Injuries in girls’ soccer and basketball: a comparison of high schools with and without athletic trainers

Pierpoint et al. Injury Epidemiology (2018) 5:29 https://doi.org/10.1186/s40621-018-0159-6 ORIGINAL CONTRIBUTION Open Access Injuries in girls’ soccer and basketball: a comparison of high schools with and without athletic trainers Lauren A. Pierpoint1*, Cynthia R. LaBella2, Christy L. Collins3, Sarah K. Fields4 and R. Dawn Comstock1,5 Abstract Background: Sports injuries impose physical and economic burdens on high school athletes, yet only 37% of high schools have access to a fulltime certified athletic trainer (AT). Although intuitively there are multiple benefits of AT coverage, research demonstrating the measurable effect of AT coverage on rates and patterns of injury is limited. Our objective was to investigate the epidemiology of girls’ basketball and soccer injuries in high schools with and without an AT. Methods: We compared data captured by two similar sports injury surveillance systems during the 2006/07–2008/ 09 academic years. High School Reporting Information Online (RIO) included a national sample of schools with ATs, and the Sports Injury Surveillance System (SISS) included a sample of Chicago public high schools without ATs. Results: Overall injury rates were higher in schools without ATs than schools with ATs in girls’ soccer (RR: 1.73, 95% CI: 1.51–2.00) and basketball (RR: 1.22, 95% CI: 1.03–1.45). Recurrent injury rates were even higher in schools without ATs compared to schools with ATs in soccer (RR: 6.00 95% CI: 4.54-7.91) and basketball (RR: 2.99, 95% CI: 2.12–4.14). Conversely, concussion rates were higher in schools with ATs than schools without ATs in soccer (RR: 8.05, 95% CI: 2. 00–32.51) and basketball (RR: 4.50, 95% CI: 1.43–14.16). Other injury patterns were similar between the two samples. Conclusions: This study demonstrated the effectiveness of AT coverage of high school girls’ soccer and basketball, both in reducing overall and recurrent injury rates and in identifying athletes with concussions. Future studies should evaluate the effect of ATs on other high school sports and on youth sports to determine if these findings are generalizable across sports and age groups. Background Sports participation provides numerous benefits for young people, including improved cardiovascular fitness, lower obesity rates, better academic performance, and lower rates of depression (Miller et al. 1999; US Department of Health and Human Services 1996). However, sports participation will always include some inherent risk of injury. In the 2008/09 academic year, an estimated 7.5 million United States (US) high school students participated in sports (National Federation of State High School Associations 2014), with participants in just 9 of the most popular sports incurring an estimated 1.2 million injuries (Comstock et al. 2009). Sports injuries * Correspondence: 1 Department of Epidemiology, Program for Injury Prevention, Education and Research, University of Colorado Anschutz, Aurora, CO, USA Full list of author information is available at the end of the article impose physical, emotional and economic burdens on high school athletes and their families, and are one of the leading reasons why young people stop participating in sports and physical activity (Centers for Disease Control and Prevention 2018). The public health challenge facing policy makers, clinicians, coaches, parents and athletes is how to mitigate the injury burden associated with sports to the lowest possible level so that young people may stay involved as a way of incorporating physical activity as part of a healthy lifestyle. Having certified athletic trainer (ATs) services available to athletes in the high school setting has the potential to reduce the number and severity of sports injuries. The National Athletic Trainer’s Association and the American Medical Association endorse the presence of ATs in secondary schools (National Athletic Trainer’s Association 2018; American Medical Association 2018). ATs © The Author(s). 2018 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. Pierpoint et al. Injury Epidemiology (2018) 5:29 are licensed health care professionals who collaborate with physicians on injury prevention, clinical evaluation and diagnosis, immediate and emergency care, treatment and rehabilitation, and professional health and well-being. Examples of ATs’ skills applied at the high school level include but are not limited to (1) developing and implementing emergency action plans and pre-season conditioning programs, (2) advising on safety of equipment, weather, and field conditions, (3) providing first response to and triage of acute injuries, (4) implementing treatment and rehabilitation for injured athletes, and (5) determining readiness for return-to-play after injury (National Athletic Trainer’s Association 2018; Almquist et al. 2004). While application of these skills is intended to reduce injury incidence and severity, the effect of the presence of ATs on sports injury rates and patterns in the high school setting has not previously been directly measured. The objective of our study was to investigate the epidemiology of girls’ basketball and soccer injuries in high schools with and without an AT over the 2006/07–2008/ 09 academic years using data from two injury surveillance systems that collected injury information on both sports during the same period of time. To our knowledge, no prior studies have been able to compare injury rates and patterns in schools that have an AT with schools that do not. The specific aims were to 1) calculate injury rates in both samples; 2) describe patterns of injury including injury type, body site injured, mechanism of injury, whether the injury was new or recurrent, and timing of injury during the season in both samples; and 3) compare injury rates and patterns across samples. Methods High School RIO™ Data from the National High School Sports-Related Injury Surveillance Study, which gathers data via the internet-based surveillance system Reporting Information Online (RIO), were used. During the 2006/07– 2008/09 academic years, schools with a National Athletic Trainers’ Association (NATA) affiliated AT with a valid email address were invited to participate. Willing participants were assigned to one of 8 sampling strata based on school size (< 1000 and ≥ 1000) and geographical region (South, Midwest, West, Northeast) (US Census Bureau 2014) with 100 schools randomly selected (12 or 13 from each strata) to obtain a nationally representative sample. If a school withdrew from the study, a replacement school was chosen from the same strata. Previous studies have described the meth (...truncated)