A Systematic Review of Head, Neck and-Facial Injuries in Cricket.

This systematic review was conducted to identify the incidence, nature and mechanisms of head, neck and facial (HNF) injuries in cricket and the reported use of helmets. Five databases were searched up to 30th November 2020. From peer-reviewed cricket injury studies published in English, studies reporting on HNF cricket injuries as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were selected. Twenty-nine studies were included. HNF injuries had a cumulative total of 794/5,886 injuries equating to 13% of all injuries. Non- specified HNF injuries (n=210, 26%) were the most prevalent type of injury followed by non-specified head injuries (n=130, 16%), other non-specified fractures (n=119, 15%) and concussions (n=60, 8%).The impact of the ball was reported as the most common mechanism for sustaining HNF injuries in cricket. The use of helmet was reported in only three studies (10%). From studies reporting on HNF cricket injuries, facial fractures, and concussions were the most common specified-types of injury. There is little evidence on reporting of HNF cricket injuries as per the international cricket consensus injury definitions, as well as the use of helmets at the time of injury.

Evaluating mild traumatic brain injury management at a regional emergency department.

BACKGROUND: Emergency departments (EDs) are usually the first point of contact, and often the only medical service available, for patients with mild traumatic brain injury (mTBI) in rural and regional areas. Clinical practice guidelines (CPGs) have been created to ensure best practice management of mTBI in EDs. Adherence to mTBI CPGs has rarely been evaluated in rural and regional areas. AIM: The aim of this paper was to assess a regional health service's adherence to their mTBI CPG. METHODS: This was a 12-month retrospective audit of 1280 ED records of patients ≥16 years presenting with mTBI to a regional Australian ED. Case selection used the Victorian Admitted Episodes Dataset codes for suspected head injury: principal diagnosis codes (S00-T98), concussive injury recorded in diagnosis codes (S06.00-S06.05) and unintentional external cause code (V00-X59). The data were collected to determine 4-hour observation rates, CT scan rates, safe discharge and appropriate referral documentation. RESULTS: Fewer people received a CT scan than qualified (n=245, 65.3%), only 45% had 4-hour observations recorded, safe discharge was documented in 74.1% of cases and 33% received educational resources. DISCUSSION/CONCLUSION: Several key elements for the management of mTBI were under-recorded, particularly 4-hour observations, safe discharge and education. Acquired brain injury clinic referrals were received in overwhelmingly fewer cases than had a CT scan (n=19, 6.3%). Overall, this study suggests that the regional health service does not currently fully adhere to the CPG and that the referral services are potentially underutilised.

Preventing Australian football injuries with a targeted neuromuscular control exercise programme: comparative injury rates from a training intervention delivered in a clustered randomised controlled trial.

BACKGROUND: Exercise-based training programmes are commonly used to prevent sports injuries but programme effectiveness within community men's team sport is largely unknown. OBJECTIVE: To present the intention-to-treat analysis of injury outcomes from a clustered randomised controlled trial in community Australian football. METHODS: Players from 18 male, non-elite, community Australian football clubs across two states were randomly allocated to either a neuromuscular control (NMC) (intervention n=679 players) or standard-practice (control n=885 players) exercise training programme delivered as part of regular team training sessions (2× weekly for 8-week preseason and 18-week regular-season). All game-related injuries and hours of game participation were recorded. Generalised estimating equations, adjusted for clustering (club unit), were used to compute injury incidence rates (IIRs) for all injuries, lower limb injuries (LLIs) and knee injuries sustained during games. The IIRs were compared across groups with cluster-adjusted Injury Rate Ratios (IRRs). RESULTS: Overall, 773 game injuries were recorded. The lower limb was the most frequent body region injured, accounting for 50% of injuries overall, 96 (12%) of which were knee injuries. The NMC players had a reduced LLI rate compared with control players (IRR: 0.78 (95% CI 0.56 to 1.08), p=0.14.) The knee IIR was also reduced for NMC compared with control players (IRR: 0.50 (95% CI 0.24 to 1.05), p=0.07). CONCLUSIONS: These intention-to-treat results indicate that positive outcomes can be achieved from targeted training programmes for reducing knee and LLI injury rates in men's community sport. While not statistically significant, reducing the knee injury rate by 50% and the LLI rate by 22% is still a clinically important outcome. Further injury reductions could be achieved with improved training attendance and participation in the programme.

The reach and adoption of a coach-led exercise training programme in community football.

OBJECTIVE: To determine the reach and adoption of a coach-led exercise training programme for lower limb injury prevention. DESIGN: Secondary analysis of data from a group-clustered randomised controlled trial. SETTING: A periodised exercise training warm-up programme was delivered to players during training sessions over an 8-week preseason (weeks 1-8) and 18-week playing season. PARTICIPANTS: 1564 community Australian football players. MAIN OUTCOME MEASUREMENTS: Reach, measured weekly, was the number of players who attended training sessions. Adoption was the number of attending players who completed the programme in full, partially or not at all. Reasons for partial or non-participation were recorded. RESULTS: In week 1, 599 players entered the programme; 55% attended 1 training session and 45% attended > 1 session. By week 12, 1540 players were recruited but training attendance (reach) decreased to <50%. When players attended training, the majority adopted the full programme-ranging from 96% (week 1) to above 80% until week 20. The most common reasons for low adoption were players being injured, too sore, being late for training or choosing their own warm-up. CONCLUSIONS: The training programme's reach was highest preseason and halved at the playing season's end. However, when players attended training sessions, their adoption was high and remained close to 70% by season end. For sports injury prevention programmes to be fully effective across a season, attention also needs to be given to (1) encouraging players to attend formal training sessions and (2) considering the possibility of some form of programme delivery outside of formal training.

Coding OSICS sports injury diagnoses in epidemiological studies: does the background of the coder matter?

OBJECTIVE: To compare Orchard Sports Injury Classification System (OSICS-10) sports medicine diagnoses assigned by a clinical and non-clinical coder. DESIGN: Assessment of intercoder agreement. SETTING: Community Australian football. PARTICIPANTS: 1082 standardised injury surveillance records. MAIN OUTCOME MEASUREMENTS: Direct comparison of the four-character hierarchical OSICS-10 codes assigned by two independent coders (a sports physician and an epidemiologist). Adjudication by a third coder (biomechanist). RESULTS: The coders agreed on the first character 95% of the time and on the first two characters 86% of the time. They assigned the same four-digit OSICS-10 code for only 46% of the 1082 injuries. The majority of disagreements occurred for the third character; 85% were because one coder assigned a non-specific 'X' code. The sports physician code was deemed correct in 53% of cases and the epidemiologist in 44%. Reasons for disagreement included the physician not using all of the collected information and the epidemiologist lacking specific anatomical knowledge. CONCLUSIONS: Sports injury research requires accurate identification and classification of specific injuries and this study found an overall high level of agreement in coding according to OSICS-10. The fact that the majority of the disagreements occurred for the third OSICS character highlights the fact that increasing complexity and diagnostic specificity in injury coding can result in a loss of reliability and demands a high level of anatomical knowledge. Injury report form details need to reflect this level of complexity and data management teams need to include a broad range of expertise.

What do community football players think about different exercise-training programmes? Implications for the delivery of lower limb injury prevention programmes.

BACKGROUND: Players are the targeted end-users and beneficiaries of exercise-training programmes implemented during coach-led training sessions, and the success of programmes depends upon their active participation. Two variants of an exercise-training programme were incorporated into the regular training schedules of 40 community Australian Football teams, over two seasons. One variant replicated common training practices, while the second was an evidence-based programme to alter biomechanical and neuromuscular factors related to risk of knee injuries. This paper describes the structure of the implemented programmes and compares players' end-of-season views about the programme variants. METHODS: This study was nested within a larger group-clustered randomised controlled trial of the effectiveness of two exercise-training programmes (control and neuromuscular control (NMC)) for preventing knee injuries. A post-season self-report survey, derived from Health Belief Model constructs, included questions to obtain players' views about the benefits and physical challenges of the programme in which they participated. RESULTS: Compared with control players, those who participated in the NMC programme found it to be less physically challenging but more enjoyable and potentially of more benefit. Suggestions from players about potential improvements to the training programme and its future implementation included reducing duration, increasing range of drills/exercises and promoting its injury prevention and other benefits to players. CONCLUSIONS: Players provide valuable feedback about the content and focus of implemented exercise-training programmes, that will directly inform the delivery of similar, or more successful, programmes in the future.

Concussion assessment and management - What do community-level cricket participants know?

OBJECTIVES: To explore Australian cricket participants' knowledge of concussion assessment and management, and awareness of current concussion guidelines. DESIGN: Cross-sectional survey. METHODS: Novel and validated surveys were disseminated online, among over 16 year Australian cricket players and officials at the end of the 2018/19 cricket season. Data were collected on knowledge and awareness of concussion and analysed using descriptive statistics and crosstabulations. Further comparisons were made for the players between injured and non-injured, and helmet wearers and non-helmet wearers using Fisher's exact statistical test. RESULTS: Both players (n = 224, 93 %) and officials (n = 36, 100 %) demonstrated strong knowledge of the importance of immediately evaluating suspected concussions. In comparison with players without helmets (n = 11), those using helmets (n = 135) considered replacing their helmets after a concussion to be vital to concussion assessment (p = 0.02). Overall, 80-97 % of players and 81-97 % of officials understood the importance of many factors regarding concussion management. When concussion management knowledge was compared by injury status, injured players (n = 17, 94 %) believed someone with a concussion should be hospitalised immediately, in contrast to non-injured players (n = 154, 69 %) (p = 0.04). Players (63 %) were less aware of concussion guidelines than officials (81 %). CONCLUSIONS: Overall, the knowledge of concussion assessment and management was satisfactory. However, there were discrepancies among players on some aspects of awareness of concussion guidelines. Increasing players' familiarity and experience in using the concussion guidelines is warranted. Targeted campaigns are needed to further improve concussion recognition and treatment at community-level cricket, so all participants play a role in making cricket a safe sport.

Sport and leisure activities in the heat: What safety resources exist?

OBJECTIVES: To conduct a document analysis of sports and leisure activity heat-related injury prevention resources in Australia and develop an understanding of the content within those resources. DESIGN & METHODS: Heat resources were included if they dealt specifically with, or could be extrapolated to, prevention of heat-related injuries. Collating strategies for the catalogue included: (1) a detailed search of the organisation's website and (2) an online search for sport specific heat resources. A content analysis of each resource was first performed, and descriptive codes were assigned to the data using qualitative data analysis software. Every coded text was recorded as an individual data point (n). Common sub-categories were identified by thematic analysis and collated under three broader categories. RESULTS: A total of 468 data points were identified within the 64 heat resources found. Guidelines (n = 20) and policies (n = 18) were the most common type of resources followed by factsheets (n = 9), webpages (n = 8), laws and by-laws (n = 2). Three overarching categories emerged through the data analysis process: preventive strategies (n = 299, 63.9%), risk factors (n = 94, 20.1%), treatment (n = 75, 16.0%). Activity modification, which included information on rescheduling games and extra breaks, was the most common intervention. Cricket, soccer, swimming and triathlon had the most complete set of heat resources. CONCLUSIONS: The findings of this study provide an insight into the composition of heat-related sports injury prevention resources within Australia and identify areas for development. As the resources were incomplete for many sports, the development of more comprehensive heat safety resources is required to ensure the safety of participants.

A decade of head, neck and facial cricket injury hospitalisations in Victoria, Australia: From 2007/08 to 2016/17.

OBJECTIVES: To present an epidemiological profile of hospital-treated head, neck and facial cricket injuries from 2007/08 to 2016/17 in Victoria, Australia. DESIGN: Retrospective analysis of emergency department and hospital admission data. METHODS: An analysis of Victorian hospital-treated head, neck and facial cricket injuries of all cricket participants over 5 years old between July 2007 and June 2017. RESULTS: Over the decade, 3907 head, neck, facial (HNF) cricket injuries were treated in Victorian hospitals. The number of HNF cricket injuries substantially increased in the 2014/15 season from 367 to 435 injuries and remained over 400 in the subsequent years. More injuries were reported for male compared to female participants, 3583 compared to 324 injuries. When adjusted for participation in competitive cricket, the injury incidence rate was 1.3 per 1000 participants for males and 0.4 per 1000 participants for females. The 10-14year age group most frequently required hospital treatment. Open wounds were the most common type of injury (1166, 29.8%) and the main mechanism for HNF cricket injury for this decade was hit/struck/crush (3361, 86.0%). CONCLUSIONS: This study provides a novel and current insight of the incidence and details of HNF injuries among cricket participants in Victoria over a decade. It is evident that males and younger participants, regardless of gender, have a higher risk of sustaining a HNF injury. This study provides a solid evidence base for stakeholders in developing strategies to minimise head, neck and facial injuries to make cricket a safe sport for all.

Abrasion injuries on artificial turf: A systematic review.

OBJECTIVES: To review the incidence of abrasion injuries sustained on artificial turf playing fields and the level of evidence existing on player perceptions of abrasion injuries on these surfaces. DESIGN: Systematic review. METHOD: A systematic search was performed using SPORTDiscus, Medline, Web of Science, Scopus and Science Direct databases. Inclusion criteria included: abrasion type injuries measured; conducted on artificial/synthetic turf; type of sport reported; peer-reviewed original research; English language search terms, but no language restrictions. A quality assessment was conducted using the Newcastle-Ottawa quality scale. RESULTS: The search yielded 76 potential articles, with 25 meeting all inclusion criteria. Twenty articles were injury-based and five were perception-based. The differences in injury definition and the lack of details of the playing surfaces produced varying results on the rate of injuries on artificial turf. Regardless of the condition of the surface, the level of play, or the sport, players perceived the fear of abrasion injuries as a major disadvantage of artificial turf surfaces. CONCLUSIONS: The review highlighted the current disparity that exists between players' perceptions of abrasion injuries and the level of evidence of abrasion injury risk on artificial turf playing surfaces. There is a need for the inclusion of greater detail of playing surfaces' specifications and condition, and an injury definition sufficiently sensitive to better measure abrasion injury incidence and severity. Without this more detailed information, it is likely that the strongly perceived risk of abrasion injuries will continue as a barrier to the adoption of artificial playing surfaces.

Concussion in community Australian football - epidemiological monitoring of the causes and immediate impact on play.

BACKGROUND: Head injuries, particularly concussion, are a major cause of concern in many sports, particularly the football codes, driving a need to better understand injury mechanisms and potential methods of prevention. The aim of this study was to describe the mechanisms and follow up care of concussion injuries sustained in adult male community Australian football to identify target areas for prevention and management. METHODS: Secondary analysis of injury data collected in a cluster randomised controlled trial in community Australian football across two states of Australia in 2007 and 2008. There were 1564 players from 18 clubs. The main outcome measures were the number and rate of head/neck/face (HNF) injuries and concussion sustained in games. A specific description of the mechanisms of the concussion injuries is presented along with the immediate return-to-play status of concussion cases. RESULTS: 143 HNF injuries were sustained by 132 players. The game HNF injury incidence was 4.9 per 1000 game hours (n = 138; 95 % confidence interval 4.1; 5.7). Just under a quarter (n = 34) of all HNF injuries were recorded as concussion. All concussions occurred during games (none in training), with all but one related to body contact with other players. Overall, 68 % of the concussions were considered within game rules, while 32 % were either outside of the rules or unclear. Most (88 %) players left the field immediately following concussion but 47 % later returned to play in the same game. CONCLUSIONS: Prevention strategies for concussion need to be based on knowledge of the mechanisms of injury. Most concussions in community Australian football occurred through body contact with other players or during tackling. Management of players post-concussion was generally poor with over half of the cases continuing to play in the same game. Therefore, new primary prevention strategies that target body-contact/tackling skills and improved secondary prevention measures relating to compliance with return-to-play protocols would be valuable.

Ground condition as a risk factor in sports injury aetiology studies: the level of concordance between objective and subjective measures.

BACKGROUND: It is well known that the condition and type of sporting ground influences the risk of sports injury. However, the lack of evidence on the relationship between subjective and objective sporting ground condition assessments in sports injury aetiology studies has implications for the development of effective injury prevention strategies. This paper aims to examine concordance between subjectively rated and objective ground hardness and moisture measurements to inform data collection methods for future sports injury aetiology studies. METHODS: Subjective, observational assessments of ground hardness and soil moisture were recorded on 36 occasions during an Australian football season using two four-point scales of 'very soft' to 'very hard' and 'very wet' to 'very dry', respectively. Independent, objectively measured hardness and soil moisture were also undertaken at nine locations on the same grounds. The maximum and minimum ground values and the computed average of ground hardness and soil moisture were analysed. Somer's d statistic was calculated to measure the level of concordance between the subjective and objective measures. RESULTS: A significant, moderate to substantial level of agreement was found between the subjective ratings and the average objective hardness values (d = 0.467, p <0.001), but there was perfect agreement on just less than half of the occasions. The level of concordance between the subjective and objective moisture ratings was low to moderate or trivial for all moisture measures (0.002 < d <0.264, p >0.05). CONCLUSIONS: Compared to objective measures, the subjective assessments were more accurate for ground hardness than for soil moisture levels and raters were just as likely to underestimate or overestimate the condition under review. This has implications for future sports injury aetiology studies that include ground condition assessments and particularly the use of subjective measures to underpin the development of future injury prevention strategies.

The relationship between ground conditions and injury: what level of evidence do we have?

OBJECTIVES: To identify studies which address the relationship between ground conditions and injury, in a sporting context and to evaluate current practice and provide recommendations for future studies that measure ground conditions and injury risk. DESIGN: Systematic review. METHODS: A comprehensive search of electronic databases from the earliest records available until the end of 2011, and supplemental hand searching was conducted to identify relevant studies. A classification scale was used to rate the methodological quality of studies. RESULTS: 79 potentially relevant articles were identified, and 27 met all inclusion criteria. They varied in methodological quality, with analytical observational studies the most common design, although four descriptive observational studies, considered to be of lower quality were also identified. Only five studies objectively measured ground conditions, and of studies that used subjective assessment, only one provided descriptors to explain their classifications. It appears that harder/drier grounds are associated with an increased injury risk but the presence of major limitations necessitates cautious interpretation of many key findings. CONCLUSIONS: There is limited high quality evidence of the relationship between injury risk and ground conditions. Further research with high quality designs, and measurement of ground conditions are required to draw more definitive conclusions regarding this relationship.

Injury risk associated with ground hardness in junior cricket.

OBJECTIVES: To establish if there is an association between ground hardness and injury risk in junior cricket. DESIGN: Nested case-series of players who played matches on specific grounds with objective ground hardness measures, within a prospective cohort study of junior community club cricket players. METHODS: Monitoring of injuries and playing exposure occurred during 434 matches over the 2007/2008 playing season. Objective assessment of the hardness of 38 grounds was undertaken using a Clegg hammer at 13 sites on 19 different junior cricket grounds on the match eve across the season. Hardness readings were classified from unacceptably low (<30 g) to unacceptably high (>120 g) and two independent raters assessed the likelihood of each injury being related to ground hardness. Injuries sustained on tested grounds were related to the ground hardness measures. RESULTS: Overall, 31 match injuries were reported; 6.5% were rated as likely to be related to ground hardness, 16.1% as possibly related and 74.2% as unlikely to be related and 3.2% unknown. The two injuries likely to be related to ground hardness were sustained whilst diving to catch a ball resulting, in a graze/laceration from contact with hard ground. Overall, 31/38 (82%) ground assessments were rated as having 'unacceptably high' hardness and all others as 'high/normal' hardness. Only one injury occurred on an objectively tested ground. CONCLUSIONS: It remains unclear if ground hardness is a contributing factor to the most common injury mechanism of being struck by the ball, and needs to be confirmed in future larger-scale studies.

Ground hardness and injury in community level Australian football.

OBJECTIVES: To describe the risk and details of injuries associated with ground hardness in community level Australian football (AF). DESIGN: Prospective injury surveillance with periodic objective ground hardness measurement. METHODS: 112 ground hardness assessments were undertaken using a Clegg hammer at nine locations across 20 grounds, over the 2007 and 2008 AF seasons. Details of 352 injuries sustained by community level players on those grounds were prospectively collected as part of a large randomised controlled trial. The ground location of the injury was matched to the nearest corresponding ground hardness Clegg hammer readings, in gravities (g), which were classified from unacceptably low (<30 g) to unacceptably high hardness (>120 g). RESULTS: Clegg hammer readings ranged from 25 to 301 g. Clegg hammer hardness categories from low/normal to high/normal were associated with the majority of injuries, with only 3.7% (13 injuries) on unacceptably high hardness and 0.3% (1 injury) on the unacceptably low hardness locations. Relative to the preferred range of hardness, the risk of sustaining an injury on low/normal hardness locations was 1.31 (95%CI: 1.06-1.62) times higher and 1.82 (95%CI: 1.17-2.85) times higher on locations with unacceptably high hardness. The more severe injuries occurred with low/normal ground hardness. CONCLUSIONS: Despite the low number of injuries, the risk of sustaining an injury on low/normal and unacceptably hard grounds was significantly greater than on the preferred range of hardness. Notably, the severity of the injuries sustained on unacceptably hard grounds was lower than for other categories of hardness.

Level of agreement between field-based data collectors in a large scale injury prevention randomised controlled trial.

In sports injury prevention field trials, data collectors are often club volunteers with considerable knowledge of the game but with limited detailed medical backgrounds or knowledge of formal scientific processes. The aim of this paper is to determine the agreement among trained primary data collectors (PDCs) with a sport science background and no prior involvement in data collection in a large randomised controlled trial. During the 'Preventing Australian Football Injury through eXercise' (PAFIX) project, player participation and injury data were collected by trained PDCs at training and games over the 2007 and 2008 playing seasons in 40 community level Australian football teams. PDC-collected data relating to player exposure and whether or not a player sustained an injury and subsequently left the field of play was compared to the same information from independent observers (IOs) who attended one randomly selected game for each of the 40 teams. There was 98% agreement between the PDC and the IO on game details (i.e., date, time, grade and score), 79% (ICC 0.9, 95% CI 0.85-0.95) agreement on the number of players per game and 76% (ICC 0.8, 95% CI 0.69-0.91) agreement on the number of injuries sustained in the games. There was 100% agreement on whether the player left the field for all injuries. This study found that exercise and sport science students are reliable data collectors in sports injury fieldwork studies.