Epidemiologic comparisons of soccer-related injuries presenting to emergency departments and reported within high school and collegiate settings

Kerr et al. Injury Epidemiology (2017) 4:19 DOI 10.1186/s40621-017-0116-9 ORIGINAL CONTRIBUTION Open Access Epidemiologic comparisons of soccerrelated injuries presenting to emergency departments and reported within high school and collegiate settings Zachary Y. Kerr1*, Lauren A. Pierpoint2, Dustin W. Currie2, Erin B. Wasserman3 and R. Dawn Comstock2,4 Abstract Background: Few studies compare sports injury patterns in different settings. This study described the epidemiology of soccer injuries presenting to emergency departments (EDs) and compared injuries presenting to EDs to injuries presenting to collegiate and high school athletic trainers (ATs). Methods: Soccer-related injuries (product code 1267) in the National Electronic Injury Surveillance System (NEISS) that were sustained by individuals at least two years of age in 2004–2013 were included. High School Reporting Information Online (HS RIO) data for high school soccer injuries during the 2005/06–2013/14 academic years were compared to NEISS data for those aged 14–17 years in 2005–2013. National Collegiate Athletic Association Injury Surveillance Program (NCAA-ISP) data for collegiate soccer injuries during the 2009/10–2013/14 academic years were compared to NEISS data for those aged 18–22 years in 2009–2013. All datasets included weights to calculate national estimates. Injury proportion ratios (IPRs) with 95% confidence intervals (CIs) compared nationally estimated injury distributions between the HS RIO/ NCAA-ISP and NEISS data subsets. Results: During the study period, 63,258 soccer-related injuries were captured by NEISS, which translates to an estimated 2,039,250 injuries seen at US EDs nationwide. Commonly injured body parts included the head/face (19.1%), ankle (17.6%), hand/wrist (15.3%), and knee (12.2%). Common diagnoses included sprains/strains (34.0%), fractures (22.2%), and contusions (17.7%). Compared to their respective age ranges in NEISS, sprains/strains comprised a larger proportion of injuries in HS RIO (48.3% vs. 33.7%; IPR = 1.38; 95% CI: 1.33, 1.42) and NCAA-ISP (51.3% vs. 37.0%; IPR = 1.39; 95% CI: 1.31, 1.46). In contrast, fractures comprised a smaller proportion of injuries in HS RIO than in NEISS (7.5% vs. 18.6%; IPR = 0.43; 95% CI: 0.39, 0.47) and NCAA-ISP (2.8% vs. 15.7%; IPR = 0.18; 95% CI: 0.14, 0.22). Conclusions: ATs more commonly reported injuries that are easily diagnosed and treated (e.g., sprains/strains); EDs more commonly reported injuries with longer recovery times and rehabilitation (e.g., fractures). Although ED surveillance data can identify the most severe sports-related injuries, high school and college sports surveillance may better describe the breadth of sports-related injuries. Our findings may provide further support for school-based sports medicine professionals, but further research is needed to comprehensively examine the potential economic and health-related benefits. Keywords: Injury surveillance, Soccer, Epidemiology, Athletic training * Correspondence: 1 Department of Exercise and Sport Science, University of North Carolina, 313 Woollen Gym CB#8700, Chapel Hill, NC 27599-8700, USA Full list of author information is available at the end of the article © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Kerr et al. Injury Epidemiology (2017) 4:19 Background Soccer is one of the most popular sports worldwide, with an estimated 265 million participants in 2006. Although the popularity of soccer is perceived to be larger outside of the United States (US), estimates of participation in the US are high, ranging from 17.6 to 24.5 million (Kunz 2007; Sports and Fitness Industry Association 2013). Soccer is a popular high school and collegiate sport in the US. During the 2013/14 academic year, the National Federation of State High School Associations (NFHS) reported 417,419 boys and 374,564 girls played high school soccer and the National Collegiate Athletic Association (NCAA) reported 23,602 males and 26,358 females played collegiate soccer (National Federation of High Schools 2013; National Collegiate Athletic Association 1981). Like all sports and recreational activities, although playing soccer provides several positive health benefits, it also poses a risk of injury. With such large numbers of participants, the injury risk associated with playing soccer poses a public health concern. Previously published works by US researchers evaluating population-based data on soccer-related injuries have been mostly limited to youth populations or are over a decade old (Adams & Schiff 2006; Leininger et al. 2007; Finch et al. 1998; Kelly et al. 2001; Walters et al. 2014; Smith et al. 2016). An examination of the epidemiology of soccer injuries across the lifespan using more recent data from varied clinical settings should help drive the development of age-appropriate interventions to reduce the incidence and severity of injury. One intervention that may assist in mitigating the severity of injury is presence of a sports medicine clinician such as a physician or athletic trainer (AT). Although the presence of an onsite sports medicine professional has long been advocated, coverage at soccer activities varies by level of play (American Medical Association 1998; Fletcher et al. 2014; Kerr et al. 2014a). The NCAA Sports Medicine Handbook advocates for all member institutions to provide appropriate AT coverage across all sports and divisions (National Collegiate Athletic Association 2014). ATs are not required at the high school level and data suggest that even though 70% of high schools have access to some form of AT coverage, only 55% of student-athletes have access to a full-time AT (Pryor et al. 2015). Having ATs available onsite: allows participants to have injuries immediately diagnosed, treated, and managed; mitigates resulting injury severity; and reduces the need to present to emergency departments (EDs) or other healthcare facilities with higher associated costs (Wham et al. 2008; 2010). Thus, it should be expected that soccer injuries presenting for treatment to ATs in the collegiate or high school setting will differ from injuries presenting for treatment in the ED setting. Page 2 of 12 To our knowledge, to date there have been no examinations of soccer-related injuries presenting to different clinical settings across the high school and collegiate age span. One study compared the epidemiology of basketball-related injuries presenting to EDs to those reported by ATs in a high school setting (Fletcher et al. 2014), finding that EDs reported larger proportions of severe injuries such as f (...truncated)