NFHS Injury Surveillance System The National High School Sports Related Injury Surveillance Study: High School RIO TM R. Dawn Comstock, PhD Center for Injury Research and Policy, Nationwide Children s Hospital The Ohio State University, College of Medicine, Department of Pediatrics and College of Public Health, Division of Epidemiology
High School Sports Participation
Background Injury Surveillance Systems Collect data to monitor trends/patterns of injury over time Recognize common injuries in different subgroups Anticipate high risk populations/environments Inform data based decision-making to drive prevention/care Changes in rules/enforcement of rules Improved protective equipment/training regimens Coaching techniques/coach education Medical care policy Enable estimation of resource needs Evaluate effect of change 3
Description of HS RIO 4
HS RIO Methodology: Original Study Prospective injury surveillance study (2005/06-present) Internet-based data collection tool ATCs = medically trained data reporters Weekly data capture during academic year Injury incidence Denominator data (athlete exposures) Detailed injury reports (athlete, injury, injury event) Representative sample of 100 US high schools Geography (4 US census regions) Size ( 1,000 vs >1,000 students) 9 sports Boys football, soccer, basketball, wrestling, and baseball Girls volleyball, soccer, basketball, and softball 5
HS RIO Methodology: Expanded Study 2008/09 expansion included an additional 9 sports Boys lacrosse, ice hockey, swimming & diving, and track & field Girls lacrosse, field hockey, gymnastics, swimming & diving, and track & field 2009/10 expansion included an additional 2 sports Boys volleyball and Cheerleading Same reporting methodology as HS RIO Original Study Different sampling methodology for US high schools Convenience sample Attempt to enroll 100 schools reporting for each sport 6
HS RIO: Study Definitions Injury = an injury that occurred as a result of an organized high school athletic practice or competition, required medical attention, and resulted in restriction of the athlete s participation for 1 days beyond the day of injury definition expanded slightly in 2007/08 to include all concussions, fractures, and dental injuries Athletic exposure (AE) = 1 athlete participating in 1 school sanctioned practice or competition 7
HS RIO Summary Data 8
HS RIO Summary Injury Data Original 9 Sport Study 05/06-08/09 Captured 18,165 injuries (4 year total) 9,427 competition 8,738 practice 7,740,400 athlete-exposures (4 year total) 2,104,008 athlete-competitions 5,636,392 athlete practices Overall 2.35 injuries per 1,000 athlete exposures 4.48 injuries per 1,000 athlete competitions 1.55 injuries per 1,000 athlete practices Injury rate significantly higher in competition IRR=2.89, 95% CI 2.81-2.98 Estimated 5,595,971 injuries nationally (4 year total) 9
HS RIO Summary Injury Data, Expanded 9 Sport Sample 08/09 Captured 1,334 injuries (1 year) 583 competition 751 practice 1,141,597 athlete-exposures (1 year) 254,966 athlete-competitions 886,631 athlete practices Overall 1.17 injuries per 1,000 athlete exposures 2.29 injuries per 1,000 athlete competitions 0.85 injuries per 1,000 athlete practices Injury rate significantly higher in competition IRR=2.70, 95% CI 2.42-3.01 No national estimates calculated 10
HS RIO Injury Rates, Original 9 Sports 05/06-08/09 Injury Rates per 1,000 Athletic Exposures Sport Competition Practice Overall Football 12.4 2.4 4.1 B Soccer 3.9 1.2 2.0 G Soccer 5.1 1.1 2.3 G Volleyball 1.4 1.2 1.2 B Basketball 2.6 1.2 1.6 G Basketball 3.4 1.2 1.8 Wrestling 3.7 1.9 2.4 Baseball 1.6 0.7 1.0 Softball 1.8 0.8 1.2 11
HS RIO Injury Rates, Expanded 9 Sports 08/09 Injury Rates per 1,000 Athletic Exposures Sport Competition Practice Overall G Field Hockey 2.8 1.4 1.8 G Gymnastics 3.5 1.8 2.2 B Ice Hockey 6.1 0.5 2.2 B Lacrosse 4.3 1.3 2.2 G Lacrosse 2.7 1.3 1.7 B Swim/Dive 0.1 0.2 0.2 G Swim/Dive 0.3 0.3 0.3 B Track/Field 1.5 0.8 0.9 G Track/Field 1.3 1.0 1.1 12
Overall Injury Rates by Year, Original 9 Sport Sample Injury Rates per 1,000 Athletic Exposures Sport 2005-06 2006-07 2007-08 2008-09 Football 4.36 4.45 4.18 3.50 B Soccer 2.43 2.27 1.75 1.62 G Soccer 2.36 2.51 2.35 2.07 G Volleyball 1.64 1.37 1.22 0.89 B Basketball 1.89 1.75 1.39 1.35 G Basketball 2.01 2.09 1.61 1.54 Wrestling 2.50 2.51 2.27 2.17 Baseball 1.19 1.25 0.93 0.78 Softball 1.13 1.11 1.29 1.04 13
Body Sites Injured, Original 9 Sport Sample 2005-09 Sport Most Frequently Injured Body Sites (% of all injuries) Football Knee (15) Ankle (14) Shoulder (12) Head/face (12) B Soccer Ankle (21) Knee (14) Upper leg (13) Head/face (13) G Soccer Ankle (23) Knee (20) Head/face (15) Upper leg (12) G Volleyball Ankle (41) Knee (11) Hand/wrist (11) Shoulder (8) B Basketball Ankle (35) Knee (12) Head/face (12) Hand/wrist (10) G Basketball Ankle (32) Knee (18) Head/face (14) Hand/wrist (9) Wrestling Shoulder (18) Knee (15) Head/face (13) Arm/elbow (11) Baseball Shoulder (17) Hand/wrist (14) Head/face (13) Ankle (12) Softball Head/face (17) Ankle (16) Hand/wrist (16) Knee (12) 14
Body Sites Injured, Expanded 9 Sport Sample 2008-09 Sport Most Frequently Injured Body Sites (% of all injuries) G Field Hockey Head/face (25) Upper leg (16) Ankle (14) Knee (9) G Gymnastics Ankle (23) Knee (21) Arm/elbow (14) Hand/wrist (9) B Ice Hockey Head/face (29) Hand/wrist (12) Shoulder (11) Knee (10) B Lacrosse Head/face (19) Trunk (14) Ankle (12) Knee (11) G Lacrosse Head/face (26) Ankle (18) Upper leg (15) Knee (13) B Swim/Diving Shoulder (39) Trunk (17) Knee (13) Head/face (13) G Swim/Diving Shoulder (55) Head/face (9) Trunk (9) Upper leg (7) B Track/Field Upper leg (49) Lower leg (13) Knee (13) Ankle (8) G Track/Field Upper leg (35) Lower leg (22) Knee (13) Ankle (9) 15
NCAA ISS and HS RIO Data Comparisons 16
Soccer Injury Rate Comparison Injury Rates per 1,000 Athlete Exposures HS (05/06-08/09) NCAA (04/05-08/09) RR 95% CI Practice 1.2 7.4 6.5 6.0-7.1 Competition 5.1 21.7 4.3 4.0-4.6 Total 2.3 10.9 4.4 4.2-4.7 RRs compare NCAA injury rate to HS injury rate 17
Soccer Competition Injury Diagnoses 12% 26% 17% Sprain/Strain Contusion 38% 48% Fracture Concussion 10% 8% Other 4% 22% 15% HS (05/06-08/09) NCAA (04/05-08/09) 18
Soccer Competition Injury Mechanism Contact with Another Player Contact with Equipment/Apparatus Contact with Playing Surface Acute non Contact Other 60 50 % of All Injuries 40 30 20 10 0 HS (05/06 08/09) NCAA (04/05 08/09) 19
Soccer Competition Injury Activity General Play Defending Ball Handling/Dribbling Heading Loose Ball Goaltending Other 35 30 % of All Injuries 25 20 15 10 5 0 HS (05/06 08/09) NCAA (04/05 08/09) 20
Field Hockey Injury Rate Comparison Injury Rates per 1,000 Athlete Exposures HS Rate (08/09) NCAA Rate (04/05-08/09) RR 95% CI Practice 1.4 7.5 5.4 4.4-6.6 Competition 2.8 14.8 5.3 4.3-6.5 Total 1.8 9.2 5.1 4.4-5.9 RRs compare NCAA injury rate to HS injury rate 21
Field Hockey Competition Injury Diagnoses 25% 22% 9% 11% 33% HS (08/09) NCAA (04/05-08/09) 22
Field Hockey Competition Injury Mechanism Contact with Another Player Contact with Equipment/Apparatus Contact with Playing Surface Acute non Contact Other 80 70 60 % of All Injuries 50 40 30 20 10 0 HS (08/09) NCAA (04/05 08/09) 23
Field Hockey Competition Injury Activity 50 General Play Defending Ball Handling/Dribbling Blocking Shot Goaltending Loose Ball Other 45 40 35 % of All Injuries 30 25 20 15 10 5 0 HS (08/09) NCAA (04/05 08/09) 24
Topics of Concern: Concussions 25
Concussion Rates, 2005-09 Rates per 1,000 Athletic Exposures Sport # of Concussions National Estimates Practice Competition Overall Football 1,050 256,186 0.23 1.83 0.50 B Soccer 145 68,990 0.05 0.53 0.19 G Soccer 199 106,108 0.06 0.87 0.30 G Volleyball 40 11,698 0.04 0.12 0.06 B Basketball 71 16,391 0.04 0.18 0.08 G Basketball 150 36,777 0.07 0.52 0.20 Wrestling 118 26,629 0.10 0.38 0.17 Baseball 26 6,579 0.02 0.07 0.04 Softball 49 16,412 0.08 0.11 0.09 26
Burden of Concussion by Sport, 2008-09 27
Mechanism of Concussion, 2008-09 28
Type of Player-Player Contact, 2009-10* Sport Head/Head Head/Other Body Part Head/Playing Surface Other Football 62.4% 23.9% 5.1% 8.7% B Soccer 41.0% 48.7% 0% 10.3% G Soccer 31.3% 45.8% 16.7% 6.3% B Basketball 13.0% 73.9% 4.3% 8.7% G Basketball 16.1% 61.3% 22.6% 0% Wrestling 20.0% 64.0% 12.0% 4.0% Field Hockey 25.0% 25.0% 25.0% 25.0% Ice Hockey 0% 41.2% 58.8% 0% B Lacrosse 22.6% 58.1% 12.9% 6.5% G Lacrosse 11.1% 88.9% 0% 0% 29
Head Position During Contact, 2009-10* Sport Up Down No Flexion Other Football 28.9% 22.5% 8.0% 40.7% B Soccer 41.0% 23.1% 12.8% 23.1% G Soccer 33.3% 20.8% 12.5% 33.4% B Basketball 39.1% 21.7% 4.3% 34.7% G Basketball 54.8% 12.9% 6.5% 25.8% Wrestling 28.0% 20.0% 0% 52.0% Field Hockey 50.0% 12.5% 0% 37.5% Ice Hockey 52.9% 23.5% 0% 23.5% B Lacrosse 25.8% 32.3% 16.1% 25.8% G Lacrosse 22.2% 33.3% 22.2% 22.2% 30
Location of Impact, 2009-10* Sport Front Back Side Top Other Football 41.0% 5.9% 19.1% 5.9% 28.0% B Soccer 25.6% 2.6% 48.7% 2.6% 20.5% G Soccer 31.3% 10.4% 45.8% 4.2% 8.3% B Basketball 39.1% 8.7% 26.1% 0% 26.0% G Basketball 48.4% 22.6% 29.0% 0% 0% Wrestling 36.0% 8.0% 8.0% 12.0% 36.0% Field Hockey 25.0% 25.0% 25.0% 0% 25.0% Ice Hockey 23.5% 23.5% 35.3% 5.9% 11.8% B Lacrosse 19.4% 9.7% 51.6% 3.2% 16.1% G Lacrosse 22.2% 0% 44.4% 0% 33.3% 31
Football Helmets Worn by Concussed Athletes, 2009-10* Helmet manufacturers: Helmet models: 17.9% were new this season of the used 46.6% were reconditioned Helmet fit: coach (57.9%), ATC (11.8%), company rep (7.5%), other adult (1.4%), athlete (1.5%), unknown (19.9%) 1.9% had after market modifications 2.6% of helmets did not fit correctly at the time of injury <1% of helmets were damaged 32
Potential Protective Equipment Issues 33
Knee Injuries, 2008-09 Specific structure 31.5% medial collateral ligament 24.6% patella/patellar tendon 19.8% cartilage/meniscus 19.2% anterior cruciate ligament 6.9% lateral collateral ligament 1.4% posterior cruciate ligament Bracing = 7.0% 42.7% rigid frame, 33.3% neoprene/sleeve Tape = 0.8% 34
Ankle Injuries, 2008-09 Specific structure 79.6% anterior talofibular ligament 36.7% calcaneofibular ligament 25.7% anterior tibiofibular ligament 12.1% posterior talofibular ligament Bracing = 12.7% 9.1% lace up, 2.2% rigid frame, 0.8% neoprene/sleeve Tape = 7.5% 35
Eye Injuries, 2008-09 Specific injury 40.6% contusion 21.9% abrasion 12.5% laceration Eye protection = 6.5% 100% off the shelf 36
Dental/Mouth Injuries, 2008-09 Specific injury 28.7% laceration 18.4% fracture 12.6% dislocation 4.6% avulsion Required surgery = 33.2% Mouthguard = 19.6% 87.8% off the shelf 12.2% professionally fitted 37
Wrap Up 38
Ultimate Uses for Surveillance Data Improved injury prevention efforts Identify/confirm risk factors Drive informed discussion Drive development of new/improvement of protective equipment Drive development and evaluation of injury prevention projects Improved injury care Monitor trends over time to better allocate resources Monitor treatment protocols and outcomes Improved communication Facts motivate policy makers Facts drive action Facts are the best education tool Facts drive research and development efforts 39
Conclusions Surveillance data can be a useful tool Injuries can t be eliminated Lower injury rate when possible Decrease severity of injuries that can t be prevented Injury rates and severity can be reduced Protective equipment Diagnosis, rehabilitation, return to play Fitness, skills, athletic equipment, coach education Integrity of the game, officials, sportsmanship 40
Contact Information comstocd@pediatrics.ohio-state.edu (614) 722-2400 Thanks to: NFHS Collaborative and Financial Support NOCSAE Research Grant CDC NCIPC New Investigator Grant NATA Research Foundation Grant CDC NCIPC ICRC Grant Christy Collins, MA, Research Associate Natalie McIlvain, BS, Research Assistant 41