Sports Injury Surveillance System Research Articles

Epidemiology of injuries in U.S. high school track and field throwing events from 2008 to 2019.

Injury characteristics of high school track and field throwing athletes in the United States are not well studied. Understanding epidemiology of injuries is important to identify treatment and prevention strategies. To describe injury rates and patterns in U.S. high school track and field throwing events from a longitudinal national sports injury surveillance system. Descriptive epidemiology study. Data were provided by the National High School Sports Related Injury Surveillance System, High School RIO (Reporting Information Online). Athletic trainers reported injury and exposure data through the High School RIO website on a weekly basis. An athlete exposure (AE) was defined as one athlete participating in one school-sanctioned practice or competition. Throwing events of discus, shot put, and javelin were analyzed in this study. Injury rate, rate ratios (RR), injury proportion ratios (IPR). U.S. high school athletes. A total of 267 track and field throwing injuries occurred during 5,486,279 AEs. Overall, the rate of injuries in competition was higher than in practice (RR 1.35, 95% confidence interval [CI] 1.01-1.80). In practice, the rate of injuries was higher for girls than boys (RR 1.53, 95% CI 1.12-2.08). The most frequently injured body part was the shoulder (21.7%), followed by the ankle (16.5%) and knee (12.0%). The most common types of injury were muscle strains (26.14%) and ligament sprains (25%). Recurrent injuries accounted for a higher proportion of chronic injuries compared to new injuries (IPR 1.85, 95% CI 1.16-2.97). This study described injury characteristics of high school track and field throwing athletes from 2008 to 2019. Based on our results, injury prevention may be particularly important for female throwers with prior injury.

Epidemiology of Ankle Ligament Injuries in US High School Athletes

Category: Sports; Ankle; Trauma Introduction/Purpose: Foot and ankle injuries account for a large percentage of the over one million injuries sustained by high school level athletes. To date, many studies have examined the epidemiology of lower extremity injuries and ankle sprains, but few studies have classified sprains into subtypes across multiple sports. The purpose of this study was to describe the epidemiology of ankle sprain subtypes across 9 common high school sports. Methods: Athlete exposure and injury specific data from 7 seasons (2014 to 2021) were collected using the internet-based High School Reporting Information Online (High School RIO), a national high school sports injury surveillance system, for athletes participating in 1 of 9 sports (boys' and girls' soccer, girls' volleyball, boys' and girls' basketball, boys' baseball, girls' softball, boys' football, boys' wrestling). Incidence and ligament involvement of foot and ankle injuries were examined, with incidence being calculated as 1 injury per 10,000 athlete exposures (AE). Results: Ankle ligament injuries accounted for 89.0% of the 7,321 foot and ankle injuries across the 9 sports (81-94%). Girls and boys' basketball had the highest incidence of sprains, 3.46 and 3.37 respectively. Ankle ligament injuries accounted for 35.9% of all lower extremity injuries in basketball players. 85.0% of the sprains were classified as lateral ligament, 4.0% medial ligament, 11.5% syndesmosis (8.6% partial and 2.9% complete syndesmosis injuries). Football had the highest percentage of syndesmosis injuries at 11.0%, and the highest incidence of both syndesmosis injuries (0.44) and medial ligament injuries (0.17). Surgical intervention was required in 4.3% of complete syndesmosis injuries and 0.7% of lateral ligament injuries. No differences were found in incidence of ankle ligament injuries comparing pre-COVID-19 seasons (2014-2020) to the 2020-2021 season. Conclusion: Ankle sprains account for a large percentage of foot and ankle injuries sustained by high school level athletes. Syndesmosis injuries occur more commonly in football and are 6 times more likely to require early surgical intervention compared to lateral ligament injuries. Identifying sports commonly involved in these injuries and classifying the sprains is the first step in implementing early identification, rehabilitation, and prevention programs. Future studies should examine the efficacy of injury prevention programs and rates of ankle sprains among high school level athletes.

Injury surveillance in community cricket: A new inning for South Africa.

Published injury rates amongst elite and club-level youth cricketers highlight the need to implement injury risk-reducing strategies amongst the youth cricketing population. Data from sports injury surveillance systems are a prerequisite for the development and evaluation of strategies to reduce injury risk. Therefore, collecting injury surveillance data is a positive move towards reducing injuries in cricket. In South Africa, a systematic, standardised, evidence-informed injury surveillance system currently does not exist for community levels of play, namely, in cricket-playing high schools and cricket clubs. Although injury surveillance systems exist at elite levels, the obvious differences in elite versus community cricket settings mean that these systems cannot be implemented in their current form at community-level cricket. An innovative model is required to implement an injury surveillance system in community cricket.Clinical implicationsThis article proposes and describes a new research–practice partnership model to implement a systematic, standardised, evidence-informed injury surveillance system at cricket-playing high schools or cricket clubs within South Africa. Once this model has been employed, database systems will need to be established to allow long-term data management and sharing.

Sports Injury Surveillance Systems and Guidelines in Japan: A Systematic Review.

This systematic review aimed to identify sports injury surveillance systems (ISSs) and injury surveillance guidelines (ISGs) developed and currently used in Japan. Additionally, the extent to which ISSs and ISGs developed overseas are employed in Japan was also examined. A systematic search of electronic databases was performed in March 2021. Prospective studies that investigated sports injuries and targeted Japanese athletes or sports in Japan were included to identify the following: (1) details of the ISSs or ISGs developed among sports in Japan, and (2) characteristics of studies focusing on sports in Japan employing ISSs or ISGs developed overseas and the method of use. A total of five ISSs developed among sports in Japan were included, most of which were based on insurance benefits or condolence payment systems. In total, 23 studies used ISSs or ISGs developed overseas, more than half of which were used as a resource for the development of other data collection tools or methods, indicating that the definition of injury and/or classification of items are modified based on the needs among sports in Japan. This review highlights the necessity of establishing club-based or organisational ISSs and ISGs that are appropriate for sports in Japan.

Foot and Ankle Injury Surveillance of Collegiate Student-Athletes Utilizing the Pac-12 Health Analytics Program

Category:Ankle; Sports; OtherIntroduction/Purpose:In order to monitor student-athlete health, identify risk factors associated with sports injuries, and develop and evaluate injury prevention programs at the collegiate level, it is necessary to implement and utilize high quality sports injury surveillance systems. The Pac-12 Health Analytics Program (HAP) addresses this need by standardizing electronic medical record entries and common data elements across all Pac-12 institutions. The literature suggests that collegiate student-athletes are at higher risk for certain injuries that have chronic effects on their health-related quality of life. Previous investigations utilizing the HAP database found ankle injuries to be the second most prevalent lower extremity injury in this population. This study aims to build upon these previous findings and further characterize below-knee injuries using the HAP database.Methods:We retrospectively reviewed archival data from Pac-12 student-athletes followed in the HAP database, a deidentified Pac-12 conference-wide sports injury surveillance system used to study the epidemiological characteristics of varsity student- athletes from 2017-2020. Data collection is part of the standard of care provided by varsity athletic trainers and entered into the Presagia Sports electronic medical record. This data is then deidentified and automatically sent to the Pac-12 for inclusion in the HAP. Individual authorization forms were obtained from student-athlete participants prior to deidentification and inclusion in the HAP database. Student-athletes who sustained a lower extremity (LE) injury below the knee were included. Data on demographics and injury characteristics were analyzed.Results:Foot and ankle injuries account for 20.3% (6,776/33,432) of all database injuries, representing 23.4% (2,214/9,444) of all student-athletes. Female-athletes (26.8%) had a higher injury rate than male-athletes (20.9%) (p<0.00001). Lower leg injuries were categorized as ankle (43.1%), foot (25.3%), lower leg (18.4%), and ankle/heel (13.2%). Ligament sprain was the most common injury type (38.1%) followed by tendinopathy (14.4%) and inflammation (7.9%). Males were more likely to sustain an acute injury (81.8%) than females (63.7%). Injuries most commonly occurred on synthetic (46.0%). Common mechanisms of injury (MOI) included running (21.6%), contact with another player (18.4%), and contact with a hard object (14.8%). Injuries most commonly occurred during in-season (48.9%) compared to off-season (25.5%) and pre-season (20.9%) segments of the competitive year. Half of injuries (50.0%) resulted in lost time from sport, however only 6.7% of injuries were season ending and only 2 injuries (<0.01%) resulted in medical retirement.Conclusion:Most ankle injuries occurred on synthetic surfaces, suggesting an opportunity for enhanced monitoring and prehabililitation programs for sports that utilize these types of surfaces. Further investigations accounting for covariates and risk factors may inform injury prevention strategies and improve student-athlete wellness. While the Pac-12 HAP database is early in development, this report demonstrates the potential value that injury surveillance systems can provide for student-athlete health. The Pac-12 HAP is a collaborative and effective injury database, setting the standard for other regional conferences.

Sports injury and illness surveillance systems in nationwide and Japan

Sports injury and illness surveillance systems in nationwide and Japan

Epidemiological Indices of Sports Injuries in Male Students of Physical Education High Schools in Kerman and Explanation of Causes of Sports Injuries in the Sports Injury

Introduction: Since school sports are the main cause of students’ injuries, awareness of the causes and factors underlying these injuries can pave the way for the development and planning of injury prevention strategies. The present study was conducted in two quantitative and qualitative phases using the data in the sports injury surveillance system and the interviews designed by the researchers to analyze the epidemiological indicators and causes of students’ injuries.Methods: This mixed-method study was conducted using qualitative and quantitative descriptive techniques. The injuries made to male students of physical education high schools in Kerman were recorded for 6 months in a sports injury surveillance system developed by the researchers. Then, the qualitative data were collected using in-depth and semi-structured interviews to explore the possible causes of sports injuries. The collected data were analyzed using a content analysis method via descriptive statistics and the chi-square test with SPSS software (version 21) at a significance level of P=0.05. Besides, the qualitative data were analyzed using a conventional content analysis technique.Results: The results of data analysis indicated that most of the injuries occurring in sports movements to the student-athletes were caused by collision. Moreover, muscle strain injuries were the most frequently found sports injuries. Improper techniques were also reported as the most important cause of sports injuries. Pain was found as the most significant indicator of the early post-injury symptoms. An analysis of the quantitative-descriptive data recorded in the sports injury surveillance system showed the injury incidence rate of 33.3 injuries per 100 student-athletes and 63.3 injuries per 100 hours of training and competition. Furthermore, the lower extremity with 51.6% and minor injuries with 45.3% showed the highest rate and improper techniques accounting for 25% of the injuries were the most important risk factor for injury.Conclusion: Given the high prevalence of muscle strains and the highest percentage of lower extremity injuries in students caused by using improper techniques, addressing sports injury indicators, as well as explaining their causes and underlying factors can significantly contribute to reducing students’ injuries. Moreover, regular systematic reviews of epidemiological studies can be effective in developing practical programs for injury prevention in students.

Player Wellness (Soreness and Stress) and Injury in Elite Junior Australian Football Players Over 1 Season

Purpose: To investigate the association between player wellness and injury in elite junior Australian football players over 1 competitive season. Methods: Prospective cohort study. Elite junior Australian football players (N = 196, average age = 17.7 y, range = 16–18 y) were recruited in the under-18 state league competition in Victoria, Australia. They recorded their wellness (sleep, fatigue, soreness, stress, and mood) according to a 5-point Likert scale 3 times weekly, with injuries (missed match/training session) entered into an online sport-injury surveillance system. A logistic generalized estimating equation was used to examine the association (expressed as odds ratio [OR]) between wellness and injury (yes/no). Results: Soreness was associated with injury at each time point across the week, with the strongest association evident for soreness reported 6 d postmatch (OR = 1.30; 95% confidence interval [CI], 1.17–1.44; P &lt; .001). Stress and injury were associated with injury for average stress values across the week, as well as specifically on day 1 postmatch (OR = 1.10; 95% CI, 1.01–1.21; P = .038). Mood reported in the middle of the week (3 d postmatch) was associated with injury (OR = 0.87; 95% CI, 0.78–0.97; P = .014), as was fatigue (OR = 1.10; 95% CI, 1.00–1.22; P = .044). Conclusions: This study demonstrates key associations between wellness and injury in elite junior Australian football, specifically soreness, stress, fatigue, and mood. Monitoring strategies help identify injury-risk profiles, which can help decision makers (coaches or medical staff) intervene when relevant to reduce injury risk.

Reduction of High School Ice Hockey Injuries With Implementation of New Checking/Boarding Rules.

Evaluate whether rule changes by the National Federation of State High School Associations (NFHS) were associated with reduced injury rates in US high school ice hockey players. We compared injury rates for the 3 seasons before the rule changes (2011-2012, 2012-2013, and 2013-2014) with the 2 subsequent seasons (2014-2015 and 2015-2016) using data from the High School Reporting Information Online (RIO) database. Convenience sample of US high schools. High school ice hockey athletes. The sports injury surveillance system that supplied the data for this study was funded in part by the Centers for Disease Control and Prevention (grant Nos. R49/CE000674-01, R49/CE001172-01, and R49/CE002106-01) as well as research funding contributions of the NFHS, National Operating Committee on Standards for Athletic Equipment (NOCSAE), DonJoy Orthotics, and EyeBlack. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or any other funding agency. In the 2014 to 2015 ice hockey season, the NFHS increased the penalty for boarding (illegally causing opponent to be thrown violently into the boards) and for checking from behind. Injury rates and mechanism of injury. There was a statistically significant 40% reduction in rates of injury attributed to being checked in the 2 seasons after the rule changes (5.0 injuries per 10 000 athlete exposures) compared with the 3 previous seasons (8.3) (rate ratio = 0.60, P = 0.002). There were no significant differences in overall injury rates (P = 0.12) or injury rates due to checking (P = 0.27), contact with the boards (P = 0.31), or contact with another player (P = 0.55). Among US high school ice hockey athletes, implementation of stricter penalties for boarding and checking from behind was associated with a significant decrease in injury rate due to being checked. Rates of injury due to other mechanisms were not significantly altered, suggesting the rule changes achieved their targeted effect.

Comparing Two Sports Injury Surveillance Systems: A Novel Systematic Approach

Purpose: The present study aimed to compare two sports injury surveillance systems per the sports injury recording system of the sports medicine federation. Methods: A sports injury surveillance system was implemented to collect injury data. Athletic trainers recorded athletes’ sports injuries in soccer, volleyball, handball, taekwondo, and wrestling for 6 months in their user account via a smartphone-based application. The sports recording system routinely collected data alongside the sports injury surveillance system. Finally, the collected results were compared with the federation’s sports injury recording system. Results: Overall, 81 sports injuries were reported to the surveillance system. The incidence rate of 1.39 injuries per 1000 registered athletes was calculated in a sports injury surveillance system. This incidence rate was equal to 0.32 injuries per 1000 athletes registered in the sports injury recording system. Contusion and bruising were the most frequent injuries. However, there was no data on injury type in the sports injury recording system. Fingers and knees were the most commonly reported body parts in the sports injury surveillance system; however, knee and thigh were the most commonly recorded parts in the sports injury recording system. There was also a significant difference between the results of the two systems (P&lt;0.05). Conclusion: Different implementation and reporting methods as well as having injury definition may affect the results. Employing easy access and user-friendly tools may facilitate injury recording.

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

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

Rates and Patterns of Lower Extremity Sports Injuries in All Gender-Comparable US High School Sports.

Background:High school athletes with lower extremity sports injuries (LESIs) frequently present to the emergency department in the United States. Previous epidemiological studies have presented rates and mechanisms of LESIs in these athletes. No studies, however, have looked at LESIs in gender-comparable sports in an attempt to evaluate what differences exist between LESIs in boys and girls.Purpose:To describe the epidemiology of LESIs among US high school athletes using a large national database of athletes in sports that could be considered gender comparable, given the rules of play and protective equipment.Study Design:Descriptive epidemiology study.Methods:Descriptive data from 2005 to 2016 were collected using the internet-based High School Reporting Information Online (High School RIO), a national high school sports injury surveillance system, for athletes participating in 8 gender-comparable sports (soccer, volleyball, basketball, baseball/softball, swimming and diving, track and field, cross-country, and tennis). Rates and patterns of injury were evaluated, with injury rates calculated as ratio of injuries per 10,000 athlete-exposures. Rate ratios (RRs) were calculated to compare the LESI rates in girls and boys.Results:In both genders, LESI rates (per 10,000 athlete-exposures) were highest in soccer (girls, 15.87; boys, 11.68) followed by basketball (girls, 11.51; boys, 9.35), and were lowest in swimming and diving (girls, 0.70; boys, 0.39). Although injury rates were significantly higher in girls compared with boys in all sports, only in tennis was the RR greater than 2 (RR, 2.03; 95% CI, 1.17-3.54). Girls had a greater proportion of severe LESIs and injuries that received radiographic evaluation, such as magnetic resonance imaging, compared with boys for all sports except volleyball. Consistency in the mechanism of injury was demonstrated between genders within each sport.Conclusion:This study demonstrated that LESIs are common among high school athletes and disproportionately affect girls more than boys, especially when looking at severe injuries and resource utilization. Further studies are needed to elucidate the cause of these findings. We hope that the awareness of gender-based differences in LESIs will lead to improvements in targeted efforts to decrease injury rates and injury severity.

Absolute and Relative Load and Injury in Elite Junior Australian Football Players Over 1 Season.

To investigate the association between training and match loads and injury in elite junior Australian football players over 1 competitive season. Elite junior Australian football players (n = 290, age 17.7 [0.3] y, range 16-18y) were recruited from the under-18 state league competition in Victoria to report load and injury information. One-week load (session rating of perceived exertion multiplied by duration) and all time-loss injuries were reported using an online sport-injury surveillance system. Absolute load measures (weekly sums) enabled the calculation of relative measures such as the acute:chronic workload ratio. Load measures were modeled against injury outcome (yes/no) using a generalized estimating equation approach, with a 1-wk lag for injury. Low (<300arbitrary units [au]) and high (>4650au) 1-wk loads were associated with significantly higher risk of injury. Furthermore, low (<100au) and high (>850au) session loads were associated with a higher risk of injury. High strain values (>13,000) were associated with up to a 5-fold increase in the odds of injury. There was a relatively flat-line association between the acute:chronic workload ratio and injury. This study is the first investigation of elite junior athletes demonstrating linear and nonlinear relationships between absolute and relative load measures and injury. Coaches should focus player loads on, or at least close to, the point at which injury risk starts to increase again (2214au for 1-wk load and 458au for session load) and use evidence-based strategies across the week and month to help reduce the risk of injury.

Evaluation Of Rule Modifications On The Reduction Of Injuries In High School Boys' Lacrosse

The National Federation of State High School Associations previously modified two lacrosse rules: Rule 5.4 in the 2012/13 academic year to heighten the penalty for any hits to the head/face/neck (HFN); and Rule 5.3.5 in the 2013/14 academic year to minimize body checking. PURPOSE: To determine if the rate of overall injury, HFN injuries, and concussions due to intentional contact (checking) differed for boys’ high school lacrosse players after two rule modifications were enacted. METHODS: Data were collected from the High School RIO (Reporting Information Online) sports injury surveillance system. During the 2008/09-2016/17 seasons, athletic trainers collected injury and athlete-exposure (AE) data for high school boys’ lacrosse teams. Overall and checking-related injury rates were calculated and stratified by competition and practice settings. Overall, HFN, and concussion injury rates were further analyzed by checking mechanism (e.g., being body/stick checked or delivering body/stick check). Incidence rate ratios (IRR) with 95% confidence intervals (CI) compared rates prior to and after the enactment of the rule modifications (Rule 5.4 – 2012/13 vs. 2008/09-2011/12; Rules 5.4 and 5.3.5 – 2013/14-2016/17 vs 2008/09-2011/12). RESULTS: There was a significant decrease in checking-related HFN injuries (IRR, 0.29; 95% CI, 0.13-0.65) and checking-related concussions (IRR, 0.29; 95%CI, 0.12-0.70) during practice in the seasons after both rule modifications were imposed, but there were no significant decreases in any checking-related injuries during competition. When both rules were enacted together, concussion risk due to delivering body check (IRR, 0.51; 95% CI 0.29-0.91) and overall injury risk due to being body checked (IRR, 0.72; 95% CI, 0.53-0.97) decreased. By injury mechanism, there were no significant decreases after only the Rule 5.4 modification took place. CONCLUSION: When both the Rule 5.4 and 5.3.5 modifications were in effect, concussion and overall injury risk decreased for the player initiating the body check and the player being body checked, respectively. However, concussion risk due to being body checked during games was not affected.

Injuries in girls\u2019 soccer and basketball: a comparison of high schools with and without athletic trainers

BackgroundSports injuries impose physical and economic burdens on high school athletes, yet only 37% of high schools have access to a fulltime certified athletic trainer (AT). Although intuitively there are multiple benefits of AT coverage, research demonstrating the measurable effect of AT coverage on rates and patterns of injury is limited. Our objective was to investigate the epidemiology of girls’ basketball and soccer injuries in high schools with and without an AT.MethodsWe compared data captured by two similar sports injury surveillance systems during the 2006/07–2008/09 academic years. High School Reporting Information Online (RIO) included a national sample of schools with ATs, and the Sports Injury Surveillance System (SISS) included a sample of Chicago public high schools without ATs.ResultsOverall injury rates were higher in schools without ATs than schools with ATs in girls’ soccer (RR: 1.73, 95% CI: 1.51–2.00) and basketball (RR: 1.22, 95% CI: 1.03–1.45). Recurrent injury rates were even higher in schools without ATs compared to schools with ATs in soccer (RR: 6.00 95% CI: 4.54-7.91) and basketball (RR: 2.99, 95% CI: 2.12–4.14). Conversely, concussion rates were higher in schools with ATs than schools without ATs in soccer (RR: 8.05, 95% CI: 2.00–32.51) and basketball (RR: 4.50, 95% CI: 1.43–14.16). Other injury patterns were similar between the two samples.ConclusionsThis study demonstrated the effectiveness of AT coverage of high school girls’ soccer and basketball, both in reducing overall and recurrent injury rates and in identifying athletes with concussions. Future studies should evaluate the effect of ATs on other high school sports and on youth sports to determine if these findings are generalizable across sports and age groups.

The incidence, prevalence, severity, mechanism and body region of injury in elite junior Australian football players: A prospective cohort study over one season

ObjectivesTo describe the incidence, prevalence, severity, mechanism and body region of injuries in elite junior Australian football (AF) players over one competitive season in order to help inform injury prevention interventions. DesignProspective cohort, data collected during the 2014 playing season. MethodsPlayer and staff-reported injuries sustained by 562 players from an under-18 state league were entered into an online sports injury surveillance system. An injury was recorded if it led to a missed training session or match. Injury incidence was calculated as the number of injuries per 1000h of training and competition. Injury severity was defined by the number of days players missed training or competition. Injury mechanism was identified as either contact, non-contact or overuse. ResultsThere were 1192 football-related injuries sustained during the season; the majority (n=1041, 87.3%) were new, occurred during competition (n=954, 86%) and led to 4–7 missed days in severity (n=429, 46%). Injury incidence was 37.2 injuries per 1000h of exposure. Over half of injuries were contact in mechanism (n=355, 51%). Most injuries were to the lower limb (n=720, 60%), with the thigh representing the highest proportion of these. ConclusionsThis study provides key information as to the aetiology of injury in this level of competition and provides a stronger foundation from which injury prevention studies could be carried out. Future research is well-placed to develop an understanding of the injury risk factors in the elite junior cohort, whilst also reducing injury risk once players transition to the AFL.

The SMS, Phone, and medical Examination sports injury surveillance system is a feasible and valid approach to measuring handball exposure, injury occurrence, and consequences in elite youth sport.

Current methods of sports injury surveillance are limited by lack of medical validation of self-reported injuries and/or incomplete information about injury consequences beyond time loss from sport. The aims of this study were to (a) evaluate the feasibility of the SMS, Phone, and medical Examination injury surveillance (SPEx) system (b) to evaluate the proportion of injuries and injury consequences reported by SPEx when compared to outcomes from a modified version of the Oslo Sports Trauma Research Centre (OSTRC) Overuse Injury Questionnaire. We followed 679 elite adolescent handball players over 31weeks using the SPEx system. During the last 7weeks, we also implemented a modified OSTRC questionnaire in a subgroup of 271 players via telephone interviews. The weekly response proportions to the primary SPEx questions ranged from 85% to 96% (mean 92%). SMS responses were received from 79% of the participants within 1day. 95% of reported injuries were classified through the telephone interview within a week, and 67% were diagnosed by medical personnel. Comparisons between reported injuries from SPEx and OSTRC demonstrated fair (κ=39.5% [25.1%-54.0%]) to substantial prevalence-adjusted bias-adjusted kappa (PABAK=66.8% [95% CI 58.0%-75.6%]) agreement. The average injury severity score difference between SPEx and the OSTRC approach was -0.2 (95% CI -3.69-3.29) of possible 100 with 95% limits of agreement from(-14.81-14.41). These results support the feasibility and validity of the SPEx injury surveillance system in elite youth sport. Future studies should evaluate the external validity of SPEx system in different cohorts of athletes.

Head Impact Locations in U.S. High School Boys' and Girls' Soccer Concussions, 2012/13-2015/16.

This study describes concussions and concussion-related outcomes sustained by high school soccer players by head impact location, sex, and injury mechanism. Data were obtained for the 2012/13-2015/16 school years from the National High School Sports-Related Injury Surveillance System, High School RIO™. This Internet-based sports injury surveillance system captures data reported by athletic trainers from an annual average of 162 U.S. high schools. Data were analyzed to describe circumstances of soccer concussion (e.g., symptomology, symptom resolution, and return-to-play time) by impact location (i.e., front- [face included], back-, side-, and top-of-the-head) and sex. Most concussions were from front-of-the-head impacts (boys, 30.5%; girls, 34.0%). Overall, 4.1 ± 2.2 and 4.6 ± 2.3 symptoms were reported in boys and girls, respectively. In boys, symptom frequency was not associated with head impact location (p = 0.66); an association was found in girls (p = 0.02), with the highest symptom frequency reported in top-of-the-head impacts (5.4 ± 2.2). Head impact location was not associated with symptom resolution time (boys, p = 0.21; girls, p = 0.19) or return-to-play time (boys, p = 0.18; girls, p = 0.07). Heading was associated with 28.0% and 26.5% of concussions in boys and girls, respectively. Most player-player contact concussions during heading occurred from side-of-the-head impacts (boys, 49.4%; girls, 43.2%); most heading-related ball contact concussions occurred from front-of-the-head (boys, 41.4%; girls, 42.6%) and top-of-the-head (boys, 34.5%; girls, 36.9%) impacts. Head impact location was generally independent of symptom resolution time, return-to-play time, and recurrence among high school soccer concussions. However, impact location may be associated with reported symptom frequency. Further, many of these clinical concussion descriptors were associated with sex.

Epidemiology of Shoulder and Elbow Injuries Among United States High School Baseball Players: School Years 2005-2006 Through 2014-2015

Background: Shoulder and elbow injuries are common in young athletes, especially high school baseball players. Understanding the risk factors associated with baseball injuries is an essential first step in the development of injury prevention strategies. Purpose: To provide a comprehensive understanding of the epidemiology of shoulder and elbow injuries among high school baseball players in the United States. Study Design: Descriptive epidemiological study. Methods: Baseball-related injury data were obtained from the National High School Sports-Related Injury Surveillance Study using High School RIO (Reporting Information Online), an Internet-based sports injury surveillance system. Athletic trainers from high schools across the country uploaded data regarding athlete-exposures (AEs) (defined as practice or game participation) and shoulder and elbow injuries from the school years 2005-2006 through 2014-2015. Results: A total of 241 shoulder injuries and 150 elbow injuries occurred during 1,734,198 AEs during the study period, for an overall shoulder injury rate of 1.39 per 10,000 AEs and an overall elbow injury rate of 0.86 per 10,000 AEs. The overall rates of injury were higher in competitions compared with practices for shoulders (rate ratio, 1.44; 95% CI, 1.11-1.85) and elbows (rate ratio, 2.15; 95% CI, 1.56-2.96). The majority of shoulder (39.6%) and elbow (56.9%) injuries were sustained by pitchers, and most injuries were chronic and caused by overuse. Position players were more likely to sustain injuries by contact with the playing surface or apparatus. For pitchers, muscle strains were the most common shoulder injuries (38.7%), while ligament sprains were the most common elbow injuries (42.7%). The majority of pitchers with shoulder (70.8%) and elbow (64.6%) injuries returned to play within 21 days. Among pitchers, a higher proportion of elbow injuries (11.4%) resulted in medical disqualification compared with shoulder injuries (5.6%). Among pitchers, the majority of shoulder (89.2%) and elbow (96.4%) injuries were managed nonsurgically. Conclusion: Shoulder and elbow injury rates and patterns in high school baseball players differed between field positions (pitchers vs position players) and by type of exposure (practice vs competition). This study suggests several areas of emphasis for targeted injury prevention interventions, most notably limiting fatigue and preventing overuse injuries.

Assessing Trends in the Epidemiology of Concussions Among High School Athletes

Objectives:Approximately 300,000 youth athletes suffer a mild form of traumatic brain injury (TBI) known as a concussion annually while participating in organized athletics. Using data from the most recent 10-year period available, this study aimed to track national trends in high school sports-related concussion incidences over time, identify whether a particular sport predisposes athletes to a higher incidence of concussions, and evaluate the association between concussion occurrences and the enactment of TBI legislation that began in 2009.Methods:Injury data for academic years 2005-2006 through 2014-2015 was collected from annual reports generated by the High School Reporting Information Online sports injury surveillance system, which prospectively captures injury data directly from athletic trainers at participating U.S. high schools. Relative proportions of total estimated concussions to total estimated injuries were compared using an injury proportion ratio (IPR) and corresponding 95% confidence intervals (CI). Concussion rate was defined as the number of concussions per 10,000 athlete-exposures (AEs, one athlete participating in one practice or competition), and rates were compared using a rate ratio (RR) and 95% CI.Results:The overall number of concussions increased 2.2-fold (p<0.0001) between 2005-2006 and 2014-2015, and significant increases were also found in the overall concussion rate (RR=2.30, 95% CI [2.04-2.59]; p<0.0001) and the overall proportion of concussions (IPR=2.68, 95% CI [2.66-2.70]; p<0.0001). Players injured during the 2014-2015 school year were more likely to have sustained a concussion if they played girls soccer than if they played girls volleyball (IPR=1.32, 95% [1.30-1.35]; p<0.0001), girls basketball (IPR=1.35, 95% CI [1.33-1.37]; p<0.0001), or boys football (IPR=1.40, 95% CI [1.39-1.41]; p<0.0001) (Table 1).Conclusion:The overall rate and proportion of concussions increased significantly post-TBI law enactment, suggesting an association between the passage of TBI laws and concussion incidences. To our knowledge, this is the first study to report that concussions now account for a higher proportion of injuries in girls soccer than boys football. Currently, no state TBI laws address the sport- or gender-specific differences identified by this study. Future studies should focus on examining specific risk factors, developing targeted measures to reduce the number of preventable concussions, and developing diagnostic and treatment algorithms to protect young athletes and improve outcomes. Table 1.Comparison of concussion rates and proportions for individual sports during the 2005-2006 and 2014-2015 academic years. aData obtained from High School Reporting Information Online. *p < 0.01.Concussions/10,000 AESaConcussions (as % of total injuries)aSport2005-20062014-2015RR [95% CI]2005-20062014-2015IPR [95% CI]Booys Football4.569.412.06 [1.74-2.44]*10.5%24.7%2.36 [2.34-2.38]*Booys Soccer2.323.031.30 [0.84-2.00]9.6%18.9%1.98 [1.95-2.01]*Girls Soccer3.589.102.52 [1.83-3.49]*15.2%34.5%2.27 [2.24-2.30]*Girls Volleyball0.512.885.68 [2.42-13.29]*3.1%26.1%8.48 [8.14-8.884]*Boys Basketwell0.660.951.51 [0.76-2.99]*3.5%8.8%2.51 [2.41-2.62]*Girls Basketwell2.394.231.79 [1.22-2.62]*11.9%25.6%2.15 [2.11-2.20]*Boys Wrestling1.224.003.33 [1.99-5.57]*4.9%18.8%3.85 [3.73-3.97]*Boys Baseball0.251.356.13 [2.11-17.79]2.1%14.3%6.83 [6.46-7.22]*Girls Softball0.471.834.09 [1.65-10.12]*4.2%18.3%4.38 [4.20-4.57]*