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Abstract
This descriptive epidemiology study describes trends in paediatric sports-related injuries resulting from 21 selected sports presenting to US emergency departments (EDs) over a 13-year period. The study was a retrospective study using data from the US Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS) for years 2001–2013. Inclusion criteria included people in the NEISS for injuries related to one of the 21 selected sports and between the ages of 5 and 18 years. Frequencies and linear regressions were calculated using provided sample weights. The results indicated there was a statistically significant increase of 10 010 nationally estimated selected sports-related injuries per year. Football, basketball, soccer and baseball resulted in 74.7% of the total national estimate for sports-related injuries presenting to US EDs for 2001–2013 for children aged 5–18 years. The results indicate that the number of paediatric sports-related injuries treated in US EDs has increased annually from 2001 to 2013.
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Introduction
An estimate of 30–45 million people between the ages of 6 and 18 play organised athletics,1 and about 7.6 million people partake in high-school sports.2 Over the last 30 years, participation in youth sports has increased.3 Although physical activity has many benefits, it is necessary to maximise children's safety while playing. Most paediatric sports-related injuries are minor; however, some can require surgery and hospitalisation. Outcomes resulting from youth sports injuries include medical care costs, absences from school and potential long-term effects of injury. The costs for hospitalisations occurring as a result of sports injuries for children aged 5–18 years were estimated to be $485 million over a 4-year time period.4
For 2000–2001, an estimated 4.3 million sports-related and recreation-related injuries were treated in US emergency departments (EDs).5 Several studies have examined the epidemiology of sports-related injuries related to one specific sport over several years,6–12 and only a few have observed multiple sports-related and recreation-related injuries over a short duration.13 ,14 However, these studies’ results are not comparable because of differences in study designs, selected sports and time periods. No study was found that previously examined all 21 sports included in this study over a period of 13 years. This study aims to observe and describe trends in paediatric sports-related injuries presenting to US EDs over 13 years. The findings will help to understand emerging trends in paediatric sports injuries and direct further research to guide prevention efforts.
Methods
This descriptive epidemiology study used retrospective data obtained from US Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS). The NEISS sample consists of data from 100 hospital EDs comprised of different-sized hospitals including children's hospitals.15 NEISS variables include treatment date, age, gender, injury diagnosis, body part affected, disposition and products mentioned. The study included cases in the NEISS dataset with an injury related to one of the 21 selected sports’ product codes listed in table 1, an age between 5 and 18 years and an ED visit date between 1 January 2001 and 31 December 2013. Observations were excluded if they had multiple product codes listed. Categories were created for body region of injury, injury diagnosis, age group and year ranges. National estimates were calculated using the sample weights provided by the NEISS. Frequency estimates were calculated for year, product codes, body region of injury and injury diagnosis. Linear regressions were performed to predict trends in sports-related injuries from 2001 to 2013 by individual sports and all sports combined, as well as body region of injury by year. All statistical analyses were conducted using Excel and SAS V.9.4 (SAS Institute, Cary, North Carolina, USA). This study was deemed exempt by the institutional review board.
NEISS product codes with descriptions
Results
There were 485 515 sports-related injury cases reported for children aged 5–18 years for 2001–2013. The national estimate for sports-related injuries presenting to US EDs for 2001–2013 among children aged 5–18 years was 15 960 113 (95% CI 13 808 105 to 18 112 121). The sports with the highest national estimates of sports-related injuries presenting to US EDs for children aged 5–18 were football, basketball, soccer and baseball with national injury estimates of 4 520 245 (95% CI 3 943 842 to 5 096 647), 4 215 389 (95% CI 3 693 247 to 4 737 531), 1 771 423 (95% CI 1 378 336 to 2 164 510) and 1 413 555 (95% CI 1 199 697 to 1 627 414), respectively. Of the total national estimate for sports-related injuries presenting to US EDs for 2001–2013 among children aged 5–18 years, 74.69% of total national estimate resulted from football, basketball, soccer and baseball. Percentages of the total national estimate for sports-related injuries resulting in EDs visits from 2001 to 2013 for this age group by each of the 21 sports are shown in table 1.
The linear regressions indicated significant decreases in the national estimates of sports-related injuries per year from 2001 to 2013 for basketball (−4586.79, p=0.026), baseball (−1038.05, p=0.004) and golf (−417.80, p<0.001). The sports with a statistically significant increase in national estimates of injuries included football (5205.37, p=0.0068), soccer (3747.77, p<0.001), cheerleading (1189.18, p<0.001), lacrosse (1065, p<0.001), swimming (889.52, p=0.034), softball (846.10, p<0.001), dancing (784.32, p<0.001), wrestling (700.60, p=0.0157), track and field (652.85, p<0.001), volleyball (480.51, p=0.011), martial arts (334.62, p=0.004) and rugby (265.14, p<0.001). Overall, the 21 selected sports had a statistically significant increase in the national estimate of sports-related injuries with an increase of 10 010 (p=0.0078) injuries per year for 2001–2013.
Of the total national estimate for sports-related injuries presenting to EDs during this time period, the most frequent injury diagnoses were strains/sprains (33.4%), fractures (20.2%) and contusions/abrasions (18.0%). However, the national estimate of sports-related injury diagnosis percentages decreased from 2001–2004 to 2009–2013 for strains and sprains (34.2%–32.6%, national estimates 1 630 970 and 2 084 369), fractures (21.1%–18.8%, national estimates 1 004 556 and 1 198 307) and contusions and abrasions (20.0%–16.2%, national estimates 953 170 and 1 031 694). While these percentages decreased, internal organ injury increased from 2.5% (national estimate n=121 179) of the national estimate of sports-related injury diagnoses for 2001–2004 to 5.9% (national estimate n=374 287) for 2009–2013. Concussion diagnoses increased from 2.0% (national estimate n=96 015) of sports-related injury diagnoses for 2001–2004 to 4.6% (national estimate n=291 762) for 2009–2013. Figure 1 depicts the percentage of injury diagnoses for concussion and internal organ injuries from the national estimate of injuries by sport for 2001–2013. Ice hockey, rugby and golf had the highest percentages of estimated internal organ injuries, while ice hockey, rugby and lacrosse had the highest per cent of estimated concussions.
Percentage of estimated concussions and internal organ injuries by sport from the national estimate of sports-related injuries presenting to US emergency departments for children aged 5–18 years, 2001–2013. Note: Percentages do not add up to 100% because only two of the diagnoses are included in the graph.
For the 13-year period, a linear regression was used to look at trends in body region of injury for sports-related injuries resulting from 21 selected sports. There was a significant increase in the national estimate of injuries to the head/neck (8145.3, p<0.001), to the lower trunk (1075.7, p<0.001), upper trunk (1654.2, p<0.001) and other (495.9, p=0.0004). Figure 2 shows the national estimates of sports-related injuries that are presented to EDs by body region of injury for years 2001–2013. Among the youngest age group, 5–10 years of age, 35.0% (national estimate n=929 532) of the national estimate of injuries were for head/neck compared with 19.1% (national estimate n=1 270 779) for 11–14 years of age and 22.6% (national estimate n=1 503 497) for 15–18 years of age.
The national estimate of sports-related injuries presenting to US emergency departments by body region of injury for 2001–2013 among children aged 5–18 years. Figure on the left displays national estimates of sports-related injuries to lower trunk, upper trunk and other body region. Figure on the right depicts the national estimate of sports-related injuries to upper extremity, lower extremity and head/neck.
Key messages
The sports with the greatest estimate of sports-related injuries in this study were football, basketball, soccer and baseball. The trend for the total national estimate of selected sports-related injuries was an increase of 10 010 injuries per year presenting to EDs for children aged 5–18 years in the USA. There were 12 sports that had statistically significant increases in the national estimate of injures.
Studies have found similar results for common causes of sports-related injuries. Basketball, football, bicycles, playgrounds and soccer were listed as the top five sport-related and recreation-related injury causes for 2001–2008 for 1–18 years of age.14 Several studies have also found strains and sprains, contusions and fractures to be the top injury diagnoses for sports-related injuries.8 ,11 ,12 ,16
An interesting finding from this study was the increase in percentage of national estimate of internal organ injuries presenting to US EDs due to sports. The percentage of estimated injuries diagnosed as internal organ injuries out of the total estimate of sports-related injuries more than doubled from 2001–2004 to 2009–2013. This is a concerning finding due to the potential severity of these injuries. Further research is needed to investigate the extent and severity of sports-related internal organ injuries.
Concussions had a similar increase in percentage over the same time periods. The percentage of estimated sports-related concussions doubled from 2.0% for 2001–2004 to 4.6% for 2009–2013. The surge in awareness about head injuries, and concussions specifically, could be a contributing driver in the change. With more parents and coaches aware of the potential severity of these types of injuries, it is not surprising to see an increase in the percentage of diagnoses.
The results of this study give rise to recommendations regarding future research needed to guide prevention methods to reduce paediatric sports-related injuries. Further studies are needed to understand the magnitude of paediatric sports-related internal organ injuries and concussions, specifically regarding the severity of these injuries and among which age groups these are occurring. Much literature focuses on sports injury prevention at the high-school level. While the 11–14 and 15–18 years age groups have a larger national estimate of sports-related injuries, the 5–10 years age group has higher percentages of internal organ injuries and injuries to the head/neck. Because of this, research and prevention efforts should be focused on avoiding these potentially serious injuries among younger children.
There are several limitations of this study. The first limitation is that a rate of injuries for each sport could not be calculated due to lack of information on sports participation. This affects the comparability from year to year. The number of injuries could be due to an influx in the number of children playing sports. The second limitation is that this data sample only includes injuries treated at EDs. Non-severe injuries may be treated by primary care providers, athletic trainers, urgent care centres and sports medicine physicians as opposed to EDs. The national estimate of sports-related injuries resulting from this data may potentially be underestimating the national estimate of sports-related injuries. The last limitation is that the data do not indicate if injury occurred from organised sport or if it resulted from sports equipment alone. Further research on the usage of treatment from sources other than EDs for sports-related injuries would add to the understanding of how many sports injuries are occurring yearly among youth and adolescents.
There has been a significant increase in the national estimate of paediatric sports-related injuries from 2001 to 2013 visiting EDs in the USA. This study indicates that additional research is warranted in order to understand ways to continue to guide prevention efforts. The results of this study indicate additional research on injury prevention strategies is needed.
What is already known on the subject
Much is known about the epidemiology of sports injuries resulting from popular sports such as basketball, soccer, baseball and football.
It is known that common injuries resulting from sports-related injuries are strains/sprains, contusions and fractures.
What this study adds
This study aims to identify trends in paediatric sports-related injuries by looking at national estimates of sports-related injuries presenting to emergency departments for 21 selected sports over a 13-year time period to compare trends in age group, injury diagnoses and body region of injury.
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References
Footnotes
Contributors DRB devised and designed the study, analysed and interpreted the data, drafted and revised the manuscript, and approved the final manuscript as submitted. TMB assisted with the design of the study, critically reviewed and revised the manuscript, and approved the final manuscript as submitted.
Competing interests None declared.
Ethics approval Indiana University.
Provenance and peer review Not commissioned; externally peer reviewed.