Access to Athletic Trainers and Emergency Medical Services Activations for Sport-Related Injuries.

CONTEXT: Having athletic trainers (ATs) employed at secondary schools is associated with improved preparedness for sport-related emergencies. The use of emergency medical services (EMS) in settings with different access to athletic training services remains unknown. OBJECTIVE: To compare the incidence of EMS activations for patients with sport-related injuries among zip codes with various levels of access to athletic training services. DESIGN: Descriptive epidemiology study. SETTING: Data were obtained from the National EMS Information System and the Athletic Training Location and Services Project. PATIENTS OR OTHER PARTICIPANTS: Zip codes where 911 EMS activations for sport-related injuries among individuals 13 to 18 years old occurred. MAIN OUTCOME MEASURE(S): Incidence of EMS activations, athletic training service level (no ATs employed [NONE], less than full-time employment [PARTIAL], all ATs employed full time [FULL]), and athletic training employment model (independent contractor [IC], medical or university facility [MUF], school district [SD], mixed employment models [MIX]) for each zip code. RESULTS: The EMS activations were 2.8 ± 3.6 per zip code (range = 1-81, N = 4923). Among zip codes in which at least 1 AT was employed (n = 2228), 3.73% (n = 83) were IC, 38.20% (n = 851) were MUF, 27.24% (n = 607) were SD, and 30.83% (n = 687) were MIX. Compared with SD, MUF had a 10.8% lower incidence of EMS activations (incidence rate ratio [IRR] = 0.892; 95% CI = 0.817, 0.974; P = .010). The IC (IRR = 0.920; 95% CI = 0.758, 1.118; P = .403) and MIX (IRR = 0.996; 95% CI = 0.909, 1.091; P = .932) employment models were not different from the SD model. Service level was calculated for 3834 zip codes, with 19.5% (n = 746) NONE, 46.2% (n = 1771) PARTIAL, and 34.4% (n = 1317) FULL. Compared with NONE, FULL (IRR = 1.416; 95% CI = 1.308, 1.532; P < .001) and PARTIAL (IRR = 1.368; 95% CI = 1.268, 1.476; P < .001) had higher incidences of EMS activations. CONCLUSIONS: Local access to athletic training services was associated with an increased use of EMS for sport-related injuries among secondary school-aged individuals, possibly indicating improved identification and triage of sport-related emergencies in the area. The difference in EMS use among employment models may reflect different policies and procedures for sport-related emergencies.

Injuries and Referral Patterns During Basic Combat Training: An Examination of Data From the Certified Athletic Trainer-Forward Program.

INTRODUCTION: Injuries sustained during basic combat training (BCT) result in large economic costs to the U.S. Army. The inclusion of athletic trainers (ATs) in other military branches has reduced Troop Medical Clinic (TMC) referrals. However, the inclusion of ATs during BCT has yet to be studied. The purpose of this study was to describe the frequency and nature of sick call visits during BCT and determine how the presence of an AT affects referrals to the TMC. MATERIALS AND METHODS: A prospective cohort study was conducted at the Fort Jackson Army Training Center for one calendar year. Soldiers in BCT, aged 18-42, who reported to sick call were included. Independent variables collected included: Soldier demographics (sex and age), visit reason, and provider impression. Training battalions were placed in three conditions: control (CON), full-time medic (FTM), and part-time athletic trainer (PAT). The dependent variable was disposition (referred or returned to duty [RTD]). Frequencies and proportions were calculated. Logistic regression compared conditions while considering the other independent variables. Return on investment was calculated. RESULTS: Fourteen thousand three hundred and four visits were documented. Most soldiers were female (n = 7,650; 53.5%) and under 20 years old (n = 5,328; 37.2%). Visits were most commonly due to physical injury (n = 7,926; 55.4%), injuries affecting the knee (n = 2,264; 15.8%) and chronic/overuse conditions (n = 2,031; 14.2%). By condition, the FTM and PAT conditions resulted in 1.303 (95%CI: 1.187, 1.430; P < .001) and 1.219 (95%CI: 1.103, 1.348; P < .001), or 30.3% and 21.9% higher, odds of being RTD compared to the CON condition, respectively. Return on investment was $23,363,596 overall and $2,423,306 for musculoskeletal-related cases. CONCLUSIONS: Injuries were common in BCT, particularly in females. Soldiers in both the PAT and FTM conditions were more likely to be RTD compared to those in the CON condition. Athletic trainers (ATs) are effective at reducing potentially unnecessary referrals, demonstrating their value as healthcare providers in the BCT environment. Understanding variables associated with recruit disposition may aid medics and ATs in the development of triage protocols and further reduction of potentially unnecessary soldier referrals. The Certified Athletic Trainer-Forward Program resulted in significant return on investment, further supporting the inclusion of ATs in BCT.

The Association Between Access to Athletic Trainers and Emergency Medical Services Activations for Sport-Related Injuries.

CONTEXT: Having athletic trainers (ATs) employed at secondary schools is associated with improved preparedness for sport-related emergencies. Utilization of emergency medical services (EMS) with different access to athletic training services remains unknown. OBJECTIVE: Compare the incidence of EMS activations for sport-related injuries between zip-codes with varying access to athletic training services. DESIGN: Descriptive epidemiology study. SETTING: Data were obtained from the National EMS Information System and the Athletic Training Location and Services Project. PATIENTS OR OTHER PARTICIPANTS: Zip-codes where 9-1-1 EMS activations for sport-related injuries among individuals 13-18 years old occurred. MAIN OUTCOME MEASURE(S): Incidence of EMS activations, athletic training service level (NONE, PART, FULL), athletic training employment model (independent contractor, IC; medical or university facility, MUF; school district, SD; mixed employment models, MIX) for each zip-code. RESULTS: There were 2.8±3.5 EMS activations per zip-code (range 1-81, n=4,923). Among zip-codes where at least 1 AT was employed (n=2,228), 3.73% (n=83) were IC, 30.83% (n=687) were MIX, 27.24% (n=607) were SD, and 38.20% (n=851) were MUF. Compared to SD, MUF had a 10.8% lower incidence of EMS activations (95%CI: 0.817, 0.974, p=0.010). IC (IRR: 0.920, 95%CI: 0.758, 1.118, p=0.403) and MIX (IRR: 0.996, 95% CI: 0.909, 1.091, p=0.932) were not significantly different from SD. Service level was calculated for 3,834 zip-codes, with 19.5% (n=746) NONE, 46.2% (n=1,771) PART, and 34.4% (n=1,317) FULL. Compared to NONE, FULL (IRR: 1.416, 95%CI: 1.308, 1.532, p<0.001) and PART (IRR: 1.368, 95%CI: 1.268, 1.476, p<0.001) had higher incidences of EMS activations. CONCLUSIONS: Local access to athletic training services is associated with an increased utilization of EMS for sport-related injuries among secondary school aged individuals, potentially indicative of improved identification and triage of sport-related emergencies the area. The difference in EMS utilization between employment models may represent the presence of different policies and procedures for sport-related emergencies.

Epidemiology of Emergency Medical Services Activations for Sport-Related Injuries in the United States.

Background Literature examining emergency medical services (EMS) activations for sport-related injuries is limited to the pediatric, high school, and collegiate student-athlete populations, excluding older individuals and recreational athletes. The purpose of this study was to examine EMS activations for sport-related injuries using the National EMS Information System Database from 2017-2018. Methods Data were obtained using the National EMS Information System Database from 2017-2018. EMS activations were limited to 9-1-1 responses for individuals aged 3-99 who sustained a sports-related injury. Independent variables included patient age group: pediatric (<18 years old) vs. adult (≥18 years old). Dependent variables were patient age, gender, and chief complaint anatomic location. Frequencies and proportions were calculated for each variable. Injury proportion ratios (IPRs) with 95% confidence intervals were calculated to compare chief complaint anatomic location by age group. Results There were 71,322 sport-related injuries. Patients were 36.6±22.9 years and most (58.1%, n=41,132) were male. Adults had higher proportions of injuries affecting the abdomen (IPR: 2.05, 95%CI: 1.83, 2.31), chest (IPR: 1.90, 95%CI: 1.75, 2.05), general/global (IPR: 1.54, 95%CI: 1.50, 1.58), and genitalia (IPR: 2.40, 95%CI: 1.39, 4.15), and lower proportions of injuries affecting the back (IPR: 0.55, 95%CI: 0.50, 0.60), lower extremity (IPR: 0.63, 95%CI: 0.60, 0.65), upper extremity (IPR: 0.50, 95%CI: 0.47, 0.53), head (IPR: 0.73, 95%CI: 0.70, 0.77), and neck (IPR: 0.18, 95%CI: 0.16, 0.20) compared to pediatric patients. Conclusion Injuries sustained differed between adult and pediatric patients, indicating sport-related emergencies may change across the lifespan. General/global chief complaints likely indicate sport-related injuries affecting multiple anatomic locations and organ systems. Stakeholders planning large or high-risk athletic events should consider arranging standby or dedicated advanced life support units for their events.

Sex-Specific Changes in Physical Risk Factors for Anterior Cruciate Ligament Injury by Chronological Age and Stages of Growth and Maturation From 8 to 18 Years of Age.

OBJECTIVE: To critically assess the literature focused on sex-specific trajectories in physical characteristics associated with anterior cruciate ligament (ACL) injury risk by age and maturational stage. DATA SOURCES: PubMed, CINAHL, Scopus, and SPORTDiscus databases were searched through December 2021. STUDY SELECTION: Longitudinal and cross-sectional studies of healthy 8- to 18-year-olds, stratified by sex and age or maturation on ≥1 measure of body composition, lower extremity strength, ACL size, joint laxity, knee-joint geometry, lower extremity alignment, balance, or lower extremity biomechanics were included. DATA EXTRACTION: Extracted data included study design, participant characteristics, maturational metrics, and outcome measures. We used random-effects meta-analyses to examine sex differences in trajectory over time. For each variable, standardized differences in means between sexes were calculated. DATA SYNTHESIS: The search yielded 216 primary and 22 secondary articles. Less fat-free mass, leg strength, and power and greater general joint laxity were evident in girls by 8 to 10 years of age and Tanner stage I. Sex differences in body composition, strength, power, general joint laxity, and balance were more evident by 11 to 13 years of age and when transitioning from the prepubertal to pubertal stages. Sex differences in ACL size (smaller in girls), anterior knee laxity and tibiofemoral angle (greater in girls), and higher-risk biomechanics (in girls) were observed at later ages and when transitioning from the pubertal to postpubertal stages. Inconsistent study designs and data reporting limited the number of included studies. CONCLUSIONS: Critical gaps remain in our knowledge and highlight the need to improve our understanding of the relative timing and tempo of ACL risk factor development.

Characteristics of Injury in Collegiate Rodeo.

OBJECTIVE: The purpose of this study was to investigate injury occurrence sustained by collegiate rodeo athletes during practice and competition. DESIGN: Descriptive epidemiology. SETTING: Eleven National Intercollegiate Rodeo Association member institutions across the United States. PARTICIPANTS: Participants included 264 male and female college rodeo athletes. Athletic trainers (ATs) from each institution reported injury and exposure data using the National Collegiate Athletic Association Injury Surveillance Program. INTERVENTIONS: Institutional ATs reported athlete exposures (AEs) and injuries that occurred from collegiate rodeo practices and competitions. MAIN OUTCOME MEASURE: Injury and AEs from practices and competitions for one college rodeo season were analyzed. Injury rates and ratios were calculated for non-time loss (NTL) and time loss (TL) with 95% confidence intervals (CI). RESULTS: Data revealed a higher proportion of TL than NTL injuries [2.47 vs 1.77 per 1000 AE; injury rate ratios (IRRs) = 1.39; 95% CI: 0.93-2.08]. There was a higher injury rate during competition as compared with practice (10.98 vs 3.09 per 1000 AE; IRR = 3.56; 95% CI: 2.36-5.35), but more injuries were reported in practice (62.2%). CONCLUSIONS: Although the injury rate during rodeo competition was significantly higher than during practice in this study, a greater number of injuries were reported during practice. This indicates all college rodeo athletes can potentially benefit from available medical care.

Non-Time-Loss and Time-Loss Softball Injuries in Secondary School Athletes: A Report From the National Athletic Treatment, Injury and Outcomes Network (NATION).

CONTEXT: Most studies of injury trends associated with softball focus on injuries requiring at least 24 hours of missed participation time (time-loss [TL] injuries), with little focus on those that do not (non-time-loss [NTL] injuries). A better understanding of injury trends associated with softball will improve athlete care. OBJECTIVE: To describe NTL and TL injuries experienced by secondary school girls' softball players. DESIGN: Descriptive epidemiology study. SETTING: Secondary school athletic training clinics. PATIENTS OR OTHER PARTICIPANTS: Secondary school girls' softball players. MAIN OUTCOME MEASURE(S): Aggregate data were collected from schools participating in the National Athletic Treatment, Injury, and Outcomes Network surveillance program during the 2011-2012 through 2013-2014 academic years. Frequencies and rates of injuries (NTL and TL) according to time of season, event type, body part injured, and diagnosis were analyzed. RESULTS: In total, 1059 injuries were reported during 140 073 athlete-exposures (AEs): overall injury rate = 7.56/1000 AEs. Of these injuries, 885 (83.6%) were NTL (NTL rate = 6.32/1000 AEs) and 174 (16.4%) were TL (TL rate = 1.24/1000 AEs). Of the NTL and TL injuries, the largest numbers occurred during the regular season (NTL: n = 443 [50.1%]; TL: n = 131 [75.3%]). Injuries sustained during practices accounted for the majority of NTL and TL injuries (NTL: n = 631 [71.3%]; TL: n = 104 [59.8%]). The NTL injuries occurred most often at the shoulder (n = 134 [15.1%]) and hand/fingers (n = 109 [12.3%]) and were diagnosed as contusions (n = 316 [35.7%]), strains (n = 157 [17.7%]), and abrasions (n = 151 [17.1%]). The largest numbers of TL injuries were to the head/face (n = 71 [40.8%]) and diagnosed as concussions (n = 50 [28.7%]) and strains (n = 28 [16.1%]). CONCLUSIONS: Secondary school softball players sustained a larger proportion of NTL injuries than TL injuries. Although NTL injuries may be less severe, they are numerous. Efforts are needed to ensure that injury-prevention programs are incorporated into the care of softball athletes to promote health and reduce injury occurrence.

Epidemiology of Secondary School Boys' and Girls' Basketball Injuries: National Athletic Treatment, Injury and Outcomes Network.

CONTEXT: Little is known about non-time-loss (NTL) injury patterns in basketball athletes. Knowledge of these patterns may aid in the development of prevention and management strategies for patients with these injuries. OBJECTIVE: To describe the epidemiology of time-loss (TL) and NTL injuries sustained by secondary school boys' and girls' basketball athletes. DESIGN: Descriptive epidemiology study. SETTING: Eighty-six unique schools provided data, with 84 and 83 contributing to boys' and girls' basketball, respectively. PATIENTS OR OTHER PARTICIPANTS: Athletes participating in secondary school-sponsored boys' and girls' basketball. MAIN OUTCOME MEASURE(S): Boys' and girls' basketball data from the National Athletic Treatment, Injury and Outcomes Network (NATION) injury-surveillance program (2011-2012 through 2013-2014 years) were analyzed. Injury counts, rates, and rate ratios (IRRs) were reported with 95% confidence intervals (CIs). RESULTS: The NATION captured 2653 injuries over 364 355 athlete-exposures (AEs) for boys' basketball and 2394 injuries over 288 286 AE for girls' basketball, producing rates of 7.28/1000 AEs (95% CI = 7.00, 7.56) for boys and 8.30/1000 AEs (95% CI = 7.97, 8.64) for girls. The overall injury rates were slightly lower for boys (IRR = 0.88; 95% CI = 0.83, 0.93). For boys, 559 (21.1%) injuries were TL and 2094 (78.9%) were NTL, producing a TL injury rate of 1.53/1000 AEs (95% CI = 1.40, 1.66) and an NTL injury rate of 5.75/1000 AEs (95% CI = 5.50, 5.99). For girls, 499 (20.8%) injuries were TL and 1895 (79.2%) were NTL, producing a TL injury rate of 1.73/1000 AEs (95% CI = 1.58, 1.88) and an NTL injury rate of 6.57/1000 AEs (95% CI = 6.28, 6.87). Rates of TL injuries were similar between boys' and girls' basketball (IRR = 0.89; 95% CI = 0.79, 1.00); NTL injury rates were lower for boys (IRR = 0.87; 95% CI = 0.82, 0.93). CONCLUSIONS: When NTL injuries were included, the rates of injury in boys' and girls' secondary school basketball were higher than previously reported.

Appropriate Medical Care Standards for Organizations Sponsoring Athletic Activity for the Secondary School-Aged Athlete: A Summary Statement.

OBJECTIVE: To present the appropriate medical care standards for organizations that sponsor athletic activities for secondary school-aged athletes. DATA SOURCES: To develop the current standards and identify current best-practices evidence, the task force used a multistep process that included reviewing the existing 2004 Appropriate Medical Care for Secondary School-Aged Athletes consensus points and cross-referencing of National Athletic Trainers' Association (NATA) statements and official documents from the strategic alliance (the NATA, NATA Foundation, Board of Certification, and Commission on Accreditation of Athletic Training Education). Gaps in the recommendations from the 2004 Appropriate Medical Care for Secondary School-Aged Athletes document were identified by the task force, and the new appropriate medical care standards were developed and refined. CONCLUSIONS AND RECOMMENDATIONS: Twelve standards, with supporting substandards, were developed that encompassed readiness to participate in activity; facilities; equipment; protective materials; environmental policies; nutrition, hydration, and dietary supplementation; wellness and long-term health; comprehensive emergency action plans; on-site immediate care; on-site therapeutic interventions; psychological concerns; and athletic health care administration. Collectively, these standards describe a comprehensive approach to providing appropriate health care to secondary school-aged athletes and should serve as a framework with which organizations can evaluate and improve the medical care supplied to adolescent athletes.

Injury Incidence in Youth, High School, and NCAA Men's Lacrosse.

BACKGROUND: We compared injury incidence and mechanisms among youth, high school (HS), and National Collegiate Athletic Association (NCAA) boys' and men's lacrosse athletes for the 2014-2015 to 2016-2017 lacrosse seasons. METHODS: Multiple injury surveillance systems were used to capture 21 youth boys', 22 HS boys', and 20 NCAA men's lacrosse team-seasons of data during the 2014-2015 to 2016-2017 seasons. Athletic trainers reported game and practice injuries and athlete exposures (AEs). Injuries included those occurring during a game and/or practice and requiring evaluation from an athletic trainer and/or physician. Injury counts, rates per 1000 AEs, and injury rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated. RESULTS: The injury rate in youth was higher than those reported in HS (10.3 vs 5.3 per 1000 AEs; IRR = 2.0; 95% CI: 1.6-2.4) and the NCAA (10.3 vs 4.7 per 1000 AEs; IRR = 2.2; 95% CI: 1.9-2.5). When considering time loss injuries only (restricted participation of ≥24 hours), the injury rate in youth was lower than those reported in HS (2.0 vs 2.9 per 1000 AEs; IRR = 0.7; 95% CI: 0.5-0.95) and the NCAA (2.0 vs 3.3 per 1000 AEs; IRR = 0.6; 95% CI: 0.4-0.8). The concussion rate in youth was higher than those in HS (0.7 vs 0.3 per 1000 AEs; IRR = 2.4, 95% CI: 1.1-5.2) and the NCAA (0.7 vs 0.3 per 1000 AEs; IRR = 2.1, 95% CI: 1.2-3.7). Injuries at the youth, HS, and NCAA levels were most commonly associated with stick contact, inflammatory conditions (including bursitis, tendonitis, and other unspecified inflammation), and noncontact mechanisms, respectively. CONCLUSIONS: Although the time loss injury rate was lowest in youth boys' lacrosse, the concussion rate was the highest. Injury prevention approaches should be specific to the mechanisms associated with each level of play (eg, equipment skill development in youth).

The First Decade of Web-Based Sports Injury Surveillance: Descriptive Epidemiology of Injuries in US High School Girls' Softball (2005-2006 Through 2013-2014) and National Collegiate Athletic Association Women's Softball (2004-2005 Through 2013-2014).

CONTEXT: The advent of Web-based sports injury surveillance via programs such as the High School Reporting Information Online system and the National Collegiate Athletic Association Injury Surveillance Program has aided the acquisition of girls' and women's softball injury data. OBJECTIVE: To describe the epidemiology of injuries sustained in high school girls' softball in the 2005-2006 through 2013-2014 academic years and collegiate women's softball in the 2004-2005 through 2013-2014 academic years using Web-based sports injury surveillance. DESIGN: Descriptive epidemiology study. SETTING: Online injury surveillance from softball teams in high school girls (annual average = 100) and collegiate women (annual average = 41). PATIENTS OR OTHER PARTICIPANTS: Girls' or women's softball players who participated in practices and competitions during the 2005-2006 through 2013-2014 academic years in high school and the 2004-2005 through 2013-2014 academic years in college. MAIN OUTCOME MEASURE(S): Athletic trainers collected time-loss injury and exposure data. Injury rates per 1000 athlete-exposures (AEs) were calculated. Injury rate ratios (IRRs) with 95% confidence intervals (CIs) compared injury rates by competition level, school size or division, event type, and time in season. RESULTS: The High School Reporting Information Online system documented 1357 time-loss injuries during 1 173 722 AEs; the National Collegiate Athletic Association Injury Surveillance Program documented 1848 time-loss injuries during 579 553 AEs. The injury rate was higher in college than in high school (3.19 versus 1.16/1000 AEs; IRR = 2.76; 95% CI = 2.57, 2.96). The competition injury rate was higher than the practice injury rate in high school (IRR = 2.02; 95% CI = 1.82, 2.25) and in college (IRR = 1.39; 95% CI = 1.27, 1.52). Softball players at both levels sustained a variety of injuries, with the most common being ankle sprains and concussions. Many injuries also occurred while fielding or running bases. CONCLUSIONS: Injury rates were greater in collegiate versus high school softball and in competitions versus practices. These findings highlight the need for injury-prevention interventions, including strength-training and prevention programs to reduce ankle sprains and provide protection for batters from pitches and fielders from batted balls.

The First Decade of Web-Based Sports Injury Surveillance: Descriptive Epidemiology of Injuries in US High School Boys' Baseball (2005-2006 Through 2013-2014) and National Collegiate Athletic Association Men's Baseball (2004-2005 Through 2013-2014).

CONTEXT: The advent of Web-based sports injury surveillance via programs such as the High School Reporting Information Online system and the National Collegiate Athletic Association Injury Surveillance Program has aided the acquisition of boys' and men's baseball injury data. OBJECTIVE: To describe the epidemiology of injuries sustained in high school boys' baseball in the 2005-2006 through 2013-2014 academic years and collegiate men's baseball in the 2004-2005 through 2013-2014 academic years using Web-based sports injury surveillance. DESIGN: Descriptive epidemiology study. SETTING: Online injury surveillance from baseball teams in high school boys (annual average = 100) and collegiate men (annual average = 34). PATIENTS OR OTHER PARTICIPANTS: Boys' or men's baseball players who participated in practices and competitions during the 2005-2006 through 2013-2014 academic years in high school or the 2004-2005 through 2013-2014 academic years in college, respectively. MAIN OUTCOME MEASURE(S): Athletic trainers collected time-loss injury and exposure data. Injury rates per 1000 athlete-exposures (AEs) were calculated. Injury rate ratios (IRRs) with 95% confidence intervals (CIs) compared injury rates by school size or division, time in season, event type, and competition level. RESULTS: The High School Reporting Information Online system documented 1537 time-loss injuries during 1 573 257 AEs; the National Collegiate Athletic Association Injury Surveillance Program documented 2574 time-loss injuries during 804 737 AEs. The injury rate was higher in college than in high school (3.20 versus 0.98/1000 AEs; IRR = 3.27; 95% CI = 3.07, 3.49). The competition injury rate was higher than the practice injury rate in high school (IRR = 2.27; 95% CI = 2.05, 2.51) and college (IRR = 2.32; 95% CI = 2.15, 2.51). Baseball players at the high school and collegiate levels sustained a variety of injuries across the body, with the most common injuries reported to the upper extremity. Many injuries also occurred while fielding or pitching. CONCLUSIONS: Injury rates were greater in collegiate versus high school baseball and in competition versus practice. These findings highlight the need for injury-prevention interventions focused on reducing the incidence of upper extremity injuries and protecting batters from pitches and fielders from batted balls.

The First Decade of Web-Based Sports Injury Surveillance: Descriptive Epidemiology of Injuries in US High School Girls' Lacrosse (2008-2009 Through 2013-2014) and National Collegiate Athletic Association Women's Lacrosse (2004-2005 Through 2013-2014).

CONTEXT: The advent of Web-based sports injury surveillance via programs such as the High School Reporting Information Online (HS RIO) system and the National Collegiate Athletic Association Injury Surveillance Program (NCAA-ISP) has aided the acquisition of girls' and women's lacrosse injury data. OBJECTIVE: To describe the epidemiology of injuries sustained in high school girls' lacrosse in the 2008-2009 through 2013-2014 academic years and collegiate women's lacrosse in the 2004-2005 through 2013-2014-academic years using Web-based sports injury surveillance. DESIGN: Descriptive epidemiology study. SETTING: Online injury surveillance from high school girls' (annual average = 55) and collegiate women's (annual average = 19) lacrosse teams. PATIENTS OR OTHER PARTICIPANTS: Female lacrosse players who participated in practices or competitions during the 2008-2009 through 2013-2014 academic years for high school or the 2004-2005 through 2013-2014 academic years for college. MAIN OUTCOME MEASURE(S): Athletic trainers collected time-loss injury (≥24 hours) and exposure data. We calculated injury rates per 1000 athlete-exposures (AEs), injury rate ratios (IRRs) with 95% confidence intervals (CIs), and injury proportions by body site and diagnosis. RESULTS: High school RIO documented 700 time-loss injuries during 481 687 AEs; the NCAA-ISP documented 1027 time-loss injuries during 287 856 AEs. The total injury rate during 2008-2009 through 2013-2014 was higher in college than in high school (2.55 versus 1.45/1000 AEs; IRR = 1.75; 95% CI = 1.54, 1.99). Most injuries occurred during competitions in high school (51.1%) and practices in college (63.8%). Rates were higher during competitions compared with practices in high school (IRR = 2.32; 95% CI = 2.00, 2.69) and college (IRR = 2.38; 95% CI = 2.09, 2.70). Concussion was the most common diagnosis among all high school and most collegiate player positions, and the main mechanism of contact was with a playing apparatus (eg, stick, ball). Ligament sprains were also common (HS RIO practices = 22.2%, competitions = 30.3%; NCAA-ISP practices = 25.5%, competitions = 30.9%). CONCLUSIONS: Rates of injury were higher in college versus high school female lacrosse players and in competitions versus practices. Injury-prevention strategies are essential to decrease the incidence and severity of concussions and ligament sprains.

The First Decade of Web-Based Sports Injury Surveillance: Descriptive Epidemiology of Injuries in US High School Boys' Lacrosse (2008-2009 Through 2013-2014) and National Collegiate Athletic Association Men's Lacrosse (2004-2005 Through 2013-2014).

CONTEXT: The advent of Web-based sports injury surveillance via programs such as the High School Reporting Information Online system and the National Collegiate Athletic Association Injury Surveillance Program has aided the acquisition of boys' and men's lacrosse injury data. OBJECTIVE: To describe the epidemiology of injuries sustained in high school boys' lacrosse in the 2008-2009 through 2013-2014 academic years and collegiate men's lacrosse in the 2004-2005 through 2013-2014 academic years using Web-based sports injury surveillance. DESIGN: Descriptive epidemiology study. SETTING: Online injury surveillance from lacrosse teams of high school boys (annual average = 55) and collegiate men (annual average = 14). PATIENTS OR OTHER PARTICIPANTS: Boys' and men's lacrosse players who participated in practices and competitions during the 2008-2009 through 2013-2014 academic years in high school or the 2004-2005 through 2013-2014 academic years in college. MAIN OUTCOME MEASURE(S): Athletic trainers collected time-loss (≥24 hours) injury and exposure data. Injury rates per 1000 athlete-exposures (AEs), injury rate ratios (IRRs) with 95% confidence intervals (CIs), and injury proportions by body site and diagnosis were calculated. RESULTS: High School Reporting Information Online documented 1407 time-loss injuries during 662 960 AEs. The National Collegiate Athletic Association Injury Surveillance Program documented 1882 time-loss injuries during 390 029 AEs. The total injury rate from 2008-2009 through 2013-2014 was higher in college than in high school (3.77 versus 2.12/1000 AEs; IRR = 1.78; 95% CI = 1.63, 1.94). Most injuries occurred during competitions in high school (61.4%) and practices in college (61.4%). Injury rates were higher in competitions compared with practices in high school (IRR = 3.59; 95% CI = 3.23, 4.00) and college (IRR = 3.38; 95% CI = 3.08, 3.71). Lower limb injuries, muscle strains, and ligament sprains were common at both levels. Concussion was the most frequent competition diagnosis for all high school player positions. CONCLUSIONS: Rates of time-loss injury were higher in college versus high school and in competitions versus practices. Attention to preventing common lower leg injuries and concussions, especially at the high school level, is essential to decrease their incidence and severity.

Changes in Patient-Reported Outcome Measures From the Time of Injury to Return to Play in Adolescent Athletes at Secondary Schools With an Athletic Trainer.

CONTEXT: Typically, athletic trainers rely on clinician-centered measures to evaluate athletes' return-to-play status. However, clinician-centered measures do not provide information regarding patients' perceptions. OBJECTIVE: To determine whether clinically important changes in patient-reported outcomes were observed from the time of lower extremity injury to the time of return to play in adolescent athletes. DESIGN: Cross-sectional study. SETTING: The National Athletic Treatment, Injury and Outcomes Network (NATION) program has captured injury and treatment data in 31 sports from 147 secondary schools across 26 states. A subsample of 24 schools participated in the outcomes study arm during the 2012-2013 and 2013-2014 academic years. PATIENTS OR OTHER PARTICIPANTS: To be included in this report, student-athletes must have sustained a knee, lower leg, ankle, or foot injury that restricted participation from sport for at least 3 days. A total of 76 initial assessments were started by athletes; for 69 of those, return-to-play surveys were completed and analyzed. MAIN OUTCOME MEASURE(S): All student-athletes completed generic patient-reported outcome measures (Patient-Reported Outcomes Measurement Information System [PROMIS] survey, Global Rating of Change scale, and Numeric Pain Rating Scale) and, depending on body region, completed an additional region-specific measure (Knee Injury and Osteoarthritis Outcome Score or Foot and Ankle Ability Measure). All applicable surveys were completed at both the initial and return-to-play time points. Means and standard deviations for the total scores of each patient-reported outcome measure at each time point were calculated. Change scores that reflected the difference from the initial to the return-to-play time points were calculated for each participant and compared with established benchmarks for change. RESULTS: The greatest improvement in patient-reported outcomes was in the region-specific forms, with scores ranging from 9.92 to 37.73 on the different region-specific subscales (Knee Injury and Osteoarthritis Outcome Score or Foot and Ankle Ability Measure; scores range from 0-100). The region-specific subscales on average still showed a 21.8- to 37.5-point deficit in reported health at return to play. The PROMIS Lower Extremity score increased on average by 13 points; all other PROMIS scales were within normative values after injury. CONCLUSIONS: Adolescent athletes who were injured at a high school with an athletic trainer may have shown improvement in patient-reported outcomes over time, but when they returned to play, their outcome scores remained lower than norms from comparable athlete groups.

Epidemiology of Exertional Heat Illnesses in National Collegiate Athletic Association Athletes During the 2009-2010 Through 2014-2015 Academic Years.

CONTEXT: Exertional heat illnesses (EHIs) among football athletes have been widely researched, but data examining all collegiate sports are limited. OBJECTIVE: To describe the epidemiology of EHI in 25 National Collegiate Athletic Association (NCAA) sports. DESIGN: Descriptive epidemiology study. SETTING: The NCAA Injury Surveillance Program during the 2009-2010 through 2014-2015 academic years. PATIENTS OR OTHER PARTICIPANTS: A voluntary sample of 166 NCAA institutions over 2048 team-seasons. MAIN OUTCOME MEASURE(S): Athletic trainers reported EHIs to the NCAA Injury Surveillance Program. Only EHIs sustained during a sanctioned practice or competition were included. The EHI rate, specific diagnoses, and number of emergency transports were measured. RESULTS: Overall, 232 EHI events were reported (0.47/10 000 athlete-exposures [AEs]; 95% confidence interval [CI] = 0.41, 0.53). Football comprised 75% of all EHI events and had the largest rate (1.55/10 000 AEs; 95% CI = 1.32, 1.78). The overall EHI rate was higher in preseason practices (1.16/10 000 AEs) than all other time periods (regular and postseason practices and all competitions; 0.23/10 000 AEs, injury rate ratio [IRR] = 4.96; 95% CI = 3.79, 6.50). This result was retained when examining the individual sports of football (3.65/10 000 versus 0.63/10 000 AEs, IRR = 5.82; 95% CI = 4.18, 8.10), men's soccer (1.11/10 000 versus 0.07/10 000 AEs, IRR = 16.819; 95% CI = 1.89, 138.55), and women's soccer (1.10/10 000 versus 0.05/10 000 AEs, IRR = 22.52; 95% CI = 2.77, 183.05). The EHI rates were highest in states with elevated annual temperatures (1.05/10 000 AEs). Heat cramps (39%), heat exhaustion (27%), and dehydration (29%) were the most common types of EHI. Nineteen athletes with EHI (8%) required emergency transport. CONCLUSIONS: Football players continue to experience the most EHIs; however, EHIs can potentially occur in all NCAA sports. Continued emphasis on preseason EHI policies and institution-specific environmental guidelines is needed to address EHI rates.

Athletic Training Service Characteristics for Patients With Ankle Sprains Sustained During High School Athletics.

CONTEXT: Limited information exists on the amount and type of care provided by athletic trainers (ATs) treating athletes who sustained ankle sprains in the high school setting. OBJECTIVE: To describe AT services provided for patients with ankle sprains injured in high school athletics. DESIGN: Descriptive epidemiology study. SETTING: Athletic training facility (ATF) visits and AT services collected from 147 high schools in 26 states. PATIENTS OR OTHER PARTICIPANTS: High school student-athletes participating in 13 boys' and 14 girls' sports who sustained a diagnosed ankle sprain during the 2011-2012 through 2013-2014 academic years. The ATs documented 3213 ankle sprains. MAIN OUTCOME MEASURE(S): Number of ATF visits and individual AT services and mean ATF visits (per injury) and AT services (per injury) were calculated by sport and for time-loss injuries (participation-restriction time of at least 24 hours) and non-time-loss injuries (participation-restriction time <24 hours). RESULTS: During the 3-year period, 19 925 ATF visits were reported, with an average of 6 (interquartile range = 1-7) ATF visits per ankle sprain. Most ATF visits were for non-time-loss injuries (65.1%). Football accounted for the largest proportions of ankle sprains (27.3%) and ATF visits (35.0%). In total, 71 404 AT services were provided for ankle sprains. Therapeutic activities or exercise were the most common AT services (47.4%), followed by neuromuscular reeducation (16.6%), strapping (14.2%), and modalities (11.5%). An average of 22 (interquartile range = 4-28) AT services were reported per ankle sprain. The average number of AT services per injury was higher among patients with time-loss than non-time-loss injuries (35 versus 19; P < .001). CONCLUSIONS: The ATs provided a variety of services to treat high school athletes who had sustained ankle sprains, including therapeutic exercises and neuromuscular reeducation, which were supported by research. However, ATs should consider using manual therapy (use supported by grade B evidence) and therapeutic exercise more (use supported by grade A evidence).

The First Decade of Web-Based Sports Injury Surveillance: Descriptive Epidemiology of Injuries in US High School Girls' Volleyball (2005-2006 Through 2013-2014) and National Collegiate Athletic Association Women's Volleyball (2004-2005 Through 2013-2014).

CONTEXT:: The advent of Web-based sports injury surveillance via programs such as the High School Reporting Information Online system and the National Collegiate Athletic Association Injury Surveillance Program has aided in the acquisition of girls' and women's volleyball injury data. OBJECTIVE:: To describe the epidemiology of injuries sustained in high school girls' volleyball in the 2005-2006 through 2013-2014 academic years and collegiate women's volleyball in the 2004-2005 through 2013-2014 academic years using Web-based sports injury surveillance. DESIGN:: Descriptive epidemiology study. SETTING:: Online injury surveillance from high school girls' (annual average = 100) and collegiate women's (annual average = 50) volleyball teams. PATIENTS OR OTHER PARTICIPANTS:: Girls' and women's volleyball players who participated in practices and competitions during the 2005-2006 through 2013-2014 academic years in high school and the 2004-2005 through 2013-2014 academic years in college. MAIN OUTCOME MEASURE(S):: Athletic trainers collected time-loss (≥24 hours) injury and exposure data. Injury rates per 1000 athlete-exposures (AEs), injury rate ratios (IRRs) with 95% confidence intervals (CIs), and injury proportions by body site and diagnosis were calculated. RESULTS:: The High School Reporting Information Online system documented 1634 time-loss injuries during 1 471 872 AEs; the National Collegiate Athletic Association Injury Surveillance Program documented 2149 time-loss injuries during 563 845 AEs. The injury rate was higher in college than in high school (3.81/1000 versus 1.11/1000 AEs; IRR = 3.43; 95% CI = 3.22, 3.66), and higher in high schools with ≤1000 students than in those with >1000 students (IRR = 1.35; 95% CI = 1.23, 1.49). Injury rates did not vary by collegiate division. The injury rate was higher during competitions than practices for high school (IRR = 1.23; 95% CI = 1.12, 1.36) but not for college (IRR = 1.01; 95% CI = 0.92, 1.10). Ankle sprains were common in both the high school and collegiate setting. However, liberos had a high incidence of concussion. CONCLUSIONS:: Injury rates were higher among collegiate than high school players. However, injury rates differed by event type in high school, unlike college. Concussion injury patterns among liberos varied from those for other positions. These findings highlight the need for injury-prevention interventions specific to setting and position.

The First Decade of Web-Based Sports Injury Surveillance: Descriptive Epidemiology of Injuries in US High School Girls' Soccer (2005-2006 Through 2013-2014) and National Collegiate Athletic Association Women's Soccer (2004-2005 Through 2013-2014).

CONTEXT:: The advent of Web-based sports injury surveillance via programs such as the High School Reporting Information Online system and the National Collegiate Athletic Association Injury Surveillance Program has aided the acquisition of girls' and women's soccer injury data. OBJECTIVE:: To describe the epidemiology of injuries sustained in high school girls' soccer in the 2005-2006 through 2013-2014 academic years and collegiate women's soccer in the 2004-2005 through 2013-2014 academic years using Web-based sports injury surveillance. DESIGN:: Descriptive epidemiology study. SETTING:: Online injury surveillance from soccer teams in high school girls (annual average = 100) and collegiate women (annual average = 52). PATIENTS OR OTHER PARTICIPANTS:: Female high school and collegiate soccer players who participated in practices or competitions during the 2004-2005 through 2013-2014 academic years. MAIN OUTCOME MEASURE(S):: Athletic trainers collected time-loss (≥24 hours) injury and exposure data. Injury rates per 1000 athlete-exposures (AEs), injury rate ratios (IRRs) with 95% confidence intervals (CIs), injury proportions by body site, and diagnoses were calculated. RESULTS:: The High School Reporting Information Online system documented 3242 time-loss injuries during 1 393 753 AEs; the National Collegiate Athletic Association Injury Surveillance Program documented 5092 time-loss injuries during 772 048 AEs. Injury rates were higher in college than in high school (6.60 versus 2.33/1000 AEs; IRR = 2.84; 95% CI = 2.71, 2.96), and during competitions than during practices in high school (IRR = 4.88; 95% CI = 4.54, 5.26) and college (IRR = 2.93; 95% CI = 2.77, 3.10). Most injuries at both levels affected the lower extremity and were ligament sprains or muscle/tendon strains. Concussions accounted for 24.5% of competition injuries in high school but 14.6% of competition injuries in college. More than one-third of competition injuries to high school goalkeepers were concussions. CONCLUSIONS:: Injury rates were higher in college versus high school and during competitions versus practices. These differences may be attributable to differences in reporting, activity intensity, and game-play skill level. The high incidence of lower extremity injuries and concussions in girls' and women's soccer, particularly concussions in high school goalkeepers, merits further exploration and identification of prevention strategies.