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When the rules of the game are broken: what proportion of high school sports-related injuries are related to illegal activity?

¹ The Research Institute at Nationwide Children’s Hospital, Center for Injury Research and Policy, Columbus, OH, USA
² The Ohio State University, College of Education and Human Ecology, School of Physical Activity and Educational Services, Columbus, OH, USA
³ The Ohio State University, College of Medicine, Department of Pediatrics and College of Public Health, Division of Epidemiology, Columbus, OH, USA

Christy Collins, MA, Center for Injury Research and Policy, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA; christy.collins{at}nationwidechildrens.org

Objectives: To compare sport and gender differences in injury rates and proportions of injuries related to illegal activity and to describe the epidemiology of injuries related to illegal activity.

Design: Descriptive epidemiology study.

Setting: 100 US high schools.

Subjects: Athletes participating in nine sports: boys’ football, soccer, basketball, wrestling, and baseball plus girls’ soccer, volleyball, basketball, and softball.

Main outcome measures: Illegal activity-related injuries were analyzed using data from the 2005–06 and 2006–07 National High School Sports-Related Injury Surveillance Study.

Results: Nationally, an estimated 98 066 injuries were directly related to an action that was ruled illegal activity by a referee/official or disciplinary committee, giving an injury rate of 0.24 injuries per 1000 athletic competition-exposures. Boys’ and girls’ soccer had the highest rates of injuries related to illegal activity, and girls’ volleyball, girls’ softball, and boys’ baseball had the lowest. Overall, 6.4% of all high school sports-related injuries were related to illegal activity, with the highest proportion in girls’ basketball (14.0%), girls’ soccer (11.9%), and boys’ soccer (11.4%). A greater proportion of injuries related to illegal activity were to the head/face (32.3%) and were concussions (25.4%) than injuries not related to illegal activity (13.8% (injury proportion ratio 2.35; 95% CI 1.82 to 3.04; p<0.001) and 10.9% (injury proportion ratio 2.35; 95% CI 1.71 to 3.22; p<0.001), respectively).

Conclusions: Illegal activity is an overlooked risk factor for sports-related injury. Reducing illegal activity through enhanced enforcement of sports’ rules and targeted education about the dangers of illegal activity for players, coaches, and referees/officials may reduce sports-related injuries.