Injury risk from popular childhood physical activities: results from an Australian primary school cohort

Trampoline Park Injury Trends

OBJECTIVES

Trampolines are an important cause of childhood injury and focus of injury prevention. Understanding and prevention of trampoline park injury is constrained by inadequate exposure data to estimate the at-risk population. This study aimed to measure trampoline park injury incidence and time trends using industry data.

METHODS

Cross-sectional study to retrospectively analyze reported injuries and exposure in 18 trampoline parks operating in Australia and the Middle East, from 2017 to 2019. Exposure was derived from ticket sales and expressed as jumper hours. Exposure-adjusted incidence was measured using marginalized 0-inflated Poisson modeling and time trends using Joinpoint regression.

RESULTS

There were 13 256 injured trampoline park users reported from 8 387 178 jumper hours; 11% sustained significant injury. Overall, trampoline park injuries occurred at a rate of 1.14 injuries per 1000 jumper hours (95% confidence intervals 1.00 to 1.28), with rates highest for high-performance (2.11/1000 jumper hours, 1.66 to 2.56) and inflatable bag or foam pit (1.91/1000 jumper hours, 1.35 to 2.50) jumping. Significant injuries occurred at a rate of 0.11 injuries per 1000 jumper hours (0.10 to 0.13), with rates highest for high-performance (0.29/1000 jumper hours, 0.23 to 0.36), and parkour (0.22/1000 jumper hours, 0.15 to 0.28) jumping. Overall, injury rates decreased by 0.72%/month (-1.05 to -0.40) over the study period.

CONCLUSIONS

Trampoline park injuries occur in important numbers with sometimes serious consequences. However, within these safety standard-compliant parks, exposure-adjusted estimates show injuries to be uncommon and injury rates to be declining. Further reductions are required, especially severe injuries, and this study can enhance injury prevention initiatives.

An evaluation of the presentation and severity of Australian football injury in children

Introduction

Child participation in sport is important for physical, cognitive and psychosocial wellbeing. Australian rules football has high participation, but also carries a high risk of injury due to the contact nature of the sport. This study aimed to evaluate changes in the presentation and hospital admission of paediatric Australian rules football-related injuries, and to compare the severity of these injuries with those from other team ball sports.

Materials and methods

At an Australian paediatric major trauma service, ED and hospital trauma registry data relating to Australian rules football injury between 2009 and 2015 were obtained. Data from other common team ball sports with a shared field of play were also identified.

Results

During the study period, there were 10,003 ED presentations, and 1110 admissions resulting from team ball sports. With 4751 ED presentations and 616 admissions, Australian rules football accounted for almost one-third of all sports-related presentations and admissions, and around half of the team ball sports cohort. Compared to other team ball sports patients, Australian rules football-related patients were 40% more likely to be admitted, and nearly twice as likely to be classified as severe injury. Australian rules football players presented with different injury patterns were compared to other team ball sports players; admitted players were significantly more likely to have sustained head or neck injuries, and were more than twice as likely to sustain truncal injury.

Conclusions

Australian rules football is a common cause of ED presentations and results in substantial morbidity, both overall and when compared with other team ball sports. Australian rules football should remain a focus for ongoing and active research into strategies which reduce injury risk.

Are active children and young people at increased risk of injuries resulting in hospital admission or accident and emergency department attendance? Analysis of linked cohort and electronic hospital records in Wales and Scotland

Introduction

Children and young people (CYP) are encouraged to increase time spent being physically active, especially in moderate and vigorous intensity pursuits. However, there is limited evidence on the prospective association of activity levels with injuries resulting in use of hospital services. We examined the relationship between objectively-measured physical activity (PA) and subsequent injuries resulting in hospital admissions or accident and emergency department (A&E) attendances, using linked electronic hospital records (EHR) from a nationally representative prospective cohort of CYP in Wales and Scotland.

Methods

We analysed accelerometer-based estimates of moderate to vigorous (MVPA) and vigorous PA (VPA) from 1,585 (777 [46%] boys) seven-year-old Millennium Cohort Study members, living in Wales or Scotland, whose parents consented to linkage of cohort records to EHRs up until their 14th birthday. Negative binomial regression models adjusted by potential individual, household and area-level confounders, were fitted to estimate associations between average daily minutes of MVPA, and VPA (in 10-minute increments), and number of injury-related hospital admissions and/or A&E attendances from age nine to 14 years.

Results

CYP spent a median of 59.5 and 18.1 minutes in MVPA and VPA/day respectively, with boys significantly more active than girls; 47.3% of children experienced at least one injury-related admission or A&E attendance during the study period. Rates of injury-related hospital admission and/or A&E attendance were positively associated with MVPA and VPA in boys but not in girls: respective adjusted incidence rate ratios (95% CI) for boys: 1.09 (1.01, 1.17) and 1.16 (1.00, 1.34), and for girls: 0.94 (0.86, 1.03) and 0.85 (0.69, 1.04).

Conclusion

Boys but not girls who engage in more intense PA at age seven years are at higher risk of injury-related hospital admission or A&E attendance when aged nine to 14 years than their less active peers. This may reflect gender differences in the type and associated risks of activities undertaken. EHRs can make a useful contribution to injury surveillance and prevention if routinely augmented with information on context and setting of the injuries sustained. Injury prevention initiatives should not discourage engagement in PA and outdoor play given their over-riding health and social benefits.

Acute and overuse injuries among sports club members and non-members: the Finnish Health Promoting Sports Club (FHPSC) study

Background

Physical activity in adolescence is promoted for its multi-dimensional health benefits. However, too intensive sports participation is associated with an increased injury risk. Our aim was to compare the occurrence of acute and overuse injuries in Finnish sports club members and non-members and to report training and competing habits associated with a higher injury risk in sports club members.

Methods

In this cross-sectional survey targeted at 14–16-year-old adolescents, a structured questionnaire was completed by 1077 sports club members and 812 non-members. The main outcome measures were self-reported acute and overuse injuries, their location and type.

Results

At least one acute injury in the past year was reported by 44.0% of sports club members and 19.8% of non-members (P < 0.001). The sex-adjusted odds ratio (OR) for acute injury in sports club members compared to non-members was 3.13 (95% confidence interval (95% CI) 2.54–3.87). Thirty-five percent of sports club members and 17.4% of non-members (P < 0.001) reported at least one overuse injury during the past year. The overuse injury OR for sports club members was 2.61 (95% CI 2.09–3.26). Sports club members who trained 7–14 h per week during training (OR 1.61, 95% CI 1.21–2.12, P = 0.001) or competition season (OR 1.55, 95% CI 1.18–2.06, P = 0.002) were more likely to report an injury compared to members who trained 3–6 h per week. Those sports club members who participated in forty competitions or more compared to 7–19 competitions per year were more likely to report an acute injury (OR 1.55, 95% CI 1.05–2.08, P = 0.028) or for an overuse injury (OR 1.53, 95% CI 1.02–2.30, P = 0.038).

Conclusions

Both acute and overuse injuries are common among youth sports club members, and the number increases along with increasing amounts of training and competitions. More effective injury prevention is needed both for adolescents engaging in sports club activities and for other adolescents.

Electronic supplementary material

The online version of this article (10.1186/s12891-019-2417-3) contains supplementary material, which is available to authorized users.

Applying a developmental lens to examine injury mortality in young people in Australia, 2001-2013

ISSUE ADDRESSED

As injuries are preventable, understanding the age profile of specific injury mechanisms is critical for developing injury prevention strategies. This study examined the profile and temporal trends of injury mortality of young people aged ≤24 years in Australia across developmental life stages.

METHOD

A retrospective analysis of injury deaths of young people aged ≤24 years was conducted using closed cases from the National Coronial Information System during 2001-2013. Negative binomial regression was used to examine temporal trends in mortality rates by age group.

RESULTS

There were 7749 injury deaths of young people in Australia. The mortality rates were estimated to decline each year for young people aged 0-4 years (by 3.4%; 95% CI: -5.10 to -1.67), 10-14 years (by 3.7%; 95% CI: -6.29 to -1.09), 15-19 years (by 4.4%; 95% CI: -5.90 to -2.85) and 20-24 years (by 4.5%; 95% CI: -5.61 to -3.37). Motor vehicle incidents were a frequent mechanism of fatal injury for all ages. For children aged ≤9 years, drowning and submersion and other threats to breathing were also frequent mechanisms of fatal injury. Young people aged 15-24 years were also frequently fatally injured as a motorcyclist or a pedestrian.

CONCLUSIONS

The age-specific injury mortality profiles reflect the changing vulnerabilities of young people influenced by physical, cognitive and social characteristics associated with different stages of their development. By focusing on different ages, targeted injury prevention interventions can be developed. SO WHAT?: While policies play a key role in reducing injury mortality, secondary interventions that aim to shift attitudes to injury prevention activities will also be critical to influence positive behaviour change.

A Review of the Anthropometric Characteristics, Grading and Dispensation of Junior and Youth Rugby Union Players in Australia

The grading of Australian junior and youth rugby union players has received substantial media attention in recent years. Media reports have focussed on size mismatches observed between players, especially players with Polynesian heritage, and the concerned parents who fear for the safety of their child owing to perceived mismatches. Although such concerns are well meaning, few media reports recognise the need for substantial evidence to determine the best grading system for junior and youth rugby union players. The current study reviewed relevant literature pertinent to the grading and dispensation of junior and youth rugby union players. Using primary and secondary search strategies, a total of 33 articles reporting the anthropometric characteristics of junior and youth rugby players were identified. Anthropometric data from the literature were compared with normative population data and currently used dispensation criteria. Junior and youth rugby players were found to be taller and heavier than normative population data. Current dispensation criteria, in terms of body mass, were found to vary and it is suggested that criteria be revised and standardised across rugby unions throughout Australia. Although it is acknowledged that other factors are important for grading players, anthropometric characteristics should be considered as potential dispensation criteria to supplement current age-based grading for junior and youth rugby union players. Measuring the body mass and stature of each junior player upon pre-season registration is suggested, which would provide data to establish valid dispensation criteria for the following season.

Combining statistics from two national complex surveys to estimate injury rates per hour exposed and variance by activity in the USA

BACKGROUND

A common issue in descriptive injury epidemiology is that in order to calculate injury rates that account for the time spent in an activity, both injury cases and exposure time of specific activities need to be collected. In reality, few national surveys have this capacity. To address this issue, we combined statistics from two different national complex surveys as inputs for the numerator and denominator to estimate injury rate, accounting for the time spent in specific activities and included a procedure to estimate variance using the combined surveys.

METHODS

The 2010 National Health Interview Survey (NHIS) was used to quantify injuries, and the 2010 American Time Use Survey (ATUS) was used to quantify time of exposure to specific activities. The injury rate was estimated by dividing the average number of injuries (from NHIS) by average exposure hours (from ATUS), both measured for specific activities. The variance was calculated using the 'delta method', a general method for variance estimation with complex surveys.

RESULTS

Among the five types of injuries examined, 'sport and exercise' had the highest rate (12.64 injuries per 100 000 h), followed by 'working around house/yard' (6.14), driving/riding a motor vehicle (2.98), working (1.45) and sleeping/resting/eating/drinking (0.23). The results show a ranking of injury rate by activity quite different from estimates using population as the denominator.

CONCLUSIONS

Our approach produces an estimate of injury risk which includes activity exposure time and may more reliably reflect the underlying injury risks, offering an alternative method for injury surveillance and research.

Longitudinal influence of musculo-skeletal injuries and extra physical education on physical fitness in schoolchildren

The aims of this study were to investigate if (A) injuries and (B) increased physical education (PE) influenced the development of physical fitness in schoolchildren. Simultaneously, to investigate if a possible PE effect was modified by sport participation outside school hours. This was a longitudinal controlled school-based study. Six schools with 270 min of PE (extra PE) and four schools with 90 min of PE were followed up for 2.5 years. In total, 1054 children were included for analysis (normal PE = 443, extra PE = 611). Development in fitness was analyzed using composite z-scores from six fitness tests measured four times. Information of injury and sport was derived from weekly automated mobile phone text messages surveying the presence of musculo-skeletal pain and organized sport participation. Injury and extra PE both influenced the development of physical fitness. Injury decreased development of physical fitness with -1.01 composite z-score units (95% CI: -1.57; -0.45). Extra PE increased physical fitness development with 0.80 (95% CI: 0.49; 1.10) composite z-score units. The influence of injury was not dependent on extra PE. No modifying effect was found by mean weekly sport participation outside school hours. In conclusion, extra PE had a positive effect, whereas injuries had a negative effect on physical fitness development in schoolchildren.

Injury risk during different physical activity behaviours in children: a systematic review with bias assessment

INTRODUCTION

The current focus on a physically active lifestyle in children puts children at increased physical activity-related injury risk.

OBJECTIVE

To summarise, in a systematic review, the evidence for the injury risk of several physical activity behaviours in 6- to 12-year-old children.

METHODS

An electronic search was performed in three databases (Embase, PubMed and SPORTDiscus). Inclusion criteria were: age 6-12 years; report on injuries related to overall physical activity, active commuting, unorganised leisure time physical activity, physical education and/or organised sports; incidence rates expressed as injuries per hours of physical activity; and published after January 1st 2000. Risk of bias was assessed for all studies included.

RESULTS

Eight studies were included. The risk of bias assessment resulted in two studies with a score that was higher than 75 %; risk bias of those two studies was considered low. The medically treated, injury incidence rate was reported to be between 0.15 and 0.27 injuries per 1,000 h of physical activity. The absolute number of injuries related to unorganised leisure time physical activity was higher than the absolute number of injuries reported in organised sports. The respective injury incidence rate expressed per 1,000 h exposure was, however, generally lower during unorganised leisure time than during organised sports. Reported injury incidence rates related to active commuting were comparable to those for unorganised leisure time physical activity. Conflicting injury incidence rates were reported for physical education. Subgroup analysis suggested that girls and children with low habitual levels of physical activity are at increased injury risk. A limitation of the review is that no standard bias assessment was available for this specific context.

CONCLUSIONS

Children are at an inherent injury risk while participating in physical activities. Most injury prevention efforts have focussed on the sports setting, but our results suggest that many children sustain an injury during unorganised leisure time physical activities.

Child development and pediatric sport and recreational injuries by age

CONTEXT

In 2010, 8.6 million children were treated for unintentional injuries in American emergency departments. Child engagement in sports and recreation offers many health benefits but also exposure to injury risks. In this analysis, we consider possible developmental risk factors in a review of age, sex, and incidence of 39 sport and recreational injuries.

OBJECTIVE

To assess (1) how the incidence of 39 sport and recreational injuries changed through each year of child and adolescent development, ages 1 to 18 years, and (2) sex differences. Design : Descriptive epidemiology study.

SETTING

Emergency department visits across the United States, as reported in the 2001-2008 National Electronic Injury Surveillance System database.

PATIENTS OR OTHER PARTICIPANTS

Data represent population-wide emergency department visits in the United States. Main Outcome Measure(s) : Pediatric sport- and recreation-related injuries requiring treatment in hospital emergency departments.

RESULTS

Almost 37 pediatric sport or recreational injuries are treated hourly in the United States. The incidence of sport- and recreation-related injuries peaks at widely different ages. Team-sport injuries tend to peak in the middle teen years, playground injuries peak in the early elementary ages and then drop off slowly, and bicycling injuries peak in the preteen years but are a common cause of injury throughout childhood and adolescence. Bowling injuries peaked at the earliest age (4 years), and injuries linked to camping and personal watercraft peaked at the oldest age (18 years). The 5 most common causes of sport and recreational injuries across development, in order, were basketball, football, bicycling, playgrounds, and soccer. Sex disparities were common in the incidence of pediatric sport and recreational injuries.

CONCLUSIONS

Both biological and sociocultural factors likely influence the developmental aspects of pediatric sport and recreational injury risk. Biologically, changes in perception, cognition, and motor control might influence injury risk. Socioculturally, decisions must be made about which sport and recreational activities to engage in and how much risk taking occurs while engaging in those activities. Understanding the developmental aspects of injury data trends allows preventionists to target education at specific groups.

Football injuries in children and adolescent players: are there clues for prevention?

Football (soccer) is the world's most popular sport with most players being younger than 18 years. Playing football can induce beneficial health effects, but there is also a high risk of injury. Therefore, it is necessary to implement measures for preventing injuries. The present review analyzes and summarizes published scientific information on the incidence and characteristics of football injuries in children and adolescent players to arrive at sound conclusions and valid considerations for the development of injury-prevention programs. A literature search was conducted up to November 2012. Fifty-three relevant scientific publications were detected. Thirty-two studies fulfilled the inclusion criteria for pooled analysis. Additional information from the remaining 21 studies was considered where appropriate to obtain a broader perspective on the injury problem in children and youth football. Training injury incidence was nearly constant for players aged 13-19 years, ranging from 1 to 5 injuries per 1,000 h training. Match injury incidence tended to increase with age through all age groups, with an average incidence of about 15 to 20 injuries per 1,000 match hours in players older than 15 years. Between 60 and 90 % of all football injuries were classified as traumatic and about 10-40 % were overuse injuries. Most injuries (60-90 %) were located at the lower extremities with the ankle, knee, and thigh being mostly affected. The frequency of upper-extremity and head/face injuries was higher in those studies that analyzed match injuries only. The most common injury types were strains, sprains, and contusions (10 up to 40 % each). There is some evidence that the risk of traumatic injuries and, in particular, of sustaining a fracture, contusion, or concussion was higher during match play than in practice sessions. Fractures were more frequent in children younger than 15 years than in older players. About half of all time-loss injuries led to an absence from sport of less than 1 week, one third resulted in an absence between 1 and 4 weeks, and 10 to 15 % of all injuries were severe. Separate data for players under the age of 11 years are almost absent. Maturation status seems to have an influence on injury characteristics, although evidence is not conclusive at this time. Three main areas seem to be of particular relevance for future prevention research in young football players: (1) the substantial number of severe contact injuries during matches, (2) the high number of fractures in younger players, and (3) the influence of maturation status and growth spurts.

Associations of objectively assessed levels of physical activity, aerobic fitness and motor coordination with injury risk in school children aged 7-9 years: a cross-sectional study

OBJECTIVES

Physical activity (PA) is important for children's health but entails an inherent risk of injuries. The objective of this study was to assess activity-related correlates of injuries in children of the general population under the age of 10 while accounting for PA behaviour objectively assessed with accelerometers.

DESIGN

Cross-sectional.

SETTING

Primary schools in Switzerland.

PARTICIPANTS

41 (56.9%) of 72 contacted schools were eligible. 11 (26.9%) of them agreed to participate. 3 more schools were recruited with a snowball system. On the individual level, 83.7% of the parents gave consent. Finally, 249 children with complete data (82.2%) from 20 grade 1-3 classes from 14 schools were analysed (mean age 7.9 years, 49.4% girls).

PRIMARY OUTCOME MEASURES

Outcome measures were retrospectively assessed injury incidence rates expressed as the number of injuries per 1000 h of objectively measured moderate-to-vigorous physical activity (MVPA) and injury risk depending on levels of PA, aerobic fitness and motor coordination, derived from logistic regression models.

RESULTS

0.43 injuries/1000 h of MVPA (95% CI 0.28 to 0.58) were reported. After controlling for sociodemographic characteristics and accounting for exposure to PA, children with medium and high levels compared with those with low levels of aerobic fitness assessed with the 20 m shuttle run test were at decreased injury risk (OR=0.37 (95% CI 0.16 to 0.85)/OR=0.29 (0.16 to 0.63)). Children with high motor coordination scores assessed with the "Körperkoordinationstest für Kinder" test were at increased injury risk compared with those in the normal range (2.59 (1.04 to 6.32)). Levels of objectively assessed PA were not associated with injury risk; they were neither expressed as rates nor as cumulative incidence.

CONCLUSIONS

This study provides novel data showing that low levels of fitness and high coordinative skills, but not objectively assessed levels of PA, were related to injury risk in children under the age of 10.