Sample Of High School Athletes Research Articles

Differences in Overuse Injuries in Gender-Comparable Sports: A Nationally Representative Sample of High School Athletes.

Participation in high school sports has physical, physiological, and social development benefits, while increasing the risk of acute and overuse injuries. Risk of sports-related overuse injury differs between boys and girls. To investigate differences in overuse injuries among United States high school athletes participating in the gender-comparable sports of soccer, basketball, and baseball/softball. Descriptive epidemiology study using a nationally representative sample from the High School Reporting Information Online (RIOTM) database. High schools. Athletes with overuse injuries during the 2006-2007 through 2018-2019 academic years. National estimates and rates of overuse injuries were extrapolated from weighted observed numbers (with the independent variables: sport, gender, academic year, class year, event type, body site, diagnosis, recurrence, activity, and position). Among an estimated 908, 295 overuse injuries nationally, 43.9% (n=398,419) occurred in boys' soccer, basketball, and baseball, while 56.1% (n=509,876) occurred in girls' soccer, basketball, and softball. When comparing gender across sports, girls were more likely to sustain an overuse injury than boys (soccer: IRR: 1.37; 95% CI: 1.20-1.57; basketball: IRR: 1.82; 95% CI: 1.56-2.14; and baseball/softball: IRR: 1.21; 95% CI: 1.04-1.41). Most overuse injuries in soccer and basketball for both genders occurred to a lower extremity (soccer: 83.9% [175,369/209,071] for boys, 90.0% [243,879/271,092] for girls; basketball: 77.0% [59,239/76,884] for boys, 80.5% [81,826/101,709] for girls), while most overuse injuries in baseball and softball were to an upper extremity (72.5% [81,363/112,213] for boys, 53.7% [73,557/136,990] for girls). For boys' baseball, pitching (43.5% [47,007/107,984]) was the most common activity associated with an overuse injury, which differed from the most common activity of throwing (31.7% [39,921/126,104]) for girls' softball. Gender differences observed in this study can help guide future strategies that are more specific to gender and sport to reduce overuse injuries among high school athletes.

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

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

Epidemiology of Overuse Injuries in U.S. Secondary School Athletics from 2014-2015 to 2018-2019 Using the National Athletic Treatment, Injury, and Outcomes Network Surveillance Program

Background:Large-scale injury surveillance systems such as the National Athletic Treatment, Injury and Outcomes Network Surveillance Program (NATION-SP) allow for the investigation of injury rates in national samples of high school athletes. The most recent studies examining overuse injury rates in high school sports reported data from 2012-2013 and therefore may not reflect current overuse injury rates in high school sports.Hypothesis/Purpose:To 1) determine overuse time-loss (TL) and non-time-loss (NTL) injury rates among high school student athletes using NATION-SP data collected from 2014-2015 to 2018-2019 and 2) compare overuse injury rates based on student-athlete gender defined by sport, sport, and injury location. We hypothesized that TL overuse injury rates would be greater than those previously reported from earlier data (1.64/10,000 athletic exposures (AEs) and 1.50/10,000 AEs). We also hypothesized that overall overuse rates would be greater in girls’ sports compared to boys’ sports and would differ between injury types (TL vs. NTL) and injury location.Methods:During the 2014-2015 through 2018-2019 school years, NATION-SP documented TL and NTL injuries from 222 high schools. This study included 23 high school sports during preseason, regular season, and post-season competitions and practices. Overuse injuries were identified using a combination of reported injury mechanism and diagnosis. Injury counts, rates, and rate ratios (IRRs) were reported with 95% confidence intervals (CIs).Results:The overall overuse injury rate was 6.6/10,000 AEs (95%CI=6.3, 6.9), the NTL overuse injury rate was 4.0/10,000 AEs (95%CI=3.8, 4.3), and the TL overuse injury rate was 2.6/10,000 AEs (95%CI=2.4, 2.8). The overuse injury rate was greater in girls’ sports compared to boys’ sports (IRR=1.8; 95%CI=1.6, 1.9). The highest rates of overuse injury regardless of sport gender were reported in girls’ cross-country (20.0/10,000 AEs; 95%CI=15.7, 25.1), girls’ field hockey (17.6/10,000 AEs; 95%CI=12.3, 24.5), and girls’ track and field (17.5/10,000 AEs; 95%CI=14.9, 20.4). Overuse injury rates were highest for the lower extremity compared to the upper extremity (IRR=5.45; 95%CI=4.76, 6.27) and for the lower extremity compared to the trunk and spine (IRR=11.08; 95%CI=9.21, 13.45).Conclusions:Using NATION-SP data collected over five consecutive school years, overuse injury rates among high school athletes were much greater than previously reported earlier in the decade. Awareness of overuse injury risk as well as prevention and intervention recommendations are necessary and should be specifically targeted towards cross-country, field hockey, and track and field athletes.Table 1.Total and Sport Gender Specific Overuse Injury Count and Athletic ExposuresFigure 1.Overall and sport gender specific overuse injury rates across years of study data collection.

Association Between Design Elements of Concussion Laws and Reporting of Sports-Related Concussions Among US High School Athletes, 2009-2017.

Studies that evaluate the effectiveness of concussion laws often use only a single variable (ie, presence of the law), failing to account for law complexity. We examined the association between multiple design elements of state concussion laws and rates of sports-related concussion reporting among US high school athletes. We derived 3 design elements of concussion laws from the 2009-2017 LawAtlas database: (1) strength of law, (2) number of law revisions, and (3) speed of law adoption. We examined the association between these design elements and rates of new and recurrent sports-related concussion reporting from the 2009-2010 through 2016-2017 academic years in a nationally representative sample of high school athletes participating in High School Report Information Online, an online data collection tool. A total of 7064 sports-related concussions (6332 [89.6%] new and 732 [10.4%] recurrent concussions) were reported during the study period, with an overall rate of 39.7 sports-related concussions per 100 000 athletic exposures (eg, game or practice). Rates of new concussion reporting were higher among high schools in states with medium- or high-strength concussion laws than in states with low-strength concussion laws and in states with at least 1 concussion law revision than in states with no concussion law revisions. Rates of recurrent concussion reporting were lower among high schools in states with ≥2 concussion law revisions than in states with <2 concussion law revisions. Early law adoption was associated with higher rates of new and recurrent concussion reporting, and late law adoption was associated with lower rates of new and recurrent concussion reporting. Our findings may help inform legislators of the public health effect of concussion laws.

Influence of Special Education, ADHD, Autism, and Learning Disorders on ImPACT Validity Scores in High School Athletes

AbstractObjective:The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is commonly used to assist with post-concussion return-to-play decisions for athletes. Additional investigation is needed to determine whether embedded indicators used to determine the validity of scores are influenced by the presence of neurodevelopmental disorders (NDs).Method:This study examined standard and novel ImPACT validity indicators in a large sample of high school athletes (n = 33,772) with or without self-reported ND.Results:Overall, 7.1% of athletes’ baselines were judged invalid based on standard ImPACT validity criteria. When analyzed by group (healthy, ND), there were significantly more invalid ImPACT baselines for athletes with an ND diagnosis or special education history (between 9.7% and 54.3% for standard and novel embedded validity criteria) when compared to athletes without NDs. ND history was a significant predictor of invalid baseline performance above and beyond other demographic characteristics (i.e., age, sex, and sport), although it accounted for only a small percentage of variance. Multivariate base rates are presented stratified for age, sex, and ND.Conclusions:These data provide evidence of higher than normal rates of invalid baselines in athletes who report ND (based on both the standard and novel embedded validity indicators). Although ND accounted for a small percentage of variance in the prediction of invalid performance, negative consequences (e.g., extended time out of sports) of incorrect decision-making should be considered for those with neurodevelopmental conditions. Also, reasons for the overall increase noted here, such as decreased motivation, “sandbagging”, or disability-related cognitive deficit, require additional investigation.

Autonomy support and control within mother-father parenting structures: A person-centered approach in youth sport

In the youth sport context, parents play an important role in the motivation of adolescent athletes. From a self-determination theory viewpoint, the provision of autonomy support versus control by parents is an essential part of this socialization process. The purpose of the present study was threefold: (a) identify distinct mother-father parenting profiles of autonomy support and control based on perceptions of adolescent athletes, (b) examine the unique influence of mother-father parenting profiles on adolescent athletes' motivational responses (i.e., parent-to-child effects), and (c) understand the contribution of adolescent athletes' motivation to the emergence of these mother-father parenting profiles (i.e., child-to-parent effects). To test our hypotheses, a person-centered approach (latent profile analysis) was employed to analyze data collected from a sample of high school athletes (N = 264; Mage = 15.7 years, 64% female). Results provided evidence supporting a four-profile solution: Strong Autonomy Support Dominant: Both Parents (n = 26, 9.8%), Weak Control Dominant: Both Parents (n = 111, 42.0%), Moderate Autonomy Support and Control: Both Parents (n = 21, 8.0%), and Weak Autonomy Support Dominant: Both Parents (n = 106, 40.2%). The four mother-father parenting profiles were found to be differentially predicted by, and predictive of, adolescent athletes' adaptive and maladaptive motivational responses (i.e., basic psychological needs satisfaction, autonomous and controlled motivation). This study illuminated a general pattern of congruency in the provision of autonomy support and control by parents within mother-father parenting structures and contributed empirical evidence pointing to the reciprocal nature of interpersonal processes in parent-athlete relationships.

The Relationships Between King-devick And SCAT5 Scores In High-school Athletes

Preseason testing is important when developing concussion-related safety programs in high-school athletics. However, the relationships between many commonly-used and valid-baseline assessments are unknown PURPOSE: To determine the relationships between King-Devick (KD) and the Sport Concussion Assessment Tool - 5thEdition (SCAT5), commonly used as part of a pre-season concussion-safety program for high-school athletes. METHODS: SCAT5 and KD baseline scores from high-school athletes (n = 404, 28 = female, aged 16 ±1 years) were recorded and later analyzed. KD testing required participants to complete two, error-free trials, which were reported to the nearest 0.0 s and a single SCAT5 assessment completed one-on-one with a physician or athletic trainer. The SCAT5 test is composed of several relevant neurocognitive components (concentration, current number of symptoms, symptom severity, orientation, memory, neurological screening, balance, and recall). Due to the dichotomous nature of the neurological screening component, those data were excluded from this analysis (n = 9 scored in the abnormal category). Pearson-product moment correlations were calculated between the best-baseline KD score and SCAT5’s component tests, including a composite score. The composite score was calculated as a sum of z-scores from each individual test making up the SCAT5. RESULTS: The mean ± standard deviation of the KD test were 52.5 ± 13.3 s. Pearson-product moment correlations revealed a weak-negative relationship with the SCAT5 component - Concentration (r = - 0.12, p = 0.02). However, no other meaningful relationships were detected [number of symptoms (r = - 0.04, p = 0.48), symptom severity (r = - 0.06, p = 0.22), orientation (r = - 0.07, p = 0.14), memory (r = - 0.02, p = 0.63), balance (r = - 0.04, p = 0.39), recall (r = 0.01, p = 0.88), and composite z-score (r = - 0.05, p = 0.30)] CONCLUSIONS:These data show that KD and SCAT5 scores are generally unrelated in this sample of high-school athletes. Clinically, the data support the true utility of neurocognitive testing resides in one’s ability to use the same test to directly compare pre- vs. post-test scores in diagnosing and monitoring recovery in athletes suspected of having a concussion. King-Devick provided access to testing services - free of charge.

Risk and recovery among high school athletes who sustained at least one sports-related concussion.

Aim:Evidence of factors explaining sports-related concussion (SRC) risk and recovery among high school athletes remains inconclusive.Materials & methods:Prospective study of a real-world sample of high school athletes (n = 77) who sustained ≤1 SRC. Among those with multiple SRCs, recovery time between events was investigated. To investigate concussion risk, baseline characteristics of athletes with a single versus multiple SRC(s) were compared.Results:Recovery time did not differ across events. There were no differences between those with a single versus multiple SRCs.Conclusion:Recovery time between initial and subsequent concussive events did not differ, suggesting that prior concussion may not prolong recovery. Baseline characteristics did not explain heightened concussion risk. Investigation of these relationships using more representative samples is needed.

Motion Sickness Susceptibility and Baseline Vestibular and Ocular-Motor Performance in Adolescent Athletes

High school athletes with a history of motion sickness susceptibility exhibit higher baseline vestibular and ocular-motor scores than those without a history of motion sickness susceptibility. To examine the effects of motion sickness susceptibility on baseline vestibular and ocular-motor functioning, neurocognitive performance, and symptom scores. Cross-sectional study. Preseason concussion testing. A convenience sample of high school athletes (N = 308, age = 15.13 ± 1.21 years) involved in a variety of sports. Vestibular/Ocular Motor Screening, computerized neurocognitive assessment, symptom scale, and Motion Sickness Susceptibility Questionnaire-Short Form (MSSQ-S). Participants were categorized into 3 groups based on a median split of the scores (eg, NONE, LOW, and HIGH). The LOW (n = 95) and HIGH (n = 92) groups (ie, MSSQ-S score > 0) were 2.64 times more likely (χ21,257 = 7.94, P = .01, 95% confidence interval = 1.32, 5.26) to have baseline Vestibular/Ocular Motor Screening scores larger than the clinical cutoffs for the NONE group (n = 70). No between-groups main effects were present for the NONE (n = 52), LOW (n = 89), and HIGH (n = 90) MSSQ-S groups for verbal (F2,230 = .09, P = .91, η2 = .001) and visual (F2,230 = .15, P = .86, η2 = .001) memory, processing speed (F2,230 = .78, P = .46, η2 = .007), or reaction time (F2,230 = 2.21, P = .11, η2 = .002). The HIGH group exhibited higher total baseline symptom scores than the LOW (U = 3325.50, z = -1.99, P = .05, r = .15) and NONE (U = 1647.50, z = -2.83, P = .005, r = .24) groups. Motion sickness should be considered a preexisting risk factor that might influence specific domains of the baseline concussion assessment and postinjury management.

Association of Functional Movement Screen and Y-Balance Test Scores With Injury in High School Athletes.

Lisman, P, Hildebrand, E, Nadelen, M, and Leppert, K. Association of functional movement screen and Y-Balance Test scores with injury in high school athletes. J Strength Cond Res 35(7): 1930-1938, 2021-The purpose of this study was to determine the association between functional movement screen (FMS) and Y-Balance Test (YBT) performance and lower extremity injury in a sample of male high school athletes. A total of 124 high school football (n = 89), lacrosse (n = 25), and baseball (n = 10) players underwent FMS and YBT before the start of their competitive seasons. Time loss lower extremity injury incidence data were tracked by each team's certified athletic trainer and used for analysis. Receiver operating characteristic (ROC) curves were calculated to determine the optimal cutpoints for FMS composite score (CS) and YBT measures, including CS and reach distance asymmetry for anterior, posteromedial, and posterolateral directions, for predicting injury. No cutpoints on the ROC curves maximized sensitivity and specificity; therefore, FMS CS and YBT measures (CS and asymmetry) were analyzed as continuous variables. Logistic regression models adjusted for age and sport revealed no significant associations between FMS CS and lower extremity injury (odds ratio [OR] = 0.99; 95% confidence interval [CI] = 0.83-1.20). Similar findings were found for YBT asymmetry in all directions (ORs ranged from 0.98 to 1.08) and CS (OR = 0.99; 95% CI = 0.95-1.04). There were also no significant associations between the presence of asymmetry and low score (score of 1) on any individual FMS test and injury. Overall, FMS and YBT were not associated with increased risk of lower extremity injury in this sample of high school athletes. These findings do not support the use of FMS and YBT as stand-alone injury risk assessments in high school athletes.

Association of Competition Volume, Club Sports, and Sport Specialization With Sex and Lower Extremity Injury History in High School Athletes.

Background:High school athletes are increasingly encouraged to participate in 1 sport year-round to increase their sport skills. However, no study has examined the association of competition volume, club sport participation, and sport specialization with sex and lower extremity injury (LEI) in a large sample of high school athletes.Hypothesis:Increased competition volume, participating on a club team outside of school sports, and high levels of specialization will all be associated with a history of LEI. Girls will be more likely to engage in higher competition volume, participate on a club team, and be classified as highly specialized.Study Design:Cross-sectional study.Level of Evidence:Level 3.Methods:High school athletes completed a questionnaire prior to the start of their competitive season regarding their sport participation and previous injury history. Multivariable logistic regression analyses were used to investigate associations of competition volume, club sport participation, and sport specialization with history of LEI, adjusting for sex.Results:A cohort of 1544 high school athletes (780 girls; grades 9-12) from 29 high schools completed the questionnaire. Girls were more likely to participate at high competition volume (23.2% vs 11.0%, χ2 = 84.7, P < 0.001), participate on a club team (61.2% vs 37.2%, χ2 = 88.3, P < 0.001), and be highly specialized (16.4% vs 10.4%, χ2 = 19.7, P < 0.001). Athletes with high competition volume, who participated in a club sport, or who were highly specialized had greater odds of reporting a previous LEI than those with low competition volume (odds ratio [OR], 2.08; 95% CI, 1.55-2.80; P < 0.001), no club sport participation (OR, 1.50; 95% CI, 1.20-1.88; P < 0.001), or low specialization (OR, 2.58; 95% CI, 1.88-3.54; P < 0.001), even after adjusting for sex.Conclusion:Participating in high sport volume, on a club team, or being highly specialized was associated with history of LEI. Girls were more likely to participate at high volumes, be active on club teams, or be highly specialized, potentially placing them at increased risk of injury.Clinical Relevance:Youth athletes, parents, and clinicians should be aware of the potential risks of intense, year-round participation in organized sports.

Relationship Between Concussion History and Concussion Knowledge, Attitudes, and Disclosure Behavior in High School Athletes.

Examine the association between self-reported concussion history and measures of concussion knowledge, attitude, and disclosure behavior. Cross-sectional survey. Classroom. A convenience sample of high school athletes (n = 167; mean age = 15.7 years) from multiple sports completed a validated survey. Concussion history (main predictor) was defined as the number of self-recalled concussions during participants' high school career. The outcomes were recalled concussion disclosure behavior (3 measures) and scales assessing both concussion knowledge and concussion attitude. A greater number of previous concussions was associated with worse attitude to concussion and negative concussion disclosure behavior. For every 3 additional self-recalled concussions, there was a mean decrease of 7.2 points (range of possible scores = 14-98) in concussion attitude score (P = 0.002), a 48% decrease in the self-reported proportion of concussion events disclosed (P = 0.013), and an increased prevalence of self-reported participation in games (67%) and practices (125%) while experiencing signs and symptoms of concussion (P < 0.001). Increased concussion history did not affect concussion knowledge score (P = 0.333). Negative trends in concussion disclosure behavior were identified in youth athletes with a positive history of concussion. Improving disclosure in this subgroup will require targeted efforts addressing negative attitude to concussion.

Long-term Stability and Reliability of Baseline Cognitive Assessments in High School Athletes Using ImPACT at 1-, 2-, and 3-year Test-Retest Intervals.

The ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) neurocognitive testing battery is a widely used tool used for the assessment and management of sports-related concussion. Research on the stability of ImPACT in high school athletes at a 1- and 2-year intervals have been inconsistent, requiring further investigation. We documented 1-, 2-, and 3-year test-retest reliability of repeated ImPACT baseline assessments in a sample of high school athletes, using multiple statistical methods for examining stability. A total of 1,510 high school athletes completed baseline cognitive testing using online ImPACT test battery at three time periods of approximately 1- (N=250), 2- (N=1146), and 3-year (N=114) intervals. No participant sustained a concussion between assessments. Intraclass correlation coefficients (ICCs) ranged in composite scores from 0.36 to 0.90 and showed little change as intervals between assessments increased. Reliable change indicesand regression-based measures (RBMs) examining the test-retest stability demonstrated a lack of significant change in composite scores across the various time intervals, with very few cases (0%-6%) falling outside of 95% confidence intervals. The results suggest ImPACT composites scores remain considerably stability across 1-, 2-, and 3-year test-retest intervals in high school athletes, when considering both ICCs and RBM. Annually ascertaining baseline scores continues to be optimal for ensuring accurate and individualized management of injury for concussed athletes. For instances in which more recent baselines are not available (1-2 years), clinicians should seek to utilize more conservative range estimates in determining the presence of clinically meaningful change in cognitive performance.

Utility of the Athlete Drinking Scale for assessing drinking motives among high school athletes

Research suggests that high school athletes are at greater risk for heavy alcohol use and alcohol-related problems than their non-athlete peers. Drinking motives unique to the athletic experience may contribute to elevated use. The Athlete Drinking Scale (ADS) was designed to assess sport-related motives for alcohol use, but has not yet been validated among high school athletes. The purpose of this study was to examine the psychometric properties of the ADS among a sample of high school athletes. Participants were 216 high school student-athlete drinkers who completed anonymous self-report surveys. A confirmatory factor analysis resulted in a revised three-factor solution with a satisfactory overall model fit. Path analyses indicated that the Positive Reinforcement motives subscale was the only ADS subscale that was significantly associated with alcohol use and alcohol-related problems when controlling for the effects of the other factors (i.e., age and gender) in this population. The ADS may be a valuable assessment tool for researchers and clinicians involved in alcohol prevention efforts for high school athletes.

Contesting orientations: Measure construction and the prediction of sportspersonship

ObjectiveThis three-study investigation was undertaken to develop, validate, and test the Contesting Orientations Scale (COS), a new measure designed to assess individuals' tendencies to use contest-is-partnership and contest-is-war conceptual metaphors (i.e., contesting orientations) when competing (Shields & Bredemeier, 2009, 2011a). DesignThe research design was correlational. Following preliminary item creation and expert review, survey based studies were conducted to develop theoretically-based, psychometrically sound scales measuring contesting orientations. MethodIn Study 1, an exploratory factor analysis (EFA) was performed on a preliminary 39-item COS administered to a sample of high school athletes (N = 233). Study 2 used EFA to evaluate a revised 23- item COS with a second sample of high school athletes (N = 92) resulting in a final reduction of the measure to twelve items. Confirmatory factor analysis (CFA) was then conducted on this 12-item COS, which proved an excellent fit to the data. A new sample of college athletes (N = 238) allowed Study 3 to (a) further examine the factorial validity of the COS, including gender invariance testing, (b) assess the concurrent validity of the COS via its correlations with goal orientations, empathy, moral identity, and moral disengagement; and, (c) assess the COS's incremental predictive utility for investigations of sportspersonship. Results and conclusionResults from the sequence of studies demonstrate that the 12-item, two-scale COS has good psychometric properties as assessed through EFA and CFA, good concurrent validity, and adds significantly to existing measures in the prediction of sportspersonship.

Shoulder Injuries Among US High School Athletes, 2005/2006–2011/2012

The objective of this study was to describe shoulder injuries in a nationally representative sample of high school athletes playing 9 sports. A national estimate of shoulder injuries among high school athletes was subsequently calculated. Injury data were collected in 9 sports (boys' football, soccer, basketball, wrestling, and baseball; girls' soccer, volleyball, basketball, and softball) during the 2005-2006 through 2011-2012 academic years from a nationally representative sample of high schools via High School Reporting Information Online. During the 2005-2006 through 2011-2012 academic years, high school athletes in this study sustained 2798 shoulder injuries during 13,002,321 athlete exposures, for an injury rate of 2.15 per 10,000 athlete exposures. This corresponds to a nationally estimated 820,691 injuries during this time period. Rates of injury were higher in competition as compared with practice (rate ratio = 3.17 [95% confidence interval: 2.94-3.41]). The highest rate of injury was in football (4.86) and the lowest in girls' soccer (0.42). The most common types of injury were strain/sprain (37.9%) and dislocation/separation (29.2%). Boys were more likely than girls to sustain their injuries after contact with another person or with the playing surface. Surgical repair was required for 7.9% of the injuries. Time loss from athletic participation varied among sports, with 40.7% of athletes returning within 1 week, whereas 8.2% were medically disqualified for their season/career. High school shoulder injury rates and patterns varied by sport and gender. Prospective epidemiologic surveillance is warranted to discern trends and patterns to develop evidence-based interventions to prevent shoulder injuries.

Knowledge, Attitude, and Concussion-Reporting Behaviors Among High School Athletes: A Preliminary Study

Many athletes continue to participate in practices and games while experiencing concussion-related symptoms, potentially predisposing them to subsequent and more complicated brain injuries. Limited evidence exists about factors that may influence concussion-reporting behaviors. To examine the influence of knowledge and attitude on concussion-reporting behaviors in a sample of high school athletes. Cross-sectional study. Participants completed a validated survey instrument via mail. A total of 167 high school athletes (97 males, 55 females, 5 sex not indicated; age = 15.7 ± 1.4 years) participating in football, soccer, lacrosse, or cheerleading. Athlete knowledge and attitude scores served as separate predictor variables. We examined the proportion of athletes who reported continuing to participate in games and practices while symptomatic from possible concussion and the self-reported proportion of recalled concussion and bell-ringer events disclosed after possible concussive injury. Only 40% of concussion events and 13% of bell-ringer recalled events in the sample were disclosed after possible concussive injury. Increased athlete knowledge of concussion topics (increase of 1 standard deviation = 2.8 points) was associated with increased reporting prevalence of concussion and bell-ringer events occurring in practice (prevalence ratio [PR] = 2.27, 95% confidence interval [CI] = 1.60, 3.21) and the reporting prevalence of bell-ringer-only events overall (PR = 1.87, 95% CI = 1.38, 2.54). Athlete attitude scores (increase of 1 standard deviation = 11.5 points) were associated with decreases in the proportion of athletes stating they participated in games (PR = 0.74, 95% CI = 0.66, 0.82) and practices (PR = 0.67, 95% CI = 0.59, 0.77) while symptomatic from concussions. Most recalled concussion events in our study were not reported to a supervising adult. Clinicians should be aware that knowledge and attitude influence concussion reporting. Clinicians and administrators should make concussion education a priority and encourage an optimal reporting environment to better manage and prevent concussive injuries in young athletes.

One-Year Test-Retest Reliability of the Online Version of ImPACT in High School Athletes

Background: The ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) neurocognitive testing battery is a popular assessment tool used for concussion management. The stability of the baseline neurocognitive assessment is important for accurate comparisons between postconcussion and baseline neurocognitive performance. Psychometric properties of the recently released online version of ImPACT have yet to be established; therefore, research evaluating the reliability of this measure is warranted. Purpose: The authors investigated the 1-year test-retest reliability of the ImPACT online version in a sample of high school athletes. Study Design: Case series; Level of evidence, 4 Methods: A total of 369 varsity high school athletes completed 2 mandatory preseason baseline cognitive assessments approximately 1 year apart as required by their respective athletics program. No diagnosed concussion occurred between assessments. Results: Intraclass correlation coefficients (ICCs) for ImPACT online indicated that motor processing speed (.85) was the most stable composite score, followed by reaction time (.76), visual memory (.70), and verbal memory (.62). Unbiased estimates of reliability were consistent with ICCs: motor processing speed (.85), reaction time (.76), visual memory (.71), and verbal memory (.62). Conclusion: The online ImPACT baseline is a stable measure of neurocognitive performance across a 1-year time period for high school athletes. These reliability data for online ImPACT are higher than the 2-year ICCs previously reported from the desktop version. Clinical Relevance: It is recommended that the ImPACT baseline assessment (both desktop and online) continue to be updated every 2 years. The online version of ImPACT appears to be a stable measure of neurocognitive performance over a 1-year period, and systematic evaluation of its stability over a 2-year period is warranted.

Concussions Among United States High School and Collegiate Athletes

An estimated 300,000 sport-related traumatic brain injuries, predominantly concussions, occur annually in the United States. Sports are second only to motor vehicle crashes as the leading cause of traumatic brain injury among people aged 15 to 24 years. To investigate the epidemiology of concussions in a nationally representative sample of high school athletes and to compare rates of concussion among high school and collegiate athletes. Descriptive epidemiologic study. 100 United States high schools and 180 US colleges. United States high school and collegiate athletes. Data from 2 injury surveillance systems, High School Reporting Information Online (RIO) and the National Collegiate Athletic Association Injury Surveillance System, were analyzed to calculate rates, describe patterns, and evaluate potential risk factors for sport-related concussion. Concussions represented 8.9% (n = 396) of all high school athletic injuries and 5.8% (n = 482) of all collegiate athletic injuries. Among both groups, rates of concussions were highest in the sports of football and soccer. In high school sports played by both sexes, girls sustained a higher rate of concussions, and concussions represented a greater proportion of total injuries than in boys. In all sports, collegiate athletes had higher rates of concussion than high school athletes, but concussions represented a greater proportion of all injuries among high school athletes. Sport-related injury surveillance systems can provide scientific data to drive targeted injury-prevention projects. Developing effective sport-related concussion preventive measures depends upon increasing our knowledge of concussion rates, patterns, and risk factors.

Sports-Related Injuries Among High School Athletes—United States, 2005-06 School Year

Participation in high school sports helps promote a physically active lifestyle. High school sports participation has grown from an estimated 4 million participants during the 1971-72 school year to an estimated 7.2 million in 2005-06. However, despite the documented health benefits of increased physical activity (e.g., weight management, improved self-esteem, and increased strength, endurance, and flexibility), those who participate in athletics are at risk for sports-related injuries. High school athletes account for an estimated 2 million injuries, 500,000 doctor visits, and 30,000 hospitalizations annually. To date, the study of these injuries has been limited by inabilities to calculate injury rates, compare results among groups, and generalize findings from small, nonrepresentative samples. During the 2005-06 school year, researchers at a children's hospital in Ohio used an Internet-based data-collection tool to pilot an injury surveillance system among athletes from a representative national sample of U.S. high schools. This report summarizes the findings of that study, which indicated that participation in high school sports resulted in an estimated 1.4 million injuries at a rate of 2.4 injuries per 1,000 athlete exposures (i.e., practices or competitions). Surveillance of exposure-based injury rates in a nationally representative sample of high school athletes and analysis of injury patterns can help guide activities aimed at reducing these injuries.