] injuries). A better understanding of injury trends associated with softball will improve athlete care. To describe NTL and TL injuries experienced by secondary school girls' softball players. Descriptive epidemiology study. Secondary school athletic training clinics. Secondary school girls' softball players. Aggregate data were collected from schools participating in the National Athletic Treatment, Injury, and Outcomes Network surveillance program during the 2011-2012 through 2013-2014 academic years. Frequencies and rates of injuries (NTL and TL) according to time of season, event type, body part injured, and diagnosis were analyzed. In total, 1059 injuries were reported during 140 073 athlete-exposures (AEs): overall injury rate = 7.56/1000 AEs. Of these injuries, 885 (83.6%) were NTL (NTL rate = 6.32/1000 AEs) and 174 (16.4%) were TL (TL rate = 1.24/1000 AEs). Of the NTL and TL injuries, the largest numbers occurred during the regular season (NTL: n = 443 [50.1%]; TL: n = 131 [75.3%]). Injuries sustained during practices accounted for the majority of NTL and TL injuries (NTL: n = 631 [71.3%]; TL: n = 104 [59.8%]). The NTL injuries occurred most often at the shoulder (n = 134 [15.1%]) and hand/fingers (n = 109 [12.3%]) and were diagnosed as contusions (n = 316 [35.7%]), strains (n = 157 [17.7%]), and abrasions (n = 151 [17.1%]). The largest numbers of TL injuries were to the head/face (n = 71 [40.8%]) and diagnosed as concussions (n = 50 [28.7%]) and strains (n = 28 [16.1%]). Secondary school softball players sustained a larger proportion of NTL injuries than TL injuries. Although NTL injuries may be less severe, they are numerous. Efforts are needed to ensure that injury-prevention programs are incorporated into the care of softball athletes to promote health and reduce injury occurrence.

Epidemiology of Secondary School Boys' and Girls' Basketball Injuries: National Athletic Treatment, Injury and Outcomes Network.

Little is known about non-time-loss (NTL) injury patterns in basketball athletes. Knowledge of these patterns may aid in the development of prevention and management strategies for patients with these injuries. To describe the epidemiology of time-loss (TL) and NTL injuries sustained by secondary school boys' and girls' basketball athletes. Descriptive epidemiology study. Eighty-six unique schools provided data, with 84 and 83 contributing to boys' and girls' basketball, respectively. Athletes participating in secondary school-sponsored boys' and girls' basketball. Boys' and girls' basketball data from the National Athletic Treatment, Injury and Outcomes Network (NATION) injury-surveillance program (2011-2012 through 2013-2014 years) were analyzed. Injury counts, rates, and rate ratios (IRRs) were reported with 95% confidence intervals (CIs). The NATION captured 2653 injuries over 364 355 athlete-exposures (AEs) for boys' basketball and 2394 injuries over 288 286 AE for girls' basketball, producing rates of 7.28/1000 AEs (95% CI = 7.00, 7.56) for boys and 8.30/1000 AEs (95% CI = 7.97, 8.64) for girls. The overall injury rates were slightly lower for boys (IRR = 0.88; 95% CI = 0.83, 0.93). For boys, 559 (21.1%) injuries were TL and 2094 (78.9%) were NTL, producing a TL injury rate of 1.53/1000 AEs (95% CI = 1.40, 1.66) and an NTL injury rate of 5.75/1000 AEs (95% CI = 5.50, 5.99). For girls, 499 (20.8%) injuries were TL and 1895 (79.2%) were NTL, producing a TL injury rate of 1.73/1000 AEs (95% CI = 1.58, 1.88) and an NTL injury rate of 6.57/1000 AEs (95% CI = 6.28, 6.87). Rates of TL injuries were similar between boys' and girls' basketball (IRR = 0.89; 95% CI = 0.79, 1.00); NTL injury rates were lower for boys (IRR = 0.87; 95% CI = 0.82, 0.93). When NTL injuries were included, the rates of injury in boys' and girls' secondary school basketball were higher than previously reported.

The Epidemiology of Sports Related Dislocations among Collegiate and High School Athletes

Athletes are at risk of sustaining a dislocation, ranging from relatively minor with minimal time lost from play to more severe with long recovery times and costly treatments. Previous studies have examined dislocations; however, most focused on specific sports or joints. PURPOSE: To describe dislocations sustained by collegiate and high school athletes. METHODS: Athletic trainers (ATs) participating in the National Collegiate Athletic Association (NCAA) Injury Surveillance Program reported athlete-exposure (AE) and injury data for 25 sports during the 2009/10-2016/17 academic years. ATs participating in the National Athletic Treatment Injury and Outcomes Network (NATION) reported AE and injury data for 27 sports during 2011/12-2013/14. Dislocations occurred during a school-sanctioned practice or competition and required medical attention. Along with dislocation characteristics, injury rates per 10,000 AEs were reported with 95% confidence intervals (CIs). RESULTS: From 2009/10-2016/17, ATs reported 542 dislocations among NCAA athletes for an injury rate of 0.81/10,000 AEs (95% CI:0.74-0.87). Men’s football (1.74; 95% CI:1.53-1.94), men’s wrestling (1.53; 95% CI:0.91-2.16), and women’s gymnastics (1.31; 95% CI:0.54-2.09) had the highest rate of dislocations. From 2011/12-2013/14, ATs reported 149 dislocations among high school athletes for an injury rate of 0.29/10,000 AEs (95% CI:0.24-0.34). Boys’ football (0.79; 95% CI:0.62-0.95), girls’ basketball (0.52; 95% CI:0.26-0.78), and boys’ wrestling (0.50; 95% CI:0.22-0.79) had the highest rate of dislocations. For NCAA and high school athletes, the most commonly dislocated body parts were the hand/finger (40.2% and 25.8%) and shoulder/clavicle (36.7% and 40.3%). A greater proportion of dislocations resulted from player contact (55.8%) and were non-time loss (40.9%) in NCAA athletes than high school athletes (39.6% and 25.9%). A similar proportion of NCAA and high school dislocations were recurrent (20.6% and 18.8%) and required surgery (21.4% and 15.8%). CONCLUSION: Some characteristics of dislocations vary across collegiate and high school athletes including mechanism of injury and time loss. More research is needed to determine how to effectively reduce the incidence of dislocations among all collegiate and high school athletes.

Changes in Patient-Reported Outcome Measures From the Time of Injury to Return to Play in Adolescent Athletes at Secondary Schools With an Athletic Trainer.

Typically, athletic trainers rely on clinician-centered measures to evaluate athletes' return-to-play status. However, clinician-centered measures do not provide information regarding patients' perceptions. To determine whether clinically important changes in patient-reported outcomes were observed from the time of lower extremity injury to the time of return to play in adolescent athletes. Cross-sectional study. The National Athletic Treatment, Injury and Outcomes Network (NATION) program has captured injury and treatment data in 31 sports from 147 secondary schools across 26 states. A subsample of 24 schools participated in the outcomes study arm during the 2012-2013 and 2013-2014 academic years. To be included in this report, student-athletes must have sustained a knee, lower leg, ankle, or foot injury that restricted participation from sport for at least 3 days. A total of 76 initial assessments were started by athletes; for 69 of those, return-to-play surveys were completed and analyzed. All student-athletes completed generic patient-reported outcome measures (Patient-Reported Outcomes Measurement Information System [PROMIS] survey, Global Rating of Change scale, and Numeric Pain Rating Scale) and, depending on body region, completed an additional region-specific measure (Knee Injury and Osteoarthritis Outcome Score or Foot and Ankle Ability Measure). All applicable surveys were completed at both the initial and return-to-play time points. Means and standard deviations for the total scores of each patient-reported outcome measure at each time point were calculated. Change scores that reflected the difference from the initial to the return-to-play time points were calculated for each participant and compared with established benchmarks for change. The greatest improvement in patient-reported outcomes was in the region-specific forms, with scores ranging from 9.92 to 37.73 on the different region-specific subscales (Knee Injury and Osteoarthritis Outcome Score or Foot and Ankle Ability Measure; scores range from 0-100). The region-specific subscales on average still showed a 21.8- to 37.5-point deficit in reported health at return to play. The PROMIS Lower Extremity score increased on average by 13 points; all other PROMIS scales were within normative values after injury. Adolescent athletes who were injured at a high school with an athletic trainer may have shown improvement in patient-reported outcomes over time, but when they returned to play, their outcome scores remained lower than norms from comparable athlete groups.

Rankings of High School Sports Injury Rates Differ Based on Time Loss Assessments.

To examine how injury definition inclusiveness affects the rank order of injury rates in 27 high school (HS) sports. The National Athletic Treatment, Injury and Outcomes Network (NATION) used certified athletic trainers (ATs) to collect injury and athlete-exposure (AE) data in practices and competitions for 27 HS sports during the 2011/2012 to 2013/2014 academic years. Time loss (TL) injuries resulted in ≥24 hours of participation restriction. Nontime loss (NTL) injuries resulted in <24 hours of participation restriction. Aggregate injury and exposure data collected from 27 HS sports. High school student-athletes. Sports injury data from the National Athletic Treatment, Injury and Outcomes Network. Time loss and TL + NTL injury rates were calculated. Sport-specific rates were placed in rank order, stratified by gender. Most of the 47 014 injuries reported were NTL (82.8%). Among boys' sports, TL injury rates were greatest in football (3.27/1000AE) and wrestling (2.43/1000AE); TL + NTL injury rates were greatest also in football (15.29/1000AE) and wrestling (11.62/1000AE). Among girls' sports, TL injury rates were greatest in soccer (1.97/1000AE) and basketball (1.76/1000AE); TL + NTL injury rates were greatest in field hockey and lacrosse (both 11.32/1000AE). The rank order of injury rates and the resulting injury prevention priorities may depend on injury definition inclusiveness, particularly in female HS sports.

The Epidemiology of Overuse Conditions in Youth Football and High School Football Players.

High-intensity sport training at the youth level has led to increased concern for overuse conditions. Few researchers have examined overuse conditions in youth sports. To examine the rates, risks, and distributions of overuse conditions between youth and high school football players. Descriptive epidemiologic study. Youth and high school football teams. The Youth Football Safety Study (YFSS) investigated youth football athletes from age 5 to 14 years. The National Athletic Treatment, Injury and Outcomes Network (NATION) focused on high school football athletes 14 to 18 years old. The YFSS data consisted of 210 team-seasons, and the NATION data consisted of 138 team-seasons. Athletic trainers collected football injury and exposure data during the 2012 and 2013 seasons. Injury rates, risks, and distributions were calculated, with injury rate ratios, risk ratios, and injury proportion ratios with 95% confidence intervals (CIs) comparing youth and high school football players. The YFSS reported 1488 injuries, of which 53 (3.6%) were overuse conditions. The NATION reported 12 013 injuries, of which 339 (2.8%) were overuse conditions. The overuse condition rate did not differ between high school and youth football (3.93 versus 3.72/10 000 athlete-exposures; injury rate ratio = 1.06; 95% CI = 0.79, 1.41). However, the 1-season risk of overuse condition was higher in high school than in youth football players (2.66% versus 1.05%; risk ratio = 2.53; 95% CI = 1.84, 3.47). Compared with high school football players, youth football players had greater proportions of overuse conditions that were nontime loss (ie, <24 hours participation-restriction time; 83.0% versus 67.0%; injury proportion ratio = 1.24; 95% CI = 1.07, 1.43) and affecting the lower extremity (92.5% versus 62.5%; injury proportion ratio = 1.48; 95% CI = 1.32, 1.65). Overuse conditions may not present a primary concern in youth and high school football players. However, differences existed between the 2 levels of competition. Although additional research on the incidence of overuse conditions across all youth and high school sports is needed, these findings may highlight the need for programming that is specific to competition level.

Factors associated with post-concussion syndrome in high school student-athletes

ObjectivesTo identify factors associated with post-concussion syndrome (PCS) among a national sample of high school student-athletes from the 2011/12–2013/14 academic years. DesignAmbispective cohort study from sports injury surveillance data. MethodsSport-related concussion data originated from the National Athletic Treatment, Injury and Outcomes Network (NATION) surveillance program, consisting of 27 sports from a convenience sample of 196 high schools across 26 states. All SRCs were reported by certified athletic trainers. The PCS and non-PCS groups consisted of concussed individuals with symptoms resolution time of >4 weeks and ≤2 weeks, respectively. Logistic regression estimated the association of athlete and concussion characteristics on the odds of PCS, and calculated adjusted odds ratios (OR) and 95% confidence intervals (CI). ResultsOverall, 1334 concussed high school athletes met inclusion criteria: 215 in the PCS group and 1119 in the non-PCS group. In the multivariable analysis, concussion symptoms associated with increased odds of PCS included: retrograde amnesia (OR=3.01, 95%CI: 1.31–6.91), difficulty concentrating (OR=2.72, 95%CI: 1.56–4.77), disorientation (OR=1.86; 95%CI: 1.04–3.33), insomnia (OR=2.79; 95%CI: 1.62–4.80), loss of balance (OR=1.76; 95%CI: 1.00–3.10), sensitivity to noise (OR=1.80; 95%CI: 1.02–3.17), and visual disturbance (OR=2.21; 95%CI: 1.23–3.97). Sex and recurrent concussion were not associated with PCS. ConclusionsAs in previous research, somatic and cognitive symptoms were associated with PCS. The identification of factors associated with PCS may assist clinicians in identifying concussed athletes at greater risk of having longer symptom resolution time.

Epidemiology of Sport-Related Concussions in High School Athletes: National Athletic Treatment, Injury and Outcomes Network (NATION), 2011-2012 Through 2013-2014.

Sports participation is one of the leading causes of concussions among nearly 8 million US high school student-athletes. To describe the epidemiology of sport-related concussion (SRC) in 27 high school sports during the 2011-2012 through 2013-2014 academic years. Descriptive epidemiology study. Aggregate injury and exposure data from 27 sports in 147 high schools in the National Athletic Treatment, Injury and Outcomes Network (NATION). Boy and girl high school athletes during the 2011-2012 through 2013-2014 academic years. Sport-related concussion counts, percentages, rates per 10 000 athlete-exposures (AEs), rate ratios (RRs), and injury proportion ratios (IPRs) were reported with 95% confidence intervals (CIs). Rate ratios and IPRs with 95% CIs not containing 1.0 were considered significant. Overall, 2004 SRCs were reported among 27 high school sports, for a rate of 3.89 per 10 000 AEs. Football had the highest SRC rate (9.21/10 000 AEs), followed by boys' lacrosse (6.65/10 000 AEs) and girls' soccer (6.11/10 000 AEs). The SRC rate was higher in competition than in practice (RR = 3.30; 95% CI = 3.02, 3.60). Among sex-comparable sports, the SRC rate was higher in girls than in boys (RR = 1.56; 95% CI = 1.34, 1.81); however, the proportion of SRCs due to player-to-player contact was higher in boys than in girls (IPR = 1.48; 95% CI = 1.27, 1.73). Common symptoms reported among all athletes with SRCs were headache (94.7%), dizziness (74.8%), and difficulty concentrating (61.0%). Only 0.8% of players with SRCs returned to play within 24 hours. The majority of athletes with SRCs (65.8%) returned to play between 7 and 28 days. More players had symptoms resolve after 7 days (48.8%) than less than a week (40.7%). Our findings provide updated high school SRC incidence estimates and further evidence of sex differences in reported SRCs. Few athletes with SRCs returned to play within 24 hours or a week. Most injured players returned after 7 days, despite a smaller proportion having symptoms resolve within a week.

Epidemiology of Sport-Related Concussions in High School Athletes: National Athletic Treatment, Injury and Outcomes Network (NATION), 2011–2012 Through 2013–2014

Epidemiology of Sport-Related Concussions in High School Athletes: National Athletic Treatment, Injury and Outcomes Network (NATION), 2011–2012 Through 2013–2014

Epidemiological Patterns of Ankle Sprains in Youth, High School, and College Football

Background: Variations in ankle injury rates and distributions among competition levels are unclear, but such data may help inform strategies to prevent ankle sprains during American football. Purpose: To describe the epidemiological patterns of ankle sprains in youth, high school (HS), and collegiate American football. Study Design: Descriptive epidemiological study. Methods: Data regarding youth, HS, and college football athletes were collected from 3 injury surveillance programs: (1) the Youth Football Safety Study (YFSS), (2) the National Athletic Treatment, Injury and Outcomes Network (NATION), and (3) the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP). During the 2012-2014 seasons, the YFSS, NATION, and NCAA ISP included 310, 184, and 71 football team-seasons, respectively. Athletic trainers (ATs) attended each practice and game and reported injuries and athlete-exposures (AEs) via their preferred injury documentation application. Ankle sprain rates for each type of ankle sprain were calculated overall, by event type (ie, practices and games), and specifically for severe injuries (ie, participation restriction time >21 days) and recurrent injuries (as defined by ATs). Rate ratios (RRs) were used to compare ankle sprain rates by competition level and event type. Injury proportion ratios (IPRs) were used to compare differences in severity, surgical needs, recurrence, injury mechanism, and injury activity by competition level. RRs and IPRs with 95% confidence intervals excluding 1.00 were considered statistically significant. Results: A total of 124, 897, and 643 ankle sprains were reported in youth, HS, and college football, respectively. This led to respective rates of 0.59, 0.73, and 1.19 sprains per 1000 AEs. The ankle sprain rate in college football was higher than the rates in HS (RR = 1.64; 95% CI, 1.48-1.82) and youth (RR = 2.01; 95% CI, 1.65-2.43) football. The proportion of ankle sprains that were recurrent in youth football was higher than the proportions in HS (IPR = 2.73; 95% CI, 1.68-4.50) and college (IPR = 2.19; 95% CI, 1.33-3.61) football. Conclusion: Ankle sprain rates were highest in college athletes. However, level-specific variations in ankle sprain severity and recurrence may highlight the need to develop level-specific policies and prevention strategies to reduce injury incidence.

High School Rowing Injuries: National Athletic Treatment, Injury and Outcomes Network (NATION).

Data on high school (HS) rowing injuries are lacking. To describe the epidemiology of HS boys' and girls' rowing injuries during the 2011-2012 through 2013-2014 academic years. Descriptive epidemiology study. Injury and exposure data from 8 and 11 boys' and girls' rowing programs providing 13 and 17 team-seasons of data, respectively. High school boys' and girls' varsity rowing student-athletes. High school rowing data from the National Athletic Treatment, Injury and Outcomes Network. Injury rates and rate ratios were reported with 95% confidence intervals (CIs). In HS boys' and girls' rowing, 59 and 190 injuries were reported, respectively, for rates of 2.39/1000 athlete-exposures (95% CI = 1.78, 3.00) and 8.60/1000 athlete-exposures (95% CI = 7.38, 9.82). The girls' rowing injury rate was 3.60 times that of boys' (95% CI = 2.69, 4.82). These findings suggest a higher injury rate among HS female rowers than HS male rowers. Additional research exploring reasons for the sex difference is warranted.

Sex Differences in the Incidence of Anterior Cruciate Ligament, Medial Collateral Ligament, and Meniscal Injuries in Collegiate and High School Sports

Background: Previous research has noted sex-based differences in anterior cruciate ligament (ACL) injury rates in young athletes, while little is known about medial collateral ligament (MCL) and meniscal injury rates in this population. The objective of this study was to compare injury rates for traumatic knee injuries (ie, ACL, MCL, and meniscal injuries) in collegiate and high school (HS) varsity student-athletes across multiple sports. Hypothesis: Knee injury rates vary by sex and across different sports and levels of competition. Study Design: Descriptive epidemiology study. Methods: Injury and athlete-exposure data were utilized from the National Athletic Treatment, Injury and Outcomes Network (NATION) and National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) during the 2009-2010 to 2013-2014 academic years. Analyses focused on ACL, MCL, and meniscal injuries. Injury rates and injury rate ratios (IRRs) with 95% CIs were calculated for basketball, ice hockey, lacrosse, soccer, and baseball/softball. Results: The ACL injury rate was higher for female than male athletes at the collegiate (IRR, 2.49; 95% CI, 1.81-3.41) and HS (IRR, 2.30; 95% CI, 1.67-3.18) levels. At the collegiate level, the highest ACL IRR comparing female to male athletes was reported in softball/baseball (IRR, 6.61; 95% CI, 1.48-29.55). At the HS level, the highest ACL IRR was reported in basketball (IRR, 3.68; 95% CI, 1.91-7.10). The MCL injury rate was higher for female than male athletes at the HS level (IRR, 2.11; 95% CI, 1.25-3.56) but lower for female than male athletes at the collegiate level (IRR, 0.73; 95% CI, 0.59-0.92). The meniscal injury rate was lower for female than male athletes at the HS level (IRR, 0.47; 95% CI, 0.31-0.71), while no differences by sex were seen at the collegiate level (IRR, 1.35; 95% CI, 0.90-2.02). Conclusion: Knee injury rates varied by sex across 5 different sports in the HS and collegiate settings. Female athletes sustained ACL injuries at a higher rate than male athletes at both the HS and collegiate levels in these 5 sports; however, there was not a distinct sex disparity in MCL and meniscal injuries. Future studies should examine the rates of concomitant and recurrent injuries to inform injury prevention and rehabilitation programs.

Methods and Descriptive Epidemiology of Services Provided by Athletic Trainers in High Schools: The National Athletic Treatment, Injury and Outcomes Network Study.

Research is limited on the extent and nature of the care provided by athletic trainers (ATs) to student-athletes in the high school setting. To describe the methods of the National Athletic Treatment, Injury and Outcomes Network (NATION) project and provide the descriptive epidemiology of AT services for injury care in 27 high school sports. Descriptive epidemiology study. Athletic training room (ATR) visits and AT services data collected in 147 high schools from 26 states. High school student-athletes participating in 13 boys' sports and 14 girls' sports during the 2011-2012 through 2013-2014 academic years. The number of ATR visits and individual AT services, as well as the mean number of ATR visits (per injury) and AT services (per injury and ATR visit) were calculated by sport and for time-loss (TL) and non-time-loss (NTL) injuries. Over the 3-year period, 210 773 ATR visits and 557 381 AT services were reported for 50 604 injuries. Most ATR visits (70%) were for NTL injuries. Common AT services were therapeutic activities or exercise (45.4%), modalities (18.6%), and AT evaluation and reevaluation (15.9%), with an average of 4.17 ± 6.52 ATR visits and 11.01 ± 22.86 AT services per injury. Compared with NTL injuries, patients with TL injuries accrued more ATR visits (7.76 versus 3.47; P < .001) and AT services (18.60 versus 9.56; P < .001) per injury. An average of 2.24 ± 1.33 AT services were reported per ATR visit. Compared with TL injuries, NTL injuries had a larger average number of AT services per ATR visit (2.28 versus 2.05; P < .001). These findings highlight the broad spectrum of care provided by ATs to high school student-athletes and demonstrate that patients with NTL injuries require substantial amounts of AT services.

The National Athletic Treatment, Injury and Outcomes Network (NATION): Methods of the Surveillance Program, 2011–2012 Through 2013–2014

Previous epidemiologic researchers have examined time-loss (TL) injuries in high school student-athletes, but little is known about the frequency of non-time-loss (NTL) injuries in these athletes. To describe the methods of the National Athletic Treatment, Injury and Outcomes Network (NATION) Surveillance Program and provide descriptive epidemiology of TL and NTL injuries across athletes in 27 high school sports. Descriptive epidemiology study. Aggregate injury and exposure data collected from 147 high schools in 26 states. High school student-athletes participating in 13 boys' sports and 14 girls' sports during the 2011-2012 through 2013-2014 academic years. Athletic trainers documented injuries and exposures using commercially available injury-tracking software packages. Standard injury-tracking software was modified by the software vendors to conform to the surveillance needs of this project. The modified software exported a set of common data elements, stripped of personally identifiable information, to a centralized automated verification and validation system before they were included in the centralized research database. Dependent measures were injury and exposure frequencies and injury rates with 95% confidence intervals stratified by sport, sex, and injury type (TL or NTL). Over the 3-year period, a total of 2337 team seasons across 27 sports resulted in 47 014 injuries and 5 146 355 athlete-exposures. The NTL injuries accounted for 38 765 (82.45%) and TL injuries for 8249 (17.55%) of the total. The NTL injuries accounted for a substantial amount of the total number of injuries sustained by high school student-athletes. This project demonstrates the feasibility of creating large-scale injury surveillance systems using commercially available injury-tracking software.

Variations in High School Sport Injury and Treatment Rates by Athletic Trainer Work Status

Many sport-related injury surveillance systems utilize athletic trainers (AT) to report athlete injuries. Yet, little research has examined how AT characteristics may affect injury reporting and management. PURPOSE: To determine whether injury and treatment rates in high school football vary by AT work status. METHODS: : ATs (n=44) supervising high school football and reporting injury data to the National Athletic Treatment, Injury and Outcomes Network (NATION) program during 2011-2013 provided work status and high school football AT/medical staff information. Overall injury rates [# injuries / # athlete-exposures (AE) * 1000], time loss injury rates (i.e., only injuries resulting in over 24 hours of time loss), and treatment rates (# treatments / # injuries) were calculated. Rate ratios (RR) and 95% confidence intervals (CI) compared rates by AT work status (high school employee vs. outside setting, including graduate student assistants). RESULTS: Fourteen ATs were high school employees; 30 ATs, 20 of whom were graduate assistants, were not high school employees. All ATs received assistance from other AT/medical staff. However, 76.7% of outside setting ATs did not work with paid AT/medical staff, whereas 71.4% of employed ATs did. The overall and time loss injury rates were 17.9 and 4.9/1000AEs, respectively. The treatment rate was 8.8 per injury. Compared to high schools with outside setting ATs, schools who employed ATs had higher rates of overall injury (27.4 vs. 7.3/1000AEs; RR=3.8; 95%CI: 3.5, 4.0; P<0.001) and treatment (9.9 vs. 3.2 per injury; RR=3.1; 95%CI: 3.0, 3.2; P<0.001). However, high schools with outside graduate assistant ATs had a higher time loss injury rate than those with other ATs (6.5 vs. 4.2/1000AEs; RR=1.5; 95%CI: 1.4, 1.7; P<0.001). CONCLUSIONS: Injury and treatment rates varied by the work status of the AT supervising high school football. Being employed by an outside setting may limit the time that ATs can attend to, manage, and report student-athlete injuries, leading to lower reported rates. Higher time loss injury rates reported among high schools with graduate assistant ATs may suggest that there is also a difference in the manner that graduate student ATs classify injuries. Continued examinations of the association of AT characteristics and rates of injury and treatment are warranted.

The National Athletic Treatment, Injury and Outcomes Network (NATION): Methods of the Surveillance Program, 2011–2012 Through 2013–2014

The National Athletic Treatment, Injury and Outcomes Network (NATION): Methods of the Surveillance Program, 2011–2012 Through 2013–2014