National Sporting Goods Association Research Articles

Epidemiology of Pediatric Gymnastics Injuries Reported in US Emergency Departments: Sex- and Age-Based Injury Patterns.

Background:Despite increasing participation rates in youth gymnastics, the majority of epidemiologic literature focuses on older elite athletes or stratifies athletes by level of competition.Hypothesis:The authors hypothesized that sex- and age-based patterns in youth gymnastics–related injuries exist, which are otherwise overlooked in an unstratified population.Study Design:Descriptive epidemiology study.Methods:Publicly available injury data from the National Electronic Injury Surveillance System were collected on pediatric gymnastics injuries presenting to emergency departments in the United States. Participation data from the National Sporting Goods Association were used to calculate national injury incidence rates in 7- to 11-year-olds (childhood) and 12- to 17-year-olds (adolescence) from January 1, 2012, to December 31, 2018. Z tests were conducted for the comparison of injury rates between girls and boys within each age group and for overall injury rate across age groups.Results:Girls participated in gymnastics at a frequency 6.5 times that of boys in childhood and 13.5 times that of boys in adolescence. An estimated 72,542 youth gymnastics–related injuries were reported in US emergency departments each year. A large proportion (61.3%) occurred in childhood, with female predominance in both age groups. Overall, there was no difference in weighted annual injury rate (injuries per 100,000 athlete-days per year) by age group (6.9 [childhood] vs 8.8 [adolescence]; P = .19) or sex (7.4 [girls] vs 8.1 [boys]; P = .65). In adolescence, boys were more likely than girls to experience injury (16.47 vs 8.2; P = .003). Wrist and lower arm fractures were more common in childhood than adolescence (1.07 vs 0.43; P = .002) and specifically in girls (childhood vs adolescence, 1.06 vs 0.37; P = .001). Ankle injuries and concussions were more common in adolescence vs childhood (P = .01 and .0002).Conclusion:Upper extremity injuries predominated among childhood gymnasts, particularly girls. In adolescence, girls and boys experienced increases in concussions and foot and ankle injuries. Although representing a lower overall number of training gymnasts as compared with girls, adolescent boys experience a higher rate of injuries overall.

Epidemiology of Pediatric Basketball Injuries Presenting to Emergency Departments: Sex- and Age-Based Patterns.

Background:There is limited epidemiologic data on pediatric basketball injuries and the comparison of these injuries before and after adolescence and between male and female athletes.Purpose:To assess common sex- and age-based injury patterns in pediatric basketball players.Study Design:Descriptive epidemiology study.Methods:Injury data from the National Electronic Injury Surveillance System (NEISS) and participation data from the National Sporting Goods Association were used to complete this study. Data on pediatric basketball injuries between January 2012 and December 2018 in patients aged 7 to 11 years (childhood) and 12 to 17 years (adolescence) were extracted and used to calculate national injury incidence rates with 95% CIs. Sex and age group patterns were examined utilizing Pearson chi-square tests. Z tests were conducted for the comparison of injury rates between female and male athletes in each age group and overall injury rate across age groups.Results:An average of 9582 basketball injuries were reported annually in the NEISS, which calculated to an annual national estimate of 294,920 injuries. The most common diagnoses were ankle strain/sprain (17.7%), finger strain/sprain/fracture (12.1%), concussion/head injury (9.4%), knee strain/sprain (4.5%), and facial laceration (3.3%). There was a significant increase in injury prevalence in adolescents (12- to 17-year-old category: 238,678 injuries per year) when compared with childhood (7- to 11-year-old category: 56,242 injuries per year) (P < .0001). Concussions/head injuries occurred at a high rate in childhood, second only to finger strain/sprain/fracture, and at a similar rate in females and males (injuries per 100,000 athlete-days: 4.9 [95% CI, 3.1-6.7] vs. 5.9 [4.3-7.5], respectively; P = .41). From childhood to adolescence, injury prevalence increased for all areas and across both sexes, except for female finger strain/sprain/fracture; however, the rate of increase for concussion/head injuries and knee injuries was significantly higher in female compared with male athletes (P < .0001 for both). In adolescents, ankle injuries were the most common injury overall.Conclusion:Ankle injuries continue to be the most predominant pediatric basketball injury. However, disproportionate rates of both knee and concussion/head injuries in female athletes during adolescent basketball are of concern and have implications for injury prevention.

Is bicycling getting safer? Bicycle fatality rates (1985–2017) using four exposure metrics

The National Highway Traffic Safety Administration cites decreasing bicyclist fatalities in the United States over the past several decades as evidence of improved bicycling safety. However, with users possessing a diverse range of tolerances, purposes, and socio-demographics, bicycle safety is an important yet complex problem, one that does not have a simple yes/no answer. To gain a better understanding, we need to take a variety of perspectives. Traditional bicycle safety analyses take a transportation engineering perspective by using distance-based exposure metrics or those based on the number of trips. But there are other perspectives – such as public health (using population) and transportation planning (using bicycle participation) – that could provide us with a fuller picture. This paper applies four measures of bicycling exposure to take a broad, interdisciplinary perspective on bicycling safety to answer the question of whether bicycling is actually getting safer and, if so, for whom. We first explore age differences with respect to the direction and magnitude of bicyclist fatality rates in the United States between 1985 and 2017. We then investigate whether any safety benefits are shared equally among commuters and recreational riders.Using fatality data from the Fatality Analysis Reporting System (FARS) and exposure data from the National Household Travel Survey (NHTS), the American Community Survey (ACS), the U.S. Census, and the National Sporting Goods Association (NSGA) – a relatively novel approach to measuring exposure through a comprehensive national bicycling participation survey – we derived trends of age-specific bicyclist fatality rates and corresponding confidence intervals for children and adults. We also compare exposure to fatality outcomes by deriving Pearson's correlation coefficients. This is the first research to provide a longitudinal, age-specific statistical analysis of bicycle fatality rates using these four exposure metrics.Results suggest that overall declines in bicycle fatality rates have been primarily driven by a sharp decline in child bicyclist fatalities while adult bicycle fatality rates have generally trended upwards (especially for the general population) or remained stagnant (for commuters). This work adds to the understanding of bicyclist safety and gives direction to future research regarding the importance of considering age and exposure sources.

SEX AND AGE-BASED DIFFERENCES IN PEDIATRIC BASKETBALL INJURIES

Background:There is limited epidemiologic data on pediatric basketball injuries and the correlation of these injuries with sex-based differences pre- and post-adolescence.Purpose:To describe sex and age-based injury rates associated with common pediatric basketball injuries.Methods:A descriptive epidemiology study was conducted utilizing publicly available injury data from the National Electronic Injury Surveillance System (NEISS) and participation data from the National Sporting Goods Association (NSGA). Data on pediatric basketball injuries from January 2012 – December 2018 in patients ages 7-17 years were extracted and used to calculate national injury incidence rates with 95% confidence intervals.Results:Over 7 years, 9,582 basketball injuries were reported annually in the NEISS in pediatric patients 7-17 years old, which corresponds to an annual national estimate of 294,920 visits.The 5 most common diagnoses were ankle strain/sprain (17.7%), finger strain/sprain and finger fracture (12.1%), concussion/head injury (9.4%), knee strain/sprain (4.5%), and facial laceration (3.3%).There was a notable increase in injury rate in adolescents when compared with childhood ages; 7- to 11-year-old category accounted for 19.1% of estimated injuries (56,242 injuries per year) and the 12- to 17-year-old category accounted for 80.9% (238,678 injuries per year). While boys accounted for the majority of injuries in both age groups [72.6% of all injuries (40,824 injuries per year) in the 7- to 11-year-old category and 74.4% of all injuries (177,572 injuries per year) in the 12- to 17-year-old category], overall, there was no significant difference in injury rate between boys and girls (boys: 91 injuries per 100,000 athlete days, 95% CI = 73-109; girls: 110 injuries per 100,000 athlete days, 95% CI = 92-128; p=0.140). Overall injury rates across the two age groups are reported in Table 1.Head injuries/concussions were a frequent cause of presentation (second only to finger injuries) in 7- to 11-year-olds, and occurred at a similar rate in girls and boys. In adolescents, ankle injuries were the most common injury overall, but there was a most notable increase in the rate of girls’ head and knee injury compared with their boy counterparts within these ages (Table 1).Conclusions:Ankle injuries continue to be the most predominant pediatric basketball injury. However, disproportionate rates of girls’ head and knee injuries during adolescent basketball suggest that style of play and knee injury prevention programs should target girls participating in youth basketball.Table 1.Rate of basketball injuries treated in US emergency departments in the NEISS from 2012-2018a Variables7- to 11-Year-Oldsp-value12- to 17-Year-Oldsp-valueBoysGirlsBoysGirls Ankle Strain/Sprain 3.4 (2.6-4.2)6.1 (4.9-7.3)0.000223.5 (19.2-27.8)27.1 (22.4-31.8)0.2688 Finger Strain/Sprain/Fracture 8.0 (6.4-9.6)13.8 (10.5-17.1)0.002011.5 (9.1-13.9)17.4 (14.3-20.5)0.0032 Concussion/Head Injury 5.9 (4.3-7.5)4.9 (3.1-6.7)0.40638.5 (6.7-10.3)19 (15.1-22.9)<0.0001 Knee Strain/Sprain 1.4 (1-1.8)1.6 (1.2-2)0.47954.9 (3.7-6.1)10.2 (8.2-12.2)<0.0001 Facial Laceration 1.5 (1.1-1.9)0.5 (0.3-0.7)<0.00014.8 (3.8-5.8)2.4 (1.8-3)<0.0001 Overall Injuries 46.7 (37.1-56.3)57.9 (47.1-68.7)0.1284116.6 (93.5-139.7)142.9 (119.6-166.2)0.1166 Overall Injuries 49.3 (39.7-58.9)-122.4 (99.9-144.9)<0.0001 a No. of injuries per 100,000 athlete days (95% confidence interval)

Trends in bicycle-related injuries, hospital admissions, and deaths in the USA 1997–2013

Objective: Cycling is associated with numerous health benefits but also the risk of traumatic injury. Recent data demonstrate an increase in overall cycling injuries as well as hospital admissions from 1997 to 2013 in the United States. We seek to better understand the causes of the increase in cycling injuries and hospital admissions.Methods: Data regarding cycling-related injuries and hospital admissions were obtained from the National Electronic Injury Surveillance System (NEISS). Participation data were derived from the National Sporting Goods Association Sports Participation Survey, and fatality data were collected from the Fatality Analysis Reporting System (FARS). Population estimates were obtained using a complex survey design. Linear regression was used to evaluate univariate relationships between cycling injuries, hospital admissions, deaths, and participation. To evaluate factors associated with hospital admission, we developed a multivariable logistic regression model that included year, age, gender, body part injured, and injury type (i.e., contusion, fracture, or laceration).Results: The number of individuals who cycle did not change significantly over time, but there was a substantial increase in cycling-related injuries, leading to an increase in per participant injuries from 701/100,000 in 1997 to 1,164/100,000 in 2013. When the injuries were evaluated by age group, younger cyclists have an increased risk for injury, whereas the rise in injuries among older cyclists stemmed from an increase in ridership rather than a unique susceptibility to injury. Trends in hospital admissions and fatalities appeared to be driven by increases in the older age groups. In the multivariable model evaluating factors related to hospital admission, the odds of hospital admission increased for each decade after age 25, as well as male gender and body part injured.Conclusion: On a per participant basis, the rate of cycling-related injuries and hospital admissions increased between 1997 and 2013. This trend likely reflects a combination of shifting demographics among cyclists with an increase in older cyclists who are at increased risk of severe injury.

Renal Trauma from Recreational Accidents Manifests Different Injury Patterns than Urban Renal Trauma

The majority of blunt renal trauma is a consequence of motor vehicle collisions and falls. Prior publications based on urban series have shown that significant renal injuries are almost always accompanied by gross hematuria alone or microscopic hematuria with concomitant hypotension. We present a series of blunt renal trauma sustained during recreational pursuits, and describe the mechanisms, injury patterns and management. Database review from 1996 to 2009 identified 145 renal injuries. Children younger than age 16 years, and trauma involving licensable motor vehicles, penetrating injuries and work related injuries were excluded from analysis. Grade, hematuria, hypotension, age, gender, laterality, mechanism, management, injury severity score and associated injuries were recorded. We identified 106 patients meeting the criteria and 85% of the injuries were snow sport related. Age range was 16 to 76 years and 92.5% of patients were male. There were 39 grade 1 injuries, 30 grade 2, 22 grade 3, 12 grade 4 and 3 grade 5 injuries. Gross hematuria was present in 56.7%, 77.2% and 83.3% of grade 2, grade 3 and grade 4 injuries, respectively. None of the patients with grade 2 or greater injuries and microscopic hematuria had hypotension except 1 grade 5 pedicle injury. The nephrectomy and renorrhaphy rate for grade 1 to grade 4 injuries was 0%. Compared to urban series of blunt renal trauma, recreationally acquired injuries appear to follow different patterns, including a paucity of associated injuries or hypotension. If imaging were limited to the presence of gross hematuria, or microscopic hematuria with hypotension, 23% of grade 2 to grade 4 injuries would be missed. Men are at higher risk than women. However, operative intervention is rarely helpful.

The Epidemiology of Pediatric Basketball Injuries Presenting to US Emergency Departments: 2000-2006

Background:There is limited published research on the epidemiology of basketball injuries treated in US emergency departments (EDs).Hypothesis:Age and sex patterns exist for the most common pediatric basketball injuries treated in EDs.Study Design:Descriptive epidemiology study.Methods:Data from the National Electronic Injury Surveillance System and the National Sporting Goods Association were used to calculate national injury incidence rates and 95% confidence intervals of pediatric basketball injuries.Results:An estimated 325 465 annual visits were made to US EDs for pediatric basketball-related injuries from 2000 to 2006. The 5 most common injuries were ankle sprains (21.7%), finger sprains (8.0%), finger fractures (7.8%), knee sprains (3.9%), and facial lacerations (3.9%). Among persons aged 12 to 17 years, girls had a higher rate of knee sprains than boys (P < 0.001), but this association did not exist among those aged 7 to 11 years (P = 0.27). Boys had a higher rate of facial lacerations than girls (P < 0.01). Among persons aged 12 to 17 years, girls had a higher rate of finger sprains (P < 0.01). For both boys and girls, the rate of the 5 most common basketball injuries was higher among those aged 12 to 17 years compared with those aged 7 to 11 years (P < 0.01).Conclusions:The annual number of basketball-related pediatric ED visits approaches a third of a million and demonstrates the extent of the public health problem that injuries in this sport pose. Distinct sex and age patterns were observed.Clinical Relevance:The study findings provide important information on basketball injury rates that may be used for targeting prevention interventions by sex and age group.

Incidence of sports-related eye injuries in the United States: 2001–2009

Dear Editor, Sports account for almost one-third of eye injuries that lead to blindness in the United States (US) [1]. An estimated 42,000 sports-related eye injuries are evaluated in emergency departments (ED) annually in the US [2]. There is a paucity of data on current trends in sports-related eye injuries in the US [3]. To this end, we examined eye injuries from 2001 to 2009 among athletes aged 7 and older who were evaluated in EDs across the US. The study received an exemption from the Rhode Island Hospital (Providence, RI, USA) Institutional Review Board. Sports-related eye injuries were extracted from the National Electronic Injury Surveillance System (NEISS), a stratified probability sample of 100 hospital EDs across the United States and territories with a minimum of six beds and a 24-hour ED including separate strata for very large, large, medium, small and children’s hospitals based on number of ED visits [4, 5]. Sports-related eye injuries were then classified based on risk of the associated sport (high, moderate, low, and eye-safe) per the American Academies of Ophthalmology and Pediatrics (Table 1) [6]. Estimated numbers of participants within each sport were obtained from the National Sporting Goods Association (NSGA) from 2001 to 2009 [7]. Injury rates were calculated by dividing the estimated number of injuries from NEISS by the estimated number of participants from the NSGA. Injury rates within risk categories were calculated by averaging injury rates for all sports within the risk group. From 2001 to 2009, an estimated 208,517 cases of sportsrelated eye injuries in the selected sports were treated in US EDs. High-risk sports contributed 55% (114,133) of eye injuries, followed by moderate-risk (27%; 56,039), low-risk (16%; 32,555) and eye-safe (3%; 5,790). Most injuries occurred in the 7–14 age group (37%; 76,172), followed by 15–24 year olds (31%; 64,915); 80% (166,744) were males. The average yearly eye injury rate was 0.64 injuries per 10,000 participants. Trends for injury rates are shown in Fig. 1. From 2001 to 2005, the rate of high-risk sportsrelated eye injuries decreased 25% (1.77 to 1.32), while the rate of moderate-risk sports-related eye injuries decreased 27% (0.94 to 0.68). A decline in sports-related eye injuries was not observed from 2006 to 2009. In contrast, analyses suggest that the rate of sports-related eye injuries has been increasing since 2007. From 2007 to 2009, the rate of eye The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the United States (US) Department of Veterans Affairs or the US Government.

Emergency Department Visits for Concussion in Young Child Athletes

The objective of this study was to characterize emergency department (ED) visits for pediatric sport-related concussion (SRC) in pre-high school- versus high school-aged athletes. A stratified probability sample of US hospitals that provide emergency services in the National Electronic Injury Surveillance System (1997-2007) and All Injury Program (2001-2005) was used. Concussion-related ED visits were analyzed for 8- to 13- and 14- to 19-year-old patients. Population data were obtained from the US Census Bureau; sport participation data were obtained from National Sporting Goods Association. From 2001 to 2005, US children who were aged 8 to 19 years had an estimated 502 000 ED visits for concussion. The 8- to 13-year-old group accounted for approximately 35% of these visits. Approximately half of all ED visits for concussion were SRC. The 8- to 13-year-old group sustained 40% of these, which represents 58% of all concussions in this group. Approximately 25% of all SRC visits in the 8- to 13-year-old group occurred during organized team sport (OTS). During the study period, approximately 4 in 1000 children aged 8 to 13 years and 6 in 1000 children aged 14 to 19 years had an ED visit for SRC, and 1 in 1000 children aged 8 to 13 years and 3 in 1000 children aged 14 to 19 years had an ED visit for concussion sustained during OTS. From 1997 to 2007, although participation had declined, ED visits for concussions in OTS in 8- to 13-year-old children had doubled and had increased by >200% in the 14- to 19-year-old group. The number of SRCs in young athletes is noteworthy. Additional research is required.

Injuries in Youth Football: National Emergency Department Visits during 2001-2005 for Young and Adolescent Players

Limited research exists describing youth football injuries, and many of these are confined to specific regions or communities. The authors describe U.S. pediatric football injury patterns receiving emergency department (ED) evaluation and compare injury patterns between the younger and older youth football participants. A retrospective analysis of ED data on football injuries was performed using the National Electronic Injury Surveillance System-All Injury Program. Injury risk estimates were calculated over a 5-year period (2001-2005) using participation data from the National Sporting Goods Association. Injury types are described for young (7-11 years) and adolescent (12-17 years) male football participants. There were an estimated total of 1,060,823 visits to U.S. EDs for males with football-related injuries. The most common diagnoses in the younger group (7-11 years) were fracture/dislocation (29%), sprain/strain (27%), and contusion (27%). In the older group (ages 12-17 years), diagnoses included sprain/strain (31%), fracture/dislocation (29%), and contusion (23%). Older participants had a significantly higher injury risk of injury over the 5-year study period: 11.0 (95% confidence interval [CI] = 9.2 to 12.8) versus 6.1 (95% CI = 4.8 to 7.3) per 1,000 participants/year. Older participants had a higher injury risk across all categories, with the greatest disparity being with traumatic brain injury (TBI), 0.8 (95% CI = 0.6 to 1.0) versus 0.3 (95% CI = 0.2 to 0.4) per 1,000 participants/year. National youth football injury patterns are similar to those previously reported in community and cohort studies. Older participants have a significantly higher injury risk, especially with TBI.

Injuries from paintball game related activities in the United States, 1997–2001

Objective: To quantify and characterize injuries resulting from paintball game related activities among persons ⩾7 years in the United States. Setting: Hospitals included in the National Electronic Injury Surveillance System...

Skateboard-associated injuries: participation-based estimates and injury characteristics.

Skateboarding is a popular recreational activity but has attendant associated risks. To place this risk in perspective, participation-based rates of injury were determined and compared with those of other selected sports. Skateboard-associated injuries were evaluated over time to determine participation-based trends in injury prevalence. Rates of skateboard-associated injury were studied for the 12-year period 1987 to 1998 for participants aged 7 years or older. The National Electronic Injury Surveillance System provided injury estimates for skateboarding and the selected additional sporting activities. The National Sporting Goods Association annual survey of nationally representative households provided participation estimates. A participation-based rate of injury was calculated from these data sets for the selected sports for the year 1998. The 1998 rate of emergency department-treated skateboard-associated injuries-8.9 injuries per 1,000 participants (95% confidence interval [CI], 6.2, 11.6)-was twice as high as in-line skating (3.9 [95% CI, 3.1, 4.8]) and half as high as basketball (21.2 [95% CI, 18.3, 24.1]). The rate of skateboard-associated injuries declined from 1987 to 1993 but is again increasing: the 1998 rate was twice that of 1993 (4.5 [95% CI, 1.6, 7.4] and 8.9 [95% CI, 6.2, 11.6], respectively). Increases occurred primarily among adolescent and young adult skateboarders. The most frequent injuries in 1998 were ankle strain/sprain and wrist fracture: 1.2 (95% CI, 0.8, 1.6) and 0.6 (95% CI, 0.4, 0.8) per 1,000, respectively. Skateboard-associated injuries requiring hospitalization occurred in 2.9% and were 11.4 (95% CI, 7.5, 17.5) times more likely to have occurred as a result of a crash with a motor vehicle than injuries in those patients not hospitalized. This study is the first to relate skateboarding and other sport injuries to participation exposures. We found that skateboarding is a comparatively safe sport; however, increased rates of injury are occurring in adolescent and young adult skateboarders. The most common injuries are musculoskeletal; the more serious injuries resulting in hospitalization typically involve a crash with a motor vehicle. This new methodology that uses participation-based injury rates might contribute to more effective injury control initiatives.

The Origins of Gun Culture in the United States, 1760-1865

An astoundingly high level of personal violence separates the United States from every other industrial nation. In 1993, when the number of murders in Canada reached a high of 630, the United States (with nearly ten times the population) experienced 24,526 murders, out of a total of nearly two million violent crimes. The weapon of choice in 69.6 percent of those murders was a gun, and thousands more are killed by firearms every year in accidents and suicides.1 More people are killed with guns in the United States in a typical week than in all of western Europe in a year. It is now thought normal and appropriate for American urban elementary schools to use metal detectors to check students for firearms. We are familiar with the manifestations of American gun culture; the sincere love and affection with which our society views its weapons pours forth daily from the television and movie screens. Every form of the media reinforces the notion that the solution to your problems can be held in your hand and provide immediate gratification. Since the United States does not register guns, we have no idea how many there are or who actually buys them. The FBI (Federal Bureau of Investigation) estimates that there are 250 million firearms in private hands; an additional 5 million are purchased every year. The National Sporting Goods Association estimates that 92 percent of all rifles are bought by men (94 percent of the shotguns). Most of those men fall into the 25to 34-year-old age group, make between $35,000 and $50,000 annually, and do not need to kill animals for their survival.2 The consequence of this culture is also very familiar. To select just a few more statistics as indicators: The chief of police and mayor of New York City were nearly euphoric that the number of murders in the city dropped below two thousand (to 1,995) in 1993; it reached a contemporary low of 1,581 in 1994. Yet the total

Sports Participation in 1984. National Sporting Goods Association, 1699 Wall Street, Mt. Prospect, IL 60056. 1985. 69 pp. $135

Sports Participation in 1984. National Sporting Goods Association, 1699 Wall Street, Mt. Prospect, IL 60056. 1985. 69 pp. $135