Athletic injury reporting. Development of universal systems

International survey of injury surveillance practices in competitive swimming

OBJECTIVE

The purpose of this study was to identify the injury surveillance practices being used in competitive swimming environments. It explored the nature of the data collected, the injury definitions used and the perceived effectiveness of injury surveillance. Finally, this study also examined barriers to injury surveillance.

DESIGN

Online cross-sectional.

PARTICIPANTS

Twenty-two responders working in competitive swimming.

OUTCOME MEASURES

Injury surveillance methods, data collected, perceived level of effectiveness and barriers associated with injury surveillance.

RESULTS

Fifteen responders participated in injury surveillance, with 13 responders using a recognised definition for injury. Ten responders did not use any sports injury classification system. Ten responders found injury surveillance to be very effective at identifying injury trends, while previous injury history and training load data were perceived to be most influential in preventing injury. Limited time, funding and compliance were common obstacles, while poor staff communication and engagement were barriers to the effective implementation of injury surveillance.

CONCLUSIONS

The implementation of injury surveillance is related to the system objectives, competitive level of those under surveillance and the resources available. This implementation requires the balance of adhering to the principles outlined in prominent consensus statements and overcoming the barriers associated with implementing a system effectively.

Increased Regular Season Soft Tissue Injury Rates in National Football League (NFL) Players May Be Associated With the Canceled 2020 NFL Preseason Due to COVID-19

Introduction The purpose of this study is to evaluate the rates of regular season soft tissue injuries in National Football League (NFL) players during the 2020 season, which had a canceled preseason due to the COVID-19 pandemic. Methods This study retrospectively reviewed the injury rates of the 2020-2021 NFL regular season in comparison to the 2018-2019 NFL regular season using publicly available injury data. The focus of our analysis was comparing the following soft tissue injuries: hamstring, groin, calf, quadriceps, thigh, knee - anterior cruciate ligament (ACL), pectoral, and Achilles. The week of injury occurrence, duration of injury in weeks, position of the injured player, and age of the NFL player at injury were obtained. Injury rates were calculated per 1000 athletic exposures with 95% confidence intervals (CIs). A chi-square test and Student's t-test were utilized as appropriate. Results There were 1370 total injuries in the 2018-2019 regular NFL season and 2086 total injuries reported in the 2020-2021 regular NFL season. The total number of injuries per 1000 athletic exposures was significantly higher in the 2020-2021 NFL season compared to the 2018-2019 NFL season (88.57 versus 58.17, p < 0.001). The rates of injuries per 1000 athletic exposures for hamstring (9.98 versus 5.31, p = 0.043), groin (5.56 versus 2.46, p = 0.007), calf (4.08 versus 1.61, p = 0.006), quadriceps (2.00 versus 0.72, p = 0.030), and thigh (1.23 versus 0.30, p = 0.012) injuries were significantly higher in the 2020-2021 regular NFL season compared to the 2018-2019 NFL regular season. Conclusions The 2020-2021 NFL season had a significantly higher incidence of soft tissue injuries compared to the 2018-2019 regular NFL season, which may have been associated with the absent preseason due to the COVID-19 pandemic and an abrupt increase in the athletic workload of players.

Cohort profile: MAVIE a web-based prospective cohort study of home, leisure, and sports injuries in France

MAVIE is a web-based prospective cohort study of Home, Leisure, and Sports Injuries with a longitudinal follow-up of French general population volunteers. MAVIE participants are voluntary members of French households, including overseas territories. Participation in the cohort involves answering individual and household questionnaires and relevant exposures and prospectively reporting injury events during the follow-up. Recruitment and data collection have been in progress since 2014. The number of participants as of the end of the year 2019 was 12,419 from 9,483 households. A total of 8,640 participants provided data during follow-up. Respondents to follow-up were composed of 763 children aged 0-14, 655 teenagers and young adults aged 15-29, 6,845 adults, and 377 people aged 75 or more. At the end of the year 2019, 1,698 participants had reported 2,483 injury events. Children, people aged 50 and more, people with poor self-perceived physical and mental health, people who engage in sports activities, and people with a history of injury during the year before recruitment were more likely to report new injuries. An interactive mobile/web application (MAVIE-Lab) was developed to help volunteers decide on personalized measures to prevent their risks of HLIs. The available data provides an opportunity to analyse multiple exposures at both the individual and household levels that may be associated with an increased risk of trauma. The ongoing analysis includes HLI incidence estimates, the determination of health-related risk factors, a specific study on the risk of home injury, another on sports injuries, and an analysis of the role of cognitive skills and mind wandering. Volunteers form a community that constitutes a population laboratory for preventative initiatives.

Sports injury and illness incidence among South Korean elite athletes in the 2018 Asian Games: a single-physician prospective study of 782 athletes

Objective

The increasing incidence of sports injury among athletes calls for systemic surveillance of injuries and illnesses in this field to develop preventive measures. The patterns of injuries and illnesses that occurred among Korean athletes during the 2018 Asian Games held in Indonesia were studied.

Methods

We recorded the occurrence of all injuries and illnesses reported to the chief medical officer, coordinated with the help of an instant social messaging application in real time.

Results

A total of 782 elite athletes participated in 46 sporting events. A total of 141 (18.03%) injuries were recorded, with 121 (15.47%) athletes suffering at least one injury. Out of 141 injuries 80 (56.74%) were in male athletes and 61 (43.26%) were in female athletes. The highest number of injuries was seen among sport climbing athletes (n=10, 71.43%), followed by sepak takraw. A total of 16 (11.35%) injuries were expected to prevent athletes from participation in competition/training. Most of the injuries occurred during training (46.10%), with lower lumbar spine being the most common part injured. A total of 209 (26.72%) illnesses were reported, with at least one illness in 170 (21.73%) athletes. The incidence among female athletes (26.90%) was comparable with that of male athletes (26.90%). Maximum illness rate was reported in table tennis (100%). The most common system involved was gastrointestinal (n=93, 44.49%), followed by respiratory (n=53, 25.36%). Environmental factors were causative in 111 athletes (53.11%) and infection in 79 (37.79%). Illnesses resulted in loss of at least 1 day among 30 (14.35%) athletes.

Conclusion

Overall 15.47% of athletes suffered at least one injury and 21.73% suffered at least one illness; the incidence of injury and illness varied depending on the type of sports.

Methods may matter in injury surveillance: "how" may be more important than "what, when or why"

To examine if and how adjustments in injury surveillance recording methodology may have influenced injury rates. Injury and exposure data were collected among professional male players from the Qatar Stars League from the 2008-2009 season to the 2017-2018 season. There have been four iterations of our data collection methods. In the first five seasons, participation in the programme was voluntary. For seasons 6-7, additional dedicated researchers were tasked with contacting the medical teams every month. At the start of season 8, an electronic recording method was instituted. In the final two seasons, injury surveillance participation was further boosted by reinforced encouragement from institutional management. Overall injury incidence increased from season 5 to season 8. Severe injuries have fallen steadily, but slightly over the ten seasons, whereas mild injuries increased dramatically from seasons 5 to 8. The current data suggest that along with the standard metrics (e.g. injury incidence, injury burden) we also need to clearly report the methods by which data were collected and verified in as much detail as possible. We suggest that sports medicine journals should adopt minimum reporting standards and perhaps checklists could be a useful step forward.

Involving research-invested clinicians in data collection affects injury incidence in youth football

It is well established that differences in injury definition and recording methodology restrict comparisons between injury surveillance programmes. There is, however, little documentation of the variation that can exist between data recorders. The aim of this study was, therefore, to explore the effect on reported injuries when team recorders or supervisors are involved in research. Injury data collected prospectively over five seasons for the U16, U17, and U18 age groups in a youth football (soccer) academy were used to compare different recording settings based on the research involvement of the clinicians. A research-invested team physiotherapist reported an 8.8 times greater incidence (P < 0.001) of non-time-loss injuries and a 2.5 times greater incidence (P < 0.001) of minimal injuries (1-3 days lost) compared to a setting where neither the team physiotherapists nor the supervisor relied on the collected data for research purposes. When team physiotherapists were not invested in research themselves but were supervised by a researcher, the incidence of non-time-loss injuries and minimal injuries was 2.5 times (P < 0.001) and 2.0 times greater (P < 0.01) than in the non-invested setting, respectively. However, there were no differences between recording settings for overall incidence of time-loss injuries. The results from this study demonstrate that involving clinicians that are relying on the collected data for research purposes can significantly affect the reported rates of non-time-loss and minimal injuries. Time-loss injuries overall were not affected by research investment, and should therefore be preferred for comparisons between teams and seasons.

Methodological quality of the injury surveillance system used in international athletics championships

OBJECTIVES

Incidence and prevalence data obtained from injury surveillance studies could be biased by the response rate as well as by the completeness and quality of the reports. It therefore appears crucial to analyse the quality of the injury surveillance system itself and thereby validate the quality of the data. This study aimed to analyse the quality of and compliance with the injury surveillance system implemented during international athletics championships.

DESIGN

Prospective, epidemiological study.

METHODS

The national medical teams and the local organising committee physicians daily reported all injuries on a standardised injury report form during 14 international athletics championships from 2007 to 2015. The quality of the injury surveillance system was analysed following the guidelines laid down by the Centre for Disease Control and Prevention.

RESULTS

On average 41.7±17.4% (mean±standard deviation) of all registered countries participated in the injury surveillance project, accounting for a coverage of athletes of 79.5±10.2% of all registered athletes. Their medical staff returned 89.2±8.4% of the expected injury report forms (information is missing for one championship). The completeness of injury data provided by medical teams and local organising committee physicians averaged 95.8±6.5%. National medical teams reported 60.6±16.6% of all injuries, and local organising committee physicians 28.7±15.0% whereas 10.6±6.5% of injuries were reported by both.

CONCLUSIONS

The injury surveillance system used during international athletics championships provided good national medical team participation, coverage of athletes, response rate, and completeness of reports. These parameters should be systematically reported for injury surveillance studies to show the quality of the study.

Measuring sports injuries on the pitch: a guide to use in practice

Sports participation is a major ally for the promotion of physical activity. However, sports injuries are important adverse effects of sports participation and should be monitored in sports populations. The purpose of this paper is to review the basic concepts of injury monitoring and discuss the implementation of these concepts in practice. The aspects discussed are: (1) sports injury definition; (2) classification of sports injuries; (3) population at risk, prevalence, and incidence; (4) severity measures; (5) economic costs; (6) systems developed to monitor sports injuries; and (7) online technology. Only with reliable monitoring systems applied in a continuous and long-term manner will it be possible to identify the burden of injuries, to identify the possible cases at an early stage, to implement early interventions, and to generate data for sports injury prevention. The implementation of sports injuries monitoring systems in practice is strongly recommended.

OARSI Clinical Trials Recommendations: Design and conduct of clinical trials for primary prevention of osteoarthritis by joint injury prevention in sport and recreation

The risk of post-traumatic osteoarthritis (PTOA) substantially increases following joint injury. Research efforts should focus on investigating the efficacy of preventative strategies in high quality randomized controlled trials (RCT). The objective of these OARSI RCT recommendations is to inform the design, conduct and analytical approaches to RCTs evaluating the preventative effect of joint injury prevention strategies. Recommendations regarding the design, conduct, and reporting of RCTs evaluating injury prevention interventions were established based on the consensus of nine researchers internationally with expertise in epidemiology, injury prevention and/or osteoarthritis (OA). Input and resultant consensus was established through teleconference, face to face and email correspondence over a 1 year period. Recommendations for injury prevention RCTs include context specific considerations regarding the research question, research design, study participants, randomization, baseline characteristics, intervention, outcome measurement, analysis, implementation, cost evaluation, reporting and future considerations including the impact on development of PTOA. Methodological recommendations for injury prevention RCTs are critical to informing evidence-based practice and policy decisions in health care, public health and the community. Recommendations regarding the interpretation and conduct of injury prevention RCTs will inform the highest level of evidence in the field. These recommendations will facilitate between study comparisons to inform best practice in injury prevention that will have the greatest public health impact.

Meta-narrative analysis of sports injury reporting practices based on the Injury Definitions Concept Framework (IDCF): A review of consensus statements and epidemiological studies in athletics (track and field)

OBJECTIVES

Consistency in routines for reporting injury has been a focus of development efforts in sports epidemiology for a long time. To gain an improved understanding of current reporting practices, we applied the Injury Definitions Concept Framework (IDCF) in a review of injury reporting in a subset of the field.

DESIGN

Meta-narrative review.

METHODS

An analysis of injury definitions reported in consensus statements for different sports and studies of injury epidemiology in athletics (track and field) published in PubMed between 1980 and 2013 was performed. Separate narratives for each of the three reporting contexts in the IDCF were constructed from the data.

RESULTS

Six consensus statements and 14 studies reporting on athletics injury epidemiology fulfilled the selection criteria. The narratives on sports performance, clinical examination, and athlete self-report contexts were evenly represented in the eligible studies. The sports performance and athlete self-report narratives covered both professional and community athletes as well as training and competition settings. In the clinical examination narrative, data collection by health service professionals was linked to studies of professional athletes at international championships.

CONCLUSIONS

From an application of the IDCF in a review of injury reporting in sports epidemiology we observed a parallel usage of reporting contexts in this field of research. The co-existence of reporting methodologies does not necessarily reflect a problematic situation, but only provided that firm precautions are taken when comparing studies performed in the different contexts.

What is a sports injury?

Current sports injury reporting systems lack a common conceptual basis. We propose a conceptual foundation as a basis for the recording of health problems associated with participation in sports, based on the notion of impairment used by the World Health Organization. We provide definitions of sports impairment concepts to represent the perspectives of health services, the participants in sports and physical exercise themselves, and sports institutions. For each perspective, the duration of the causative event is used as the norm for separating concepts into those denoting impairment conditions sustained instantly and those developing gradually over time. Regarding sports impairment sustained in isolated events, 'sports injury' denotes the loss of bodily function or structure that is the object of observations in clinical examinations; 'sports trauma' is defined as an immediate sensation of pain, discomfort or loss of functioning that is the object of athlete self-evaluations; and 'sports incapacity' is the sidelining of an athlete because of a health evaluation made by a legitimate sports authority that is the object of time loss observations. Correspondingly, sports impairment caused by excessive bouts of physical exercise is denoted as 'sports disease' (overuse syndrome) when observed by health service professionals during clinical examinations, 'sports illness' when observed by the athlete in self-evaluations, and 'sports sickness' when recorded as time loss from sports participation by a sports body representative. We propose a concerted development effort in this area that takes advantage of concurrent ontology management resources and involves the international sporting community in building terminology systems that have broad relevance.

iReport SportsPhysio Platform

An accumulation of scientific evidence has emerged during the 1980s and 1990s, that is, physical activity would have significant benefits on health and well-being. Consequently, increasing participation of people in physical activities over the last decades has also led to a growing number of sports injuries and, simultaneously, higher demands on financial resources in global healthcare systems. Today, sports injuries are seen as a major public health problem in many developed, as well as developing, countries. This article illustrates the importance of having a platform such as iReport SportsPhysio to address such a rising issue globally. iReport SportsPhysio is a Web-based platform directed to sports health professionals to provide standard sports injuries monitoring and surveillance at a national level. The platform supports the acquisition, analysis and dissemination of sports injuries information, allowing health professionals to register and analyze sports injuries across various sports populations. Essentially, the platform provides a mechanism to house diverse statistical data in the form of tables and charts to analyze injuries at three levels: (1) athlete level independently of where individual athlete practices; (2) specific sports level across organizations; and (3) sports organizations level. A module for a global analysis is also made available, which allows the iReport SportsPhysio to obtain the incidence and prevalence measures, besides the socioeconomics costs relating to sports injuries at a global level. In order to offer these features, the platform is based on a global sports injury data model with the goal of standardizing data related to sports injuries.

Forefoot midsole stiffness affects forefoot and rearfoot kinematics during the stance phase of gait

BACKGROUND

The forefoot midsole stiffness of the shoe may affect the kinematics of the foot segments. We evaluated the effects of two different levels of forefoot midsole stiffness on the angular displacement of the forefoot and rearfoot in the three planes of motion during the stance phase of gait.

METHODS

Thirty-six participants walked on a 10-m walkway at their self-selected speed wearing shoes having either low or high forefoot midsole stiffness. Three-dimensional kinematic data of the foot segments were obtained during the stance phase of gait using an eight-camera motion analysis system synchronized with a force platform. The dependent variables were forefoot and rearfoot total range of motion and maximum and minimum angle values in the sagittal, frontal, and transverse planes of motion.

RESULTS

Reduced forefoot midsole stiffness produced significantly greater forefoot total range of motion in the sagittal plane (1.59°). The low-stiffness condition also increased the magnitude of the forefoot dorsiflexion angles (4.14°). Furthermore, the low-stiffness condition increased the magnitude of the rearfoot inversion (1.21°) and adduction (11.38°) angles and reduced the rearfoot abduction angle (12.1°).

CONCLUSIONS

It is likely that reduced stiffness of the forefoot midsole stretched the plantar fascia, increasing rearfoot stability during the stance phase of gait. Increased muscular contraction may also explain increases in rearfoot stability. Therefore, the integrity of the plantar fascia and ankle muscles' force and resistance should be considered when choosing a shoe with reduced or increased forefoot midsole stiffness for walking.

Evaluation of the effectiveness of anterior cruciate ligament injury prevention programme training components: a systematic review and meta-analysis

BACKGROUND

Anterior cruciate ligament (ACL) injury prevention programmes have shown mixed results, which may be due to differing emphasis on training components. The purpose of this study was to (1) quantify the overall and relative duration of each training component encompassed within these programmes and (2) examine the effect of these durations on ACL injury rates.

METHODS

A systematic review was completed and meta-analyses performed on eligible studies to produce a pooled OR estimate of the effectiveness of these programmes. Meta-regression was used to detect any relationship that programme duration and the duration of individual training components had on ACL injury rates.

RESULTS

13 studies were included for review. Results of the meta-analyses revealed a significant reduction of injuries after preventative training programmes for all ACL injuries (pooled OR estimate of 0.612, 95% CI 0.44 to 0.85; p=0.004) and for non-contact ACL injuries (OR 0.351, 95% CI 0.23 to 0.54; p<0.001). Results of meta-regression analysis revealed that a greater duration of balance training was associated with a higher injury risk for ACL injury (p=0.04), while greater durations of static stretching was associated with a lower injury risk for non-contact ACL injuries (p=0.04).

CONCLUSIONS

While ACL prevention programmes are successful in reducing the risk of ACL injury, the ideal combination and emphasis of training components within these programmes remains unclear. Evidence indicates that greater emphases on balance training and static stretching may be associated with an increase and decrease in injury risk, respectively.

Ballet injuries: injury incidence and severity over 1 year

STUDY DESIGN

Prospective, descriptive single-cohort study.

OBJECTIVE

To assess the incidence and severity of injuries to a professional ballet company over 1 year.

METHODS

Data for an elite-level ballet company of 52 professional dancers were collected by an in-house medical team using a time-loss injury definition.

RESULTS

A total of 355 injuries were recorded, with an overall injury incidence of 4.4 injuries per 1000 hours (female, 4.1; male, 4.8; P>.05) and a mean of 6.8 injuries per dancer (female, 6.3; male, 7.3; P>.05). Mean injury severity was 7 days (female, 4; male, 9; P<.05). Most injuries were classified as overuse (64%; female, 68%; male, 60%; P>.05); mean severity of injury was 3 days for females and 9 days for males (P<.05). The percentage of traumatic injuries was 32% for females and 40% for males (P<.05); the corresponding severity was 6 and 10 days, respectively (P<.05).

CONCLUSION

The relatively high number of injuries reported and the resulting loss of dance time support the need to introduce interventions to reduce the risk of injury in professional dancers.J Orthop Sports Phys Ther 2012;42(9):781-790. Epub 19 July 2012. doi:10.2519/jospt.2012.3893.

Injury in community-level soccer: development of an injury surveillance system

BACKGROUND

Few descriptive epidemiologic studies of injury in soccer are of community-level players. Although many sports injury surveillance systems have been described in the scientific literature, only 1 has been implemented in community-level soccer and that was restricted to adolescent players in a single club.

PURPOSE

The objective of this study was to develop a method for undertaking routine surveillance of injury in community-level soccer.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

A cohort of 880 community-level players aged 13 years and over was followed over 1 winter competitive season. Each week, each player was contacted by telephone and an interview conducted to collect data on participation in matches and training sessions, injuries, and adherence to injury prevention measures.

RESULTS

Seventy-five percent (n = 510) of the cohort was male and the median age was 16 years. Data were collected on 11 268 player-matches totaling 13 483 player-match hours and 11 540 player-training sessions totaling 16 031 player-training hours. A total of 677 match injury events were reported, giving overall incidence rates of 50.2 injury events per 1000 player-match hours and 6.0 injury events per 100 player-matches. The incidence rate for match injury events was significantly higher for females than for males (63.9 vs 46.9). A total of 145 training injury events were reported, giving overall incidence rates of 9.0 injury events per 1000 player-training hours and 1.3 injury events per 100 player-training sessions. The most common injuries were sprains and strains of the lower limb, and tackling was the most common cause of injury.

CONCLUSION

This study has shown that routine injury surveillance, using a cohort design with exposure measurement, can be successfully implemented in community-level soccer.

A cost-outcome approach to pre and post-implementation of national sports injury prevention programmes

In New Zealand (NZ), the Accident Compensation Corporation (ACC) has developed a pre and post-implementation cost-outcome formulae for sport injury prevention to provide information regarding the success of a prevention programme. The ACC provides for the cost of all personal injuries in NZ and invests in prevention programmes to offset 1.6 million annual claims that cost $NZD 1.9 billion. The ACC invests in nine national community sport injury prevention programmes that represent 40% of sport claims and costs. Pre-implementation is used to determine the decision whether to invest in implementation and to determine the level of such investment for the injury prevention programme. Post-implementation is calculated two ways: unadjusted, assuming ceteris paribus; and adjusted assuming no prevention programme was in place. Post-implementation formulae provide a return on investment (ROI) for each dollar invested in the programme and cost-savings. The cost-outcome formulae approach allows ACC to manage expectations of the prevention programme as well as when it will provide a ROI, allowing it to take a long-term view for investment in sport injury prevention. Originally developed for its sport injury prevention programmes, the cost-outcome formulae have now been applied to the other prevention programmes ACC invests in such as home, road and workplace injury prevention.

For debate: consensus injury definitions in team sports should focus on missed playing time

OBJECTIVE

To compare the most commonly used and proposed injury definitions for surveillance systems in team sports and attempt to assess their suitability for consensus definitions in terms of reliability and functionality.

DATA SOURCES

The PubMed and SportDiscus databases were searched for papers on team sports that discussed consensus definitions or compared various definitions of injury.

DATA SYNTHESIS

A continuum between the most broad "tissue damage" definition and the most narrow "match time loss only" definition was developed.

RESULTS

A "match time loss only" injury definition can be reliably and accurately applied but only captures a small percentage of the total pool of all "tissue damage" injuries. There are some inherent biases in using a match time loss only definition (late season matches, matches with unequal breaks between games), but these are clearly visible. All other definitions improve the volume of data captured but suffer serious theoretical and/or practical flaws with respect to accuracy and reliability. No study using a broad definition has demonstrated good reliability to date (eg, using 2 independent recorders at the same team).

CONCLUSION

A "match time loss only" injury definition is the most accurate and reliable of those commonly used in team sports. Other injury definitions are broader and may be more appropriate for individual team and specific injury studies. However, a match time loss definition is the most accurate and reliable tool for comparing injury rates at different teams and between different seasons within teams. Hence, we recommend this as the basis for the injury definition in a consensus statement.

For debate: consensus injury definitions in team sports should focus on encompassing all injuries

OBJECTIVE

The purpose of this paper is to highlight the most effective method of collecting injury data by using a definition that encompasses all injuries into the data collection system. The definition provides an accurate picture of injury incidence and also allows filtering of records so that data can be reported in a variety of comparable ways.

DATA SOURCES/SYNTHESIS

A qualitative review of literature in team sports, plus expert opinion, served as the basis for data collection strategies. Articles were retrieved from SportsDiscus and PubMed using the terms "sports injury definition" and "injury definition." These terms were searched for the period 1966 to November 2006.

RESULTS

One of the major results (from this paper) that supports the use of an all-encompassing injury definition is that 70% to 92% of all injuries sustained fall into the transient category--that is, by only recording injuries that result in missed matches, the majority of injuries are missed and therefore injury rates are underreported.

CONCLUSION

An injury definition should be the most encompassing definition that enables a true, global picture of injury incidence to be seen in participation in any team sport.

A dynamic model of etiology in sport injury: the recursive nature of risk and causation

The purpose of this manuscript is to outline a new model representing a dynamic approach that incorporates the consequences of repeated participation in sport, both with and without injury. This model builds on the previous work, while emphasizing the fact that adaptations occur within the context of sport (both in the presence and absence of injury) that alter risk and affect etiology in a dynamic, recursive fashion. Regardless of the type of injury, it is often preceded by a chain of shifting circumstances that, when they come together, constitute sufficient cause to result in an injury. If we are to truly understand the etiology of injury and target appropriate prevention strategies, we must look beyond the initial set of risk factors that are thought to precede an injury and take into consideration how those risk factors may have changed through preceding cycles of participation, whether associated with prior injury or not. This model considers the implications of repeated exposure, whether such exposure produces adaptation, maladaptation, injury or complete/incomplete recovery from injury. When feasible, future studies on sport injury prevention should adopt a methodology and analysis strategy that takes the cyclic nature of changing risk factors into account to create a dynamic, recursive picture of etiology.

Injury Surveillance in Young Athletes

As participation in junior, high-school and college sports has increased dramatically over the last three decades, sports injuries have increased commensurately. In the US alone, sports-related injuries account for 2.6 million visits to the emergency room made by children and young adults (aged 5-24 years). Injuries sustained by high-school athletes have resulted in 500000 doctor visits, 30000 hospitalisations and a total cost to the healthcare system of nearly 2 billion dollars per year. Sports injury surveillance studies have long formed the backbone of injury prevention research, serving to highlight the types and patterns of injury that merit further investigation. Injury surveillance studies have been integral in guiding rule changes, equipment improvement and training regimens that prevent injury. Despite findings that the methodology of injury surveillance studies may significantly influence the design and efficacy of preventative interventions, relatively few sources address epidemiological considerations involved in such studies. The purpose of this review is 3-fold. First, to perform a review of the current injury surveillance literature in order to identify key epidemiological and methodological issues that arise when reading or conducting an injury surveillance study. Second, to identify and describe how injury surveillance studies have addressed these issues. Third, to provide recommendations about the identified issues in order to guide clinicians in the interpretation of data presented in such studies. Searches of Ovid MEDLINE (1966-present) and PubMed were performed. Thirty-three descriptive and review articles addressing epidemiological and methodological considerations in injury surveillance were selected, as well as 54 cohort studies and studies with an experimental design. Data with respect to each study's treatment of the three epidemiological issues of interest were extracted and synthesised into a table. This review identifies the following three key epidemiological issues to consider when reading injury surveillance literature or when designing an injury surveillance study: (i) the definition of a sports injury; (ii) the denominator with which injuries are reported; and (iii) the method of data collection. A meaningful definition of injury should incorporate time lost from participation in order to reduce the bias associated with estimates of incidence. The use of multiple denominators (e.g. both athlete-hours of exposure and total athletes) provides the most precise information about injury rate and injury risk. The method of data collection that captures the widest range of injuries, while also allowing for the collection of exposure data, will vary depending on geographical location and the organisation of youth sports in that area.

Injury rates, risk factors, and mechanisms of injury in minor hockey

BACKGROUND

Hockey is one of the top sports for participation in youth in Canada. There are limited data on the epidemiology of injury in youth hockey.

PURPOSE

Through implementation and validation of an injury surveillance system, youth ice hockey injury rates, risk factors, and mechanisms of injury will be examined.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

During the 2004-2005 season in minor hockey in Calgary, Alberta, Canada, 71 hockey teams (N = 986) were studied, including teams from each age group (Atom, 9/10 years; Pee Wee, 11/12 years; Bantam, 13/14 years; Midget, 15/16 years) and division of play (7-10 divisions per age group). A certified athletic therapist or candidate did weekly assessments of any identified hockey injury. Injury definition included any injury occurring during the regular hockey season that required medical attention, removal from a session, or missing a subsequent session.

RESULTS

Of the 986 participating players, 216 players sustained a total of 296 injuries in the 2004-2005 season. The overall injury rate was 30.02 injuries per 100 players per season (95% confidence interval, 27.17-32.99) or 4.13 injuries per 1000 player hours (95% confidence interval, 3.67-4.62). Forty-five percent of all injuries occurred during body checking. Compared with the youngest age group, Atom, the risk of injury was greater in Pee Wee (relative risk, 2.97; 95% confidence interval, 1.63-5.8), Bantam (relative risk, 3.72; 95% confidence interval, 2.08-7.14), and Midget (relative risk, 5.43; 95% confidence interval, 3.14-10.17) leagues. The risk of injury in Pee Wee was greatest in the most elite divisions (relative risk, 2.45; 95% confidence interval, 1.15-5.81). Concussion, shoulder sprain/dislocation, and knee sprain were the most common injuries.

CONCLUSION

Significant differences in injury rates were found by age and division of play. The public health significance of body checking injury in minor hockey is great. Future research will include expansion of surveillance to further examine body checking injuries and prevention strategies in minor hockey.

Epidemiology of Stress Fracture and Lower-Extremity Overuse Injury in Female Recruits

PURPOSE

The purpose of this prospective study was to examine rates and risk factors for overuse injuries among 824 women during Marine Corps Recruit Depot basic training at Parris Island, SC, in 1999.

METHODS

Data collected included training day exposures (TDE), baseline performance on a standardized 1.5-mile timed run, and a pretraining questionnaire highlighting exercise and health habits. The women were followed during training for occurrence of stress fracture and other lower-extremity overuse injury.

RESULTS

There were 868 lower-extremity overuse injuries for an overall injury rate of 12.6/1000 TDE. Rates for initial and subsequent injury were 8.7/1000 and 20.7/1000 TDE, respectively. There were 66 confirmed lower-extremity stress fractures among 56 (6.8%) women (1.0/1000 TDE). Logistic regression modeling indicated that low aerobic fitness (a slower time on the timed run (> 14.4 min)), no menses in six or more consecutive months during the past year, and less than 7 months of lower-extremity weight training were significantly associated with stress fracture incidence. Self-rated fair-poor fitness at baseline was the only variable significantly associated with other non-stress fracture overuse injury during basic training.

CONCLUSIONS

Among this sample of women, the risk of lower-extremity overuse injury was high, with a twofold risk of subsequent injury. The results suggest that stress fracture injury might be decreased if women entered training with high aerobic fitness and participated frequently in lower-extremity strength training. Furthermore, women reporting a history of menstrual irregularity at their initial medical exam may require closer observation during basic training.

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 these two systems to determine which was the more reliable and easier to apply in the classification of injury diagnoses of patients who presented to sports physicians in private sports medicine practice.

METHODS

Ten sports physicians/sports physician registrars each coded one of 10 different lists of 30 sports medicine diagnoses according to both ICD-10-AM and OSICS-8 in random order. The coders noted the time taken to apply each classification system, and allocated an ease of fit score for individual diagnoses into the systems. The 300 diagnoses were each coded twice more by "expert" coders from each system, and these results compared with those of the 10 volunteers.

RESULTS

Overall, there was a higher level of agreement between the different coders for OSICS-8 than for ICD-10-AM. On average, it was 23.5 minutes quicker to complete the task with OSICS-8 than with ICD-10-AM. Furthermore, there was also higher concordance between the three coders with OSICS-8. Subjective analysis of the codes assigned indicated reasons for disagreement and showed that, in some instances, even the "expert" coders had difficulties in assigning the most appropriate codes.

CONCLUSIONS

Based on the results of this study, OSICS-8 appears to be the preferred system for use by inexperienced coders in sports medicine research. The agreement between coders was, however, lower than expected. It is recommended that changes be made to both OSICS-8 and ICD-10-AM to improve their reliability for use in sports medicine research.

The Influence of Methodological Issues on the Results and Conclusions from Epidemiological Studies of Sports Injuries

Data obtained from epidemiological studies of sports injuries are an essential requirement for developing injury prevention, treatment and rehabilitation strategies. Although many authors have discussed the strengths and weaknesses of research methods employed in epidemiology, the potential effects that variations in research design and methods of analysis can have on study conclusions have not been clearly illustrated. This article addresses a number of methodological issues and illustrates their potential effects using examples based on injury data obtained from a single, large epidemiological study in professional rugby union. The examples demonstrate that conflicting conclusions can be reached depending on how the data are collected and analysed. The pivotal roles played by injury definition (loss-of-time, missed matches, diagnostic assessment and surgery), recurrent injury definition (clinical judgement and same injury/same location/same season), method of reporting injuries (number, proportions and incidence) and method of calculating incidence (injuries per 1000 player-hours, per 1000 athlete-exposures and per 1000 matches) are highlighted and illustrated. Other examples show that if training and match injuries are combined, the incidence of injury is more likely to reflect the incidence of training injuries but the distributions of injuries are more likely to reflect the distributions of match injuries. An example is presented that demonstrates that the identification of injuries causing the greatest concern within a sport depends on whether the assessment is based on injury incidence, severity or risk. Finally, examples are presented to show that the relationships identified between sports injuries and risk factors may be dependent on whether case-control or cohort study designs are used. Although there are no simple solutions available to resolve the issues raised, the discussion demonstrates the importance, at least within a sport, of reaching consensus agreements on acceptable study designs and methods of data analysis in sports epidemiology.

Evaluation of risk factors for injury in adolescent soccer: implementation and validation of an injury surveillance system

BACKGROUND

There are limited data on the epidemiology of adolescent soccer injury across all levels of play.

HYPOTHESIS

Through implementation and validation of an injury surveillance system in adolescent soccer, risk factors for injury will be identified.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

The study population was a random sample of 21 adolescent soccer teams (ages 12-18). A certified athletic therapist completed preseason baseline measurements and did weekly assessments of any identified soccer injury. The injury definition included any injury occurring in soccer that resulted in 1 or more of the following: medical attention, the inability to complete a session, or missing a subsequent session.

RESULTS

Based on completeness of data in addition to validity of time loss, this method of surveillance has proven to be effective. The overall injury rate during the regular season was 5.59 injuries per 1,000 player hours (95% confidence interval, 4.42-6.97). Soccer injury resulted in time loss from soccer for 86.9% of the injured players. Ankle and knee injuries were the most common injuries reported. Direct contact was reported to be involved in 46.2% of all injuries. There was an increased risk of injury associated with games versus practices (relative risk = 2.89; 95% confidence interval, 1.69-5.21). The risk of injury in the under 14 age group was greatest in the most elite division. Having had a previous injury in the past 1 year increased the risk of injury (relative risk = 1.74; 95% confidence interval, 1.0-3.1).

CONCLUSION

There were significant differences in injury rates found by division, previous injury, and session type (practice vs game). Future research should include the use of such a surveillance system to examine prevention strategies for injury in adolescent soccer.

Epidemiology of non-submersion injuries in aquatic sporting and recreational activities

Although the issues of drowning and near-drowning in aquatic sporting and recreational activities receive considerable attention in the epidemiological literature, there is not a recognised literature on non-submersion injuries occurring in these activities. This review draws together the epidemiological literature on non-submersion injuries and describes the incidence, nature and causes of these injuries, common risk factors, and strategies for prevention. Activities covered by the review include swimming, diving, boating, surf sports, fishing, water polo and water sliding. For most activities there is a dearth of good quality descriptive studies, with most involving cases-series designs and few providing estimates of incidence. Inconsistencies in inclusion criteria and the reporting of incidence rates makes comparisons within and between activities difficult. Incidence rates were identified for most activities and in general the incidence of injury was low, especially for more serious injury. However, some activities were associated with severely disabling injury, such as spinal cord injury (diving) and amputation (from propeller strikes in water skiing and swimming). Only three studies reporting the significance of postulated risk factors were identified. Lack of knowledge about the water being entered and alcohol consumption are significant risk factors in recreational diving; increased blood alcohol concentrations were reported to increase the risk of death in boating; and obesity and tandem riding were reported to increase the risk of injury on public water slides. Few evaluations of preventive measures were identified. Two studies reported reductions in the incidence of water slide injuries following the introduction of design changes and supervision, but neither had a non-intervention comparison group. Improvements in swimming and diving skills were reported in three studies, but these were not designed to measure changes in the risk of injury.This review demonstrates that there is a need for well-designed epidemiological research on non-submersion injury in aquatic sporting and recreational activities. The first priority should be for studies designed to describe accurately the incidence, nature, severity and circumstances of these injuries, followed by research on the significance of postulated risk factors. Once this research has been undertaken, interventions targeted at reducing the incidence of injury in aquatic sporting and recreational activities can be designed and evaluated.

Football injuries during FIFA tournaments and the Olympic Games, 1998-2001: development and implementation of an injury-reporting system

BACKGROUND

Standardized assessment of sports injuries provides not only important epidemiological information, but also directions for injury prevention, and the opportunity for monitoring long-term changes in the frequency and characteristics of injury.

PURPOSE

Development and implementation of an easy to use injury-reporting system to analyze the incidence, circumstances and characteristics of injury during major international football tournaments.

STUDY DESIGN

Prospective survey.

METHODS

A comprehensive injury report form was developed, and implemented during 12 international football tournaments. The physicians of all participating teams were asked to report all injuries after each match. The response rate was 84% on average.

RESULTS

A total of 901 injuries were reported from 334 matches, which is equivalent to an incidence of 2.7 injuries per match. Approximately one injury per match resulted in a player's absence from training or matches. On average 86% of the injuries arose as a result of contact with another player, and approximately half of all injuries were caused by foul play. The number of injuries per match differed substantially between the tournaments for players of different age, sex and skill-level.

CONCLUSION

An injury-reporting system has been implemented as matter of routine in FIFA tournaments. The consistent findings in the present study demonstrate the high quality of the data obtained.

Snowblading injuries in Eastern Canada

OBJECTIVES

To evaluate injury patterns of snowbladers and compare them with those of skiers and snowboarders. To determine possible effects of helmet use in these sports on injury to the head and neck.

METHODS

This prospective case series observational study was conducted by collecting the injury reports from the ski patrol during the 1999-2000 season at Mont Tremblant ski resort, Quebec. All participants in downhill winter sports who presented themselves to the ski patrol with traumatic injury related to their sport were included. A concussion was defined as any loss of consciousness, amnesia, confusion, disorientation, vertigo, or headache that resulted from injury. The ski patroller reported helmet use on the accident report at the time of injury.

RESULTS

Snowbladers present with a unique pattern of injury compared with skiers and snowboarders. The incidence of leg, knee, and ankle/foot injuries were 20.5%, 25.6%, and 10.3% respectively. Concussions represented 11% of all injuries. There was no increase in other injury, including neck injury, related to helmet use.

CONCLUSIONS

Unique injury patterns in snowbladers warrant reconsideration of equipment design. Concussion is a common injury on the ski slope. Although the effects of helmet use on concussion rate are inconclusive based on this study, helmet use did not increase the rate of neck injury, even when adjusted for age.

Injury in the Australian sport of calisthenics: a prospective study

The aims of this study were to determine the rate, anatomical regions, onset, severity, and type of injury in the sport of calisthenics and compare injuries reported by elite and non-elite participants. Prospective reports of injuries were collected over a 12-month period from 550 elite and non-elite calisthenics participants. The participants recorded the number of training sessions, competition, and performances per week, hours of training, and information on any injuries sustained each week during the survey period. Five hundred and fifty participants reported 190 injuries during the survey period, 0.4 injuries per participant year or 0.3 injured participants per participant year. The odds ratio of injury in the elite to the non-elite group was 2.0 (95% CI 1.3 to 2.9). Injuries to the lower back (32.4% of all injuries), hip thigh and groin (25.4% of all injuries) were most common. Activities involving lumbar extension (29.8% of all injuries and 61.0% of lower back injuries) were perceived by participants to have led to injury. In general, injuries were minor and mainly involved soft tissue structures (95.6% of all injuries). Participants had difficulty in identifying why their injuries had occurred. Calisthenics participants did not report high injury rates, but activities that involve lumbar extension are implicated in low back injuries and warrant further attention

Injuries in short track speed skating

BACKGROUND

Little is known about the pattern of injury in short track speed skating.

PURPOSE

To investigate the incidence and characteristics of injuries in short track speed skating.

STUDY DESIGN

Retrospective study.

METHODS

Ninety-five of 150 elite-level skaters (63.3%) were surveyed to collect information on training and competition load as well as on injuries sustained during the 1999-2000 competitive season. Injuries were characterized in terms of anatomic location, type of injury, time loss from training and competition, and circumstance of injury (acute onset during competition, on-ice practice, off-ice training, or insidious onset).

RESULTS

Sixty-one of the 95 skaters (64.2%) reported sustaining at least one injury. The knee, ankle, spine, leg, and groin were the most commonly reported sites of injury. Skaters were also asked to list previous on-ice injuries. The two most common injuries occurring on-ice before the 1999-2000 season were lacerations from the knee down (11.1%) and ankle fractures (10.2%).

CONCLUSION

The results of this study suggest that there is a high incidence of injury in competitive short track speed skating.

Rates and risks of injury during intercollegiate basketball

BACKGROUND

Previous studies of basketball injury have not been able to assess injury incidence and risk.

PURPOSE

To determine rates and risks of injury in Canadian intercollegiate basketball.

STUDY DESIGN

Prospective cohort study.

METHODS

Standardized data were collected with a validated instrument from 98.1% of the 318 athletes on the eight men's basketball teams in the Canada West Division of the Canadian Intercollegiate Athletic Union.

RESULTS

A total of 142 athletes sustained 215 injuries (44.7% of players injured) over the 2-year study period. The greatest number of injuries resulting in more than seven sessions of time loss involved the knee, whereas the most common injuries causing fewer than seven sessions of time loss involved the ankle. The most common mechanism of injury was contact with another player, especially in the "key." Injuries occurred 3.7 times more often in games than during practice. Centers had the highest rate of injury, followed by guards, and then forwards. The relative risk of reinjury was significantly increased by previous injuries to the elbow, shoulder, knee, hand, lower spine or pelvis, and by concussions.

CONCLUSIONS

Risk factors for injury were previous injury, games as opposed to practice, player position, player contact, and court location.

Musculoskeletal injuries in the Norwegian National Ballet: a prospective cohort study

The purpose of the present study was to determine the incidence of musculoskeletal injuries among professional ballet dancers in the Norwegian National Ballet. A 19 weeks prospective study with registration and clinical assessment of dancers with injuries was conducted. Medical staff working for the National Ballet registered incidence of injuries. In addition the dancers filled out a questionnaire about previous injuries, their work situation, and factors they believed increased the risk of injuries. Of the 41 dancers (80% response rate), 31 dancers experienced one injury or more. The majority of injuries involved foot and ankle. Twenty-two per cent of the injuries were acute injuries. Seventy-five per cent of the injuries were soft tissue injuries. Most injuries were of mild to moderate severity. Sixteen per cent of the injuries resulted in absence from work. Factors, the dancers believed were associated with risk of injuries were related to training, organizational factors and environmental factors. Seventy-eight per cent of the dancers experienced "negative" stress at work. Sixty-four per cent experienced that they had little influence on their work conditions. This study showed, however, no significant association between these psychological factors and musculoskeletal injuries. It is concluded that there is a high incidence of musculoskeletal injuries in the Norwegian National Ballet.

Survey of the injury rate for children in community sports

OBJECTIVE

To determine the baseline injury rate for children ages 7 to 13 participating in community organized baseball, softball, soccer, and football.

METHODS

In this observational cohort study, 1659 children were observed during 2 seasons of sports participation in an urban area. Data were collected by coaches using an injury survey tool designed for the study. A reportable injury was defined as one requiring on-field evaluation by coaching staff, or causing a player to stop participation for any period of time, or requiring first aid during an event. Logistic regression analyses were done within and across sports for injury rates, game versus practice injury frequencies, and gender differences where appropriate.

RESULTS

The injury rates, calculated per 100 athlete exposures during total events (games plus practices), were: baseball, 1.7; softball, 1.0; soccer, 2.1; and football, 1.5. The injury rates for baseball and football were not significantly different. Across sports, contusions were the most frequent type of injury. Contact with equipment was the most frequent method of injury, except in football where contact with another player was the most frequent method. In baseball, 3% of all injuries reported were considered serious (fracture, dislocation, concussion); in soccer, 1% were considered serious; and in football, 14% were considered serious. The frequency of injury per team per season (FITS), an estimation of injury risk, was 3 for baseball and soccer, 2 for softball, and 14 for football for total events. For all sports, there were more game than practice injuries; this difference was significant except for softball. There were no significant gender differences in soccer for injury rates during total events.

CONCLUSIONS

Given the classification of football as a collision sport, the high number of exposures per player, the FITS score, and the percentage of injuries considered serious, youth football should be a priority for injury studies. Health professionals should establish uniform medical coverage policies for football even at this age level. RECOMMENDATIONS FOR MODIFICATIONS: Injury surveillance for youth sports is gaining momentum as an important step toward formulating injury prevention methods. However, establishing patterns of injuries, taking preventive measures, and evaluating equipment and coaching modifications may take years. In addition to the objective findings of this study, our direct observations of community sports through 2 seasons showed areas where immediate modifications could reduce injury risk. The first recommendation is that youth sports leagues provide and require first aid training for coaches. Training could be done by sports medicine professionals and include recognition and immediate response to head, neck, and spine injuries, as well as heat-related illnesses. The second recommendation is that youth sports leagues have clear, enforceable return to play guidelines for concussions, neck and back injuries, fractures, and dislocations. The third recommendation is that baseball and softball leagues consider the injury prevention potential of face guards on batting helmets.

Is it possible to prevent sports injuries? Review of controlled clinical trials and recommendations for future work

Sports injuries are one of the most common injuries in modern western societies. Treating sports injuries is often difficult, expensive and time consuming, and thus, preventive strategies and activities are justified on medical as well as economic grounds. A successful injury surveillance and prevention requires valid pre- and post-intervention data on the extent of the problem. The aetiology, risk factors and exact mechanisms of injuries need to be identified before initiating a measure or programme for preventing sports injuries, and measurement of the outcome (injury) must include a standardised definition of the injury and its severity, as well as a systematic method of collecting the information. Valid and reliable measurement of the exposure includes exact information about the population at risk and exposure time. The true efficacy of a preventive measure or programme can be best evaluated through a well-planned randomised trial. Until now, 16 randomised, controlled trials (RCT) have been published on prevention of sports injuries. According to these RCT, the general injury rate can be reduced by a multifactorial injury prevention programme in soccer (relative risk 0.25, p < 0.001, in the intervention group), or by ankle disk training, combined with a thorough warm-up, in European team handball [odds ratio 0.17; 95% confidence interval (CI) 0.09 to 0.32, p < 0.01]. Ankle sprains can be prevented by ankle supports (i.e. semirigid orthoses or air-cast braces) in high-risk sporting activities, such as soccer and basketball (Peto odds ratio 0.49; 95% CI 0.37 to 0.66), and stress fractures of the lower limb by the use of shock-absorbing insoles in footwear (Peto odds ratio 0.47; 95% CI 0.30 to 0.76). In future studies, it is extremely important for researches to seek consultation with epidemiologists and statisticians to be certain that the study hypothesis is appropriate and that the methodology can lead to reliable and valid information. Further well-designed randomised studies are needed on preventive actions and devices that are in common use, such as preseason medical screenings, warming up, proprioceptive training, stretching, muscle strengthening, taping, protective equipment, rehabilitation programmes and education interventions (such as increasing general injury awareness among a team). The effect of a planned rule change on the injury risk in a particular sport could be tested via a RCT before execution of the change. The most urgent needs are in commonly practised or high-risk sports, such as soccer, American football, rugby, ice hockey, European team handball, karate, floorball, basketball, downhill skiing and motor sports.

Injuries in whitewater kayaking

OBJECTIVE

To provide epidemiological data on whitewater kayaking injuries using a descriptive study.

METHODS

A retrospective survey was distributed at whitewater events and club meetings, and made available and advertised on the world wide web, through postings and announcements to newsgroups, related sites, and search engines. Data on sex, age, experience, and ability were collected. Injury data collected included mechanism, activity, difficulty of rapid, and self reported severity.

RESULTS

Of the 392 kayaking respondents included in the final analysis, 219 suffered 282 distinct injury events. The number of days spent kayaking per season was the only independent predictor of injury. The overwhelming majority of injuries occurred while the kayaker was still in the boat (87%). Striking an object was the most common mechanism of injury (44%), followed by traumatic stress and overuse (25% each). The most common types of injury were abrasion (25%), tendinitis (25%), contusion (22%), and dislocation (17%). The upper extremity, especially the shoulder, was the most commonly injured area of the body. Although half of injured kayakers sought medical care for their injury, and almost one third missed more than one month of kayaking because of the injury, almost all (96%) reported a complete or good recovery.

CONCLUSIONS

Factors relating to likelihood of injury appear to be connected with exposure, namely the number of days a year that the sport was pursued. Except for class V (extreme) kayakers, reports of injuries paralleled the number of participants. Kayakers reported injuries predominantly on rivers that they assessed to be at a level appropriate to their skills.

Emergency visits for sports-related injuries

STUDY OBJECTIVE

We sought to estimate the effect and magnitude of patients with sports-related injuries presenting to hospital emergency departments in the United States and to examine differences in patient and visit characteristics between sports- and nonsports-related injuries.

METHODS

Data from the 1997 and 1998 National Hospital Ambulatory Medical Care Survey, a national probabilistic sample of 496 US hospital EDs, were combined to examine emergency visits for sports-related injuries. Data from 16,997 sample ED encounter records for injuries that included narrative cause of injury text were analyzed. Narrative text entries were coded to 1 of 84 sport and recreational activity codes. Sample weights were applied to provide annual national estimates. Estimates of sports-related injury visits were based on 1,775 records with an assigned sports-related activity code.

RESULTS

There were an average annual estimated 2.6 million emergency visits for sports-related injuries by persons between the ages of 5 and 24 years. They accounted for over 68% of the total 3.7 million sport injuries presented to the ED by persons of all ages. As a proportion of all kinds of injuries presenting to the ED, sports-related injuries accounted for more than one fifth of the visits by persons 5 to 24 years old. The use rate was 33.9 ED visits per 1,000 persons in this age group (95% confidence interval 30.3 to 37.5). The sports-related injury visit rate for male patients was more than double the rate for female patients (48.2 versus 19.2 per 1,000 persons between 5 and 24 years of age). Visits from sports-related activities for this age group were more frequent for basketball and cycling compared with other categories (eg, baseball, skateboarding, gymnastics). Compared with nonsports-related injuries for this age group, sports-related injuries were more likely to be to the brain or skull and upper and lower extremities. Patients with sports-related injuries were more likely to have a diagnosis of fracture and sprain or strain and less likely to have an open wound. They were also more likely to have diagnostic and therapeutic services provided, especially orthopedic care.

CONCLUSION

Sports-related activities by school-age children and young adults produce a significant amount of emergency medical use in the United States. The ED is an appropriate venue to target injury prevention counseling.

High school cross country running injuries: a longitudinal study

OBJECTIVE

To determine the incidence rate of injury among high school cross country runners over a 15-year period.

DESIGN

Prospective-longitudinal.

SETTING

Twenty-three high schools in western Washington State under the surveillance of the University of Washington Athletic Health Care System between 1979-1994.

PARTICIPANTS

One hundred and ninety-nine cross country teams.

MAIN OUTCOME MEASURE

Injuries resulting from running in a cross country practice or meet.

RESULTS

There were 1,622 injuries for an overall injury rate of 13.1/1,000 athletic exposures (AEs), i.e., participation of a runner in a practice or meet. Girls had a significantly higher overall injury rate (16.7/1,000 AEs) than boys (10.9/1,000 AEs) (p < 0.0001). Girls also had significantly higher injury rates than boys for both initial (p < 0.0001) and subsequent injuries (p < 0.0001), especially those at the same body location (p = 0.0001). This difference in risk estimates was consistent over a 15-year period. Nearly three-fourths of the injuries resulted in < or =4 days of disability. Overall, higher rates of initial injuries were reported during practices (9.2/1,000 AEs) than in meets (7.8/1,000 AEs) (p = 0.04). Shin injuries had the highest overall rates of new injury (1.9/1,000 AEs) and reinjury at the same body location (53.9/1,000 AEs). Girls had significantly higher initial injury rates than boys for shin (p < 0.0001), hip. and foot injuries (p < 0.01), and higher reinjury rates for knee. calf, and foot injuries, respectively (p < 0.05).

CONCLUSION

The results of this study suggest that girl cross country runners are at higher risk of injury and reinjury than boy cross country runners.

Injury surveillance during medical coverage of sporting events--development and testing of a standardised data collection form

Medical coverage services have the potential to play a key role in sports injury surveillance activities. Provided that injury surveillance activities are fully coordinated and a standardised data collection procedure is implemented, valuable sports injury information can be obtained by medical coverage personnel. This paper describes the development of a standardised injury data collection form for use by medical coverage personnel during large sporting events. The form was trialed during two large sporting events in Melbourne, Australia in 1995. A range of sports medicine and sports first aid personnel was involved in the trial and injury details were collected on all persons receiving treatment from the coverage team, irrespective of injury severity. The final sports injury data collection form is easy to use, can be used by all types of medical coverage personnel and can provide valuable data in a timely manner. The form has since been adopted as the injury data collection standard at a number of major Australian sporting events. Recommendations for incorporating injury surveillance activities when organising sporting events and planning medical coverage services are given. Suggestions for maximising compliance with data collection procedures are also discussed.

The North Carolina High School Athletic Injury Study: design and methodology

PURPOSE

Organized interscholastic athletics are an integral part of the educational program at almost every school level. With this growing popularity of sports and their inclusion in more public school programs, it becomes increasingly apparent that additional consideration must be given to the injury problem associated with sport. The North Carolina High School Athletic Injury Study (NCHSAIS) was undertaken to identify patterns of injury among male and female athletes in North Carolina high schools participating in any of 12 sports. Specific aims are to measure the incidence, severity and etiology of injuries; to determine the relationship of demographic factors and protective equipment, exposure to play, and school characteristics to injuries; to study the relationship of coaches' training and experience to injury occurrence; and to compare the incidence and severity of injury among female and male athletes in the same or comparable sports.

METHODS

A two-stage cluster sample of 100 high schools in North Carolina was selected for this 4-yr prospective study.

RESULTS

Participation by the initial sample or a random replacement was achieved for 91 of the 100 schools. Nonresponse occurred at multiple levels of the sample for this study, and the weekly participation form posed the greatest respondent burden.

CONCLUSIONS

The NCHSIAS offers a successful methodology for addressing sports injuries. In this paper we describe the design, methodology, and implementation issues that emerge in conducting a large scale epidemiological study in a population of high school athletes.