Sports Injury Classification System Research Articles

Epidemiology of bone stress injuries in Australian high performance athletes: A retrospective cohort study

ObjectivesTo examine the epidemiology of bone stress injuries in an elite sports institute. DesignRetrospective cohort study at the Australian Institute of Sport. MethodsA retrospective analysis of the clinical records contained within the Australian Institute of Sport Athlete Management System electronic database was performed. Records with Orchard Sports Injury Classification System codes relating to bone stress injuries and stress fractures were reviewed and descriptive statistics relating to sport, site of injury, athlete age, sex and activity were analysed. ResultsIn the three-year period January 2014–2017, 11,942 injuries were recorded across 48 sports. 181 bone stress injuries (0.15% of all injuries) were recorded across 16 sports. BSIs in the foot and lumbar spine were the most common accounting for 30% and 23% of all the reported BSIs respectively. Gymnasts had a high frequency of lumbar spine stress injuries (n=24, 51%) and rowers had a high frequency of rib stress injuries (n=22, 88%). The most common location for stress injuries, equally distributed across a variety of sports, were in the foot (n=54, 30%). Female athletes recorded more BSIs than males. ConclusionAcross a three-year period, 0.15% of injuries were related to bone stress injuries. Almost double the cases were recorded in female athletes. Sport specific injury sites were observed in the dataset.

Subsequent Injury Risk Is Elevated Above Baseline After Return to Play: A 5-Year Prospective Study in Elite Australian Football

Background: The risk of sustaining a subsequent injury is elevated in the weeks after return to play (RTP) from an index injury. However, little is known about the magnitude, duration, and nature by which subsequent injury risk is increased. Purpose: To quantify and describe the risk of injury in a 12-week period after RTP from an index injury in Australian football players. Study Design: Cohort study; Level of evidence, 2. Methods: Injury data were collected from 79 players over 5 years at 1 Australian Football League club. Injuries were classified with the Orchard Sports Injury Classification System and by side of the body. Furthermore, injury severity was classified as time loss (resulting in ≥1 matches being missed) or non–time loss (no matches missed). Subsequent injury was categorized with the SIC-2.0 model and applied to the data set via an automated script. The probability of a time loss subsequent injury was calculated for in-season index injuries for each week of a 12-week period after RTP via a mixed effect logistic regression model. Results: Subsequent injury risk was found to be highest in the week of RTP for both time loss injuries (9.4%) and non–time loss injuries (6.9%). Risk decreased with each week survived after RTP; however, it did not return to baseline risk of participation (3.6%). Conclusion: These findings demonstrate that athletes returning to play are at an increased risk of injury for a number of weeks, thus indicating the requirement for tertiary prevention strategies to ensure that they survive this period.

Collecting Health and Exposure Data in Australian Olympic Combat Sports: Feasibility Study Utilizing an Electronic System.

BackgroundElectronic methods are increasingly being used to manage health-related data among sporting populations. Collection of such data permits the analysis of injury and illness trends, improves early detection of injuries and illnesses, collectively referred to as health problems, and provides evidence to inform prevention strategies. The Athlete Management System (AMS) has been employed across a range of sports to monitor health. Australian combat athletes train across the country without dedicated national medical or sports science teams to monitor and advocate for their health. Employing a Web-based system, such as the AMS, may provide an avenue to increase the visibility of health problems experienced by combat athletes and deliver key information to stakeholders detailing where prevention programs may be targeted.ObjectiveThe objectives of this paper are to (1) report on the feasibility of utilizing the AMS to collect longitudinal injury and illness data of combat sports athletes and (2) describe the type, location, severity, and recurrence of injuries and illnesses that the cohort of athletes experience across a 12-week period.MethodsWe invited 26 elite and developing athletes from 4 Olympic combat sports (boxing, judo, taekwondo, and wrestling) to participate in this study. Engagement with the AMS was measured, and collected health problems (injuries or illnesses) were coded using the Orchard Sports Injury Classification System (version 10.1) and International Classification of Primary Care (version 2).ResultsDespite >160 contacts, athlete engagement with online tools was poor, with only 13% compliance across the 12-week period. No taekwondo or wrestling athletes were compliant. Despite low overall engagement, a large number of injuries or illness were recorded across 11 athletes who entered data—22 unique injuries, 8 unique illnesses, 30 recurrent injuries, and 2 recurrent illnesses. The most frequent injuries were to the knee in boxing (n=41) and thigh in judo (n=9). In this cohort, judo players experienced more severe, but less frequent, injuries than boxers, yet judo players sustained more illnesses than boxers. In 97.0% (126/130) of cases, athletes in this cohort continued to train irrespective of their health problems.ConclusionsAmong athletes who reported injuries, many reported multiple conditions, indicating a need for health monitoring in Australian combat sports. A number of factors may have influenced engagement with the AMS, including access to the internet, the design of the system, coach views on the system, previous experiences with the system, and the existing culture within Australian combat sports. To increase engagement, there may be a requirement for sports staff to provide relevant feedback on data entered into the system. Until the barriers are addressed, it is not feasible to implement the system in its current form across a larger cohort of combat athletes.

Vitamin D Deficiency and Injury Risk During Basic Military Training in the Maltese Armed Forces

Background: Military recruits undertake intense loads of physical training as part of their recruitment to reach a physical level compatible with their line of duties. This training is often conducted over a short time span and complicated by injuries and premature recruit discharge. Identification of risk factors that could decrease the risk of injuries is ideal. Objectives: The present study aimed at correlating pre-recruitment vitamin D levels to injury risk during basic military training in a group of recruits. Methods: A total of 90 recruits commencing their basic military training were invited to participate in the study. The cohort comprised 81 males and 9 females, with a mean age of 22.6. All acute and gradual onset musculoskeletal injuries as well as medical ailments were recorded using the Orchard Sports Injury Classification System. Injuries and medical ailments were analyzed for associations with vitamin D levels. Recruits were grouped according to their serum vitamin D levels into deficient, insufficient, or sufficient as per the Endocrine Society range guidelines. Results: A total of 34 (26.2%) recruits sustained at least 1 injury during the course of their basic military training. Vitamin D level as well as vitamin D status was not associated with injury risk although weak rejection of association with leg injuries and vitamin D insufficiency status was noted (P = 0.057). A total of 60% of recruits were identified as being vitamin D deficient or as having insufficient vitamin D levels. Conclusions: Vitamin D deficiency and insufficiency are relatively common in areas with high mean sunlight exposure and should be considered in individuals who might otherwise be at risk. Further studies are recommended in the military using larger populations and possibly focusing on leg injuries. Keywords: Athletic Injuries; Military Personnel; Leg; Vitamin D

Subsequent Injuries Are More Common Than Injury Recurrences: An Analysis of 1 Season of Prospectively Collected Injuries in Professional Australian Football

Background: It is known that some people can, and do, sustain >1 injury over a playing season. However, there is currently little high-quality epidemiological evidence about the risk of, and relationships between, multiple and subsequent injuries. Purpose: To describe the subsequent injuries sustained by Australian Football League (AFL) players over 1 season, including their most common injury diagnoses. Study Design: Cohort study; Level of evidence, 3. Methods: Within-player linked injury data on all date-ordered match-loss injuries sustained by AFL players during 1 full season were obtained. The total number of injuries per player was determined, and in those with >1 injury, the Subsequent Injury Classification (SIC) model was used to code all subsequent injuries based on their Orchard Sports Injury Classification System (OSICS) codes and the dates of injury. Results: There were 860 newly recorded injuries in 543 players; 247 players (45.5%) sustained ≥1 subsequent injuries after an earlier injury, with 317 subsequent injuries (36.9% of all injuries) recorded overall. A subsequent injury generally occurred to a different body region and was therefore superficially unrelated to an index injury. However, 32.2% of all subsequent injuries were related to a previous injury in the same season. Hamstring injuries were the most common subsequent injury. The mean time between injuries decreased with an increasing number of subsequent injuries. Conclusion: When relationships between injuries are taken into account, there is a high level of subsequent (and multiple) injuries leading to missed games in an elite athlete group.

The use and effectiveness of the Orchard Sports Injury Classification System (OSICS) in a self referral NHS outpatient musculoskeletal setting

The use and effectiveness of the Orchard Sports Injury Classification System (OSICS) in a self referral NHS outpatient musculoskeletal setting

Risk factors for lower leg, ankle and foot injuries during basic military training in the Maltese Armed Forces

ObjectivesBasic military training is physically and psychologically demanding placing recruits at high risk of injury and premature discharge. This study aimed to identify risk factors for lower leg, ankle and foot injury in Maltese military recruits during basic training. DesignThis was a prospective cohort study. SettingAn armed forces barracks. Participants127 recruits commencing one basic military training course agreed to participate in the study. The cohort comprised 114 males and 13 females with a mean age of 21.7 ± 2.4 years. Main outcome measuresAll injuries to the lower leg, ankle and foot were recorded using the Orchard Sports Injury Classification System. Injuries were analysed for associations with fitness scores, smoking status, body mass index and foot type. ResultsA total of 34 (26.2%) recruits sustained at least one injury, with 10 recruits (7.9%) terminating their training prematurely (three due to musculoskeletal injury). Smoking history, body mass index and foot type were not associated with injury risk. Lower fitness levels at the commencement of basic military training compared with fitness levels measured six months prior, were associated with higher injury risk. ConclusionsLower fitness at the commencement of basic training was associated with higher injury risk in army recruits. Thus, conditioning programmes aimed at improving recruit fitness should be considered within an injury prevention strategy.

THE IMPACT OF THE TACKLE: SHOULDER INJURIES IN A RUGBY UNION TEAM

BackgroundRugby Union (rugby) is the third most popular contact sport in the world and has one of the highest reported incidences of injuries amongst all sports. Thoroughly characterising these injuries...

Coding OSICS sports injury diagnoses in epidemiological studies: does the background of the coder matter?

ObjectiveTo compare Orchard Sports Injury Classification System (OSICS-10) sports medicine diagnoses assigned by a clinical and non-clinical coder.DesignAssessment of intercoder agreement.SettingCommunity Australian football.Participants1082 standardised injury surveillance records.Main outcome measurementsDirect comparison...

Utilització d’un mètode de codificació per l’estudi i seguiment epidemiològic de la patologia esportiva. Avaluació de dos períodes olímpics amb l’equip nacional de taekwondo

Introduction and purpose The epidemiological study of sports injuries is essential to assess their causes and consequences on the athlete. The Orchard Sports Injury Classification System (OSICS) model was chosen to determine its usefulness to manage and evaluate sports injury epidemiology, using as a handy reference, the medical care offered to the Taekwondo national athletes team who resided in the Olympic Training Centre of Sant Cugat del Valles for two Olympic cycles. Methods There are encoded in OSICS All medical care given to Taekwondo athletes from 1st January 1997 to 31th December 2004 were encoded in OSICS, in order to count the number of episodes and visits generated. This medical care was according to gender, anatomic location of the damaged structure, and type of injury. Results With the OSICS system it was easy to obtain the following information: a total of 3969 visits were made which corresponded to 2912 episodes, representing an average of 1.36 visits per episode. Of these 30.0% corresponded to medical pathology and 69.5% to sports injuries. The most affected anatomical location was the lower limbs, the knee being the structure that generated the largest number of episodes and visits. Episodes of wounds and bruises are the most recorded, and overuse injuries were the ones that generated more visits per episode. Conclusions The encoding method used, is practical and effective to assess the epidemiological pathology in sport. Also by determining the prevalence of injuries in Taekwondo, it would be useful for developing preventive plans.

Revision, uptake and coding issues related to the open access Orchard Sports Injury Classification System (OSICS) versions 8, 9 and 10.1

The Orchard Sports Injury Classification System (OSICS) is one of the world’s most commonly used systems for coding injury diagnoses in sports injury surveillance systems. Its major strengths are that it has wide usage, has codes specific to sports medicine and that it is free to use. Literature searches and stakeholder consultations were made to assess the uptake of OSICS and to develop new versions. OSICS was commonly used in the sports of football (soccer), Australian football, rugby union, cricket and tennis. It is referenced in international papers in three sports and used in four commercially available computerised injury management systems. Suggested injury categories for the major sports are presented. New versions OSICS 9 (three digit codes) and OSICS 10.1 (four digit codes) are presented. OSICS is a potentially helpful component of a comprehensive sports injury surveillance system, but many other components are required. Choices made in developing these components should ideally be agreed upon by groups of researchers in consensus statements.

Coding sports injury surveillance data: has version 10 of the Orchard Sports Injury Classification System improved the classification of sports medicine diagnoses?

Objectives:To compare versions 8 and 10 of the Orchard Sports Injury Classification System (OSICS) to determine whether the revised version of OSICS has improved its use in a sports medicine...

The Orchard Sports Injury Classification System (OSICS) Version 10

Injury classification systems are generally used in sports medicine (1) to accurately classify diagnoses for summary studies, permitting easy grouping into parent categories for tabulation and (2) to create a database from which cases can be extracted for research on specific injuries. Clarity is most important for the first purpose, whereas diagnostic detail is particularly important for the second. An ideal classification system is versatile and appropriate for all sports and all data collection scenarios. The Orchard Sports Injury Classification System (OSICS) was developed in 1992 primarily for the first purpose, a specific study examining the incidence of injury at the elite level of football in Australia. As usage of the OSICS expanded into different sports, limitations were noted and therefore many revisions have been made. A recent study found the OSICS-8, whilst superior to the International Classification of Diseases Australian Modification (ICD-10-AM) in both speed of use and 3-coder agreement, still achieved a lower level of agreement than expected. The study also revealed weaknesses in the OSICS-8 that needed to be addressed. A recent major revision resulted in the development of the new 4-character OSICS-10. This revision attempts to improve interuser agreement, partly by including more diagnoses encountered in a sports medicine setting. The OSICS-10 should provide far greater depth in classifications for the benefit of those looking to maintain diagnostic information. It is also structured to easily collapse down into parent classifications for those wanting to preserve basic information only. For those researchers wanting information collected under broader injury headings, particularly those not using fully computerized systems, the simplicity of the OSICS-8 system may still suffice.

From Study Design and Analysis to Conclusion: New Horizons for Epidemiological Rigor in Sport Medicine

From Study Design and Analysis to Conclusion: New Horizons for Epidemiological Rigor in Sport Medicine

Classifying sports medicine diagnoses: a comparison of the International classification of diseases 10-Australian modification (ICD-10-AM) and the Orchard sports injury classification system (OSICS-8)

Background: The International classification of diseases 10-Australian modification (ICD-10-AM) and the Orchard sports injury classification system (OSICS-8) are two classifications currently being used in sports injury research. Objectives: To compare...

Injuries Presenting to Army Physiotherapy in North Queensland, Australia

To analyze archival physiotherapy records at a major military base in North Queensland, Australia, to investigate the epidemiology of injuries associated with sports and training, examining for possible risk factors for military training injury. A retrospective study was undertaken during a 62-month period, from 1987 to 1992, at Lavarack Barracks, Townsville, Australia, which services a dynamic population base of some 5,000 uniformed staff. Sociodemographic basic data, as well as treatment-related data (treatment area, number and type, interval between onset and initial treatment, reported cause), were used. Admission records were recoded according to the Orchard Sports Injury Classification System (version 2.0) standard. During the 62-month period from 1987 to 1992, 4,993 personnel, 96.2% (4,803/4,993) males and 3.7% (190/4,993) females, were referred for 5,025 physiotherapy treatments. The incidence of injuries requiring physiotherapy was 80.4 new patients per 5,000 personnel per month, and the incidence rate of injury was 19.3% per year or 0.19 injuries per person per year. The mean age of patients was 25.7 +/- 6.2 (SD) years, and the median age was 24 years, with a range of 17 to 59 years. Injuries were related to military training (29.3%, 1,471/5,025), diverse causes (21.2%, 1,072/5,025), sports (13.8%, 694/5,025), insidious onset (11.8%, 589/5,025), football (11.7%, 586/5,025), manual handling (4.2%, 211/5,025), motor vehicle crashes (4.1%, 206/5,025), and surgery (3.9%, 196/5,025). The four major body areas treated by physiotherapists were the knee joint (37.0%, 1,321/3,612), lumbar spine (29.8%, 1,075/3,612), ankle (19.9%, 719/3,612), and shoulder joints (13.8%, 497/3,612), which accounted for nearly three-quarters of all admissions. Of these, most were referred without definitive diagnosis (71.1%, 2,572/3,612), with the remainder comprising joint injuries (17.5%, 634/3,612), other types of pathology such as chest infections or neurological involvement, soft-tissue injuries (3.5%, 128/3,612), and bone damage (1.0%, 38/3,612). Most injuries (59.0%, 2,959/5,019) occurred during the 6 months between April and September referred to as the winter season, during which 71.8% of all football and 66.8% of all sports-related referrals were made. Significant associations were found between gender and injury cause (p < 0.001), gender and injury type (p < 0.01), body area affected and injury type (p < 0.00001), body area affected and injury cause (p < 0.00001), injury cause and injury type (p < 0.00001), and season and injury cause (p < 0.00001). Pretreatment interval was significantly associated with cause of injury (p < 0.00001), body area affected (p < 0.0001), and type of injury (p < 0.0001). Total number of consecutive treatments provided was significantly associated with both body area affected (p < 0.05) and injury type (p < 0.001). This study has used archival physiotherapy records for the purpose of exploring injury reporting patterns associated with a military population. The incidence profile for injuries using physiotherapy admissions is likely to be conservative because the patients are a group of injured military personnel selected by medical officers for physiotherapy treatment. This selection process needs further study, particularly because the majority of injuries referred for physiotherapy treatment are undiagnosed. This may be attributable in part to the cumulative and diverse nature of some injuries. Injury prevention needs to focus on activities relating to military training and football and other sports. Improved systems for recording detailed and accurate physiotherapy admission, treatment, and follow-up information are needed.