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.

Injuries sustained in National Collegiate Athletic Association men's and women's basketball, 2009/2010-2014/2015.

BACKGROUND/AIM: Recent rule changes regarding the safety of basketball athletes necessitate up-to-date reports of injury incidence. This study describes the epidemiology of injuries in men's and women's National Collegiate Athletic Association (NCAA) basketball during the 2009/2010-2014/2015 seasons. METHODS: Basketball injury data originate from the 2009/2010-2014/2015 academic years from the NCAA Injury Surveillance Program (NCAA-ISP) from 78 men's and 74 women's NCAA basketball programmes which provided 176 and 181 team-seasons, respectively. A reportable injury occurred during organised practice or competition and required attention from an athletic trainer (AT) or physician. Injury rates, injury proportions and rate ratios (RRs) were calculated. All 95% CIs not containing 1.0 were considered statistically significant. RESULTS: A total of 2308 and 1631 injuries were reported in men's and women's basketball, respectively, for injury rates of 7.97 and 6.54/1000 athlete-exposures (AEs). The rate was higher in men than women (RR=1.22; 95% CI 1.15 to 1.30). Non-time-loss (NTL) injuries (resulting in participation restriction time under 24 hours) accounted for 64.8% and 53.6% of men's competition and practice injuries, respectively, and 53.9% and 51.3% of women's competition and practice injuries, respectively. Injuries to the lower extremity were the most common in competitions (men: 54.9%; women: 59.0%) and practices (men: 62.4%; women: 67.3%). The most common injury in men's and women's basketball was ankle sprain (17.9% and 16.6%, respectively). CONCLUSIONS: NTL injuries account for over half of all injuries in basketball. Most injuries were lower extremity injuries, specifically ankle sprains. While rule changes have been implemented to make basketball safer, continued research is needed to assess the effectiveness of these changes.

Coaches' Implementation of the USA Football "Heads Up Football" Educational Program.

An integral part of the Heads Up Football (HUF) educational program is the Player Safety Coach (PSC), who is responsible for teaching other coaches within a youth football league about safer blocking/tackling and injury prevention. This study examines the association between youth football coaches' interactions with the PSC (i.e., attending the PSC clinic at the beginning of the season and seeing the PSC on-field during practices) and their subsequent implementation of the HUF educational program. Data were collected via online questionnaire completed by 1,316 youth football coaches from HUF leagues. Data were analyzed with frequencies and logistic regression. Nearly half of coaches (44.8%) did not attend the PSC clinic; 25.9% reported not seeing their league's PSC on the field on a regular basis. The lack of PSC on-site presence was significantly associated with worse implementation for "concussion recognition and response," "heat preparedness and hydration," and "sudden cardiac event preparedness." PSC clinic attendance was not associated with implementation. Opportunities exist for improvement in the HUF educational program as there appears to be inconsistent implementation. Further research is warranted to understand how to optimize the role of the PSC in the youth sports context.

Epidemiology of National Collegiate Athletic Association Women's Lacrosse Injuries, 2009-10 Through 2014-15.

CONTEXT: Participation in collegiate women's lacrosse has increased dramatically, but little recent epidemiological data exists regarding injuries. OBJECTIVE: Describe the epidemiology of National Collegiate Athletic Association (NCAA) women's lacrosse injuries during the 2009-10 through 2014-15 academic years. SETTING: Aggregate injury and exposure data collected from 40 women's lacrosse programs providing 83 team-seasons of data. PATIENTS OR OTHER PARTICIPANTS: Collegiate women's lacrosse student-athletes. INTERVENTION: Women's lacrosse data from the NCAA Injury Surveillance Program were analyzed. MAIN OUTCOME MEASURES: Injury rates; injury rate ratios; and injury proportions by body site, diagnosis, and injury mechanism were reported with 95% confidence intervals (CI). Time loss (TL) injuries resulted in participation restriction time of at least 24 hours. Nontime loss (NTL) injuries resulted in participation restriction time under 24 hours. RESULTS: There were 705 TL and NTL women's lacrosse injuries, resulting in an injury rate of 4.93/1000 athlete-exposures (AEs; 95% CI: 4.57-5.30). The TL and NTL injury rates were 2.18/1000 AE (95% CI: 1.93-2.42) and 2.64/1000 AE (95% CI: 2.37-2.90), respectively. Most injuries were to the lower extremity (competition: 64.4%; practice: 71.2%). Most injuries in competition were sprains (26.0%), contusions (19.6%), and strains (19.2%); most injuries in practice were strains (21.4%), sprains (18.1%), and inflammatory conditions (15.8%). Concussions comprised the highest proportion of head/face injuries (competition: 82.1%; practice: 54.5%). No eye injuries were reported. The highest proportion of injuries were player contact (27.4%) in competitions and noncontact (32.1%) in practices. Contact with the ball and stick comprised 21.5% of competition and 14.0% of practice injuries. CONCLUSIONS: This study is the most robust assessment of collegiate women's lacrosse injuries to date, utilizing surveillance data that includes both TL and NTL injuries. Over half of all injuries were NTL; inclusion of such injuries further highlights the breadth of injuries managed by team medical staff.

The epidemiology of back/neck/spine injuries in National Collegiate Athletic Association men's and women's ice hockey, 2009/2010 to 2014/2015.

This study describes the epidemiology of back/neck/spine injuries in National Collegiate Athletic Association (NCAA) men's and women's ice hockey. Data from 66 NCAA men's and 29 women's ice hockey programmes (total of 147 and 67 team-seasons, respectively) were analysed from the NCAA Injury Surveillance Program during the 2009/2010-2014/2015 academic years. In the study period, 226 and 97 back/neck/spine injuries were reported in men and women, respectively, for injury rates of 0.56 and 0.65/1000 athlete exposures. Injury rates were higher in competitions than practices in men (injury rate ratio [IRR] = 4.22; 95% confidence interval [CI]: 3.24-5.49) and women (IRR = 2.49; 95% CI: 1.67-3.70). Most injuries occurred in the lower back/lumbar spine (men: 52.2%; women: 48.5%). There were notably low rates of fractures and severe spinal injuries for both sexes. This study enhances our understanding of the incidence, mechanisms and factors influencing these injuries and can ultimately lead to more effective injury prevention.

Epidemiology of 3825 injuries sustained in six seasons of National Collegiate Athletic Association men's and women's soccer (2009/2010-2014/2015).

AIM: To describe the epidemiology of National Collegiate Athletic Association (NCAA) men's and women's soccer injuries during the 2009/2010-2014/2015 academic years. METHODS: This descriptive epidemiology study used NCAA Injury Surveillance Program (NCAA-ISP) data during the 2009/2010-2014/2015 academic years, from 44 men's and 64 women's soccer programmes (104 and 167 team seasons of data, respectively). Non-time-loss injuries were defined as resulting in <24 h lost from sport. Injury counts, percentages and rates were calculated. Injury rate ratios (RRs) and injury proportion ratios (IPRs) with 95% CIs compared rates and distributions by sex. RESULTS: There were 1554 men's soccer and 2271 women's soccer injuries with injury rates of 8.07/1000 athlete exposures (AE) and 8.44/1000AE, respectively. Injury rates for men and women did not differ in competitions (17.53 vs 17.04/1000AE; RR=1.03; 95% CI 0.94 to 1.13) or practices (5.47 vs 5.69/1000AE; RR=0.96; 95% CI 0.88 to 1.05). In total, 47.2% (n=733) of men's soccer injuries and 47.5% (n=1079) of women's were non-time loss. Most injuries occurred to the lower extremity and were diagnosed as sprains. Women had higher concussion rates (0.59 vs 0.34/1000AE; RR=1.76; 95% CI 1.32 to 2.35) than men. CONCLUSIONS: Non-time-loss injuries accounted for nearly half of the injuries in men's and women's soccer. Sex differences were found in competition injuries, specifically for concussion. Further study into the incidence, treatment and outcome of non-time-loss injuries may identify a more accurate burden of these injuries.

Rankings of High School Sports Injury Rates Differ Based on Time Loss Assessments.

OBJECTIVE: To examine how injury definition inclusiveness affects the rank order of injury rates in 27 high school (HS) sports. DESIGN: The National Athletic Treatment, Injury and Outcomes Network (NATION) used certified athletic trainers (ATs) to collect injury and athlete-exposure (AE) data in practices and competitions for 27 HS sports during the 2011/2012 to 2013/2014 academic years. Time loss (TL) injuries resulted in ≥24 hours of participation restriction. Nontime loss (NTL) injuries resulted in <24 hours of participation restriction. SETTING: Aggregate injury and exposure data collected from 27 HS sports. PARTICIPANTS: High school student-athletes. INTERVENTIONS: Sports injury data from the National Athletic Treatment, Injury and Outcomes Network. MAIN OUTCOME MEASURES: Time loss and TL + NTL injury rates were calculated. Sport-specific rates were placed in rank order, stratified by gender. RESULTS: Most of the 47 014 injuries reported were NTL (82.8%). Among boys' sports, TL injury rates were greatest in football (3.27/1000AE) and wrestling (2.43/1000AE); TL + NTL injury rates were greatest also in football (15.29/1000AE) and wrestling (11.62/1000AE). Among girls' sports, TL injury rates were greatest in soccer (1.97/1000AE) and basketball (1.76/1000AE); TL + NTL injury rates were greatest in field hockey and lacrosse (both 11.32/1000AE). CONCLUSIONS: The rank order of injury rates and the resulting injury prevention priorities may depend on injury definition inclusiveness, particularly in female HS sports.

Epidemiology of National Collegiate Athletic Association men's and women's tennis injuries, 2009/2010-2014/2015.

BACKGROUND: This study describes the epidemiology of men's and women's tennis injuries reported by the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) during the 2009/2010-2014/2015 academic years. METHODS: Injuries and athlete-exposure (AE) data originated from 19 varsity men's programmes (38 team-seasons); women's tennis data originated from 25 varsity programmes (52 team-seasons). Injury rates, injury rate ratios (IRRs) and injury proportions ratios (IPRs) were reported with 95% CIs. RESULTS: The ISP captured 181 and 227 injuries for men's and women's tennis, respectively, for injury rates of 4.89 and 4.88/1000 AE for men and women, respectively. There were 32.2% and 63.9% reductions in men's and women's tennis practice injury rates between 2009/2010-2011/2012 and 2012/2013-2014/2015, but no reductions in competition injury rates. Competition injury rates were higher than practice injury rates in men's (IRR=2.32; 95% CI 1.72 to 3.13) and women's tennis (IRR=1.77; 95% CI 1.35 to 2.33). Most injuries in men's and women's tennis occurred to the lower extremities (47.0% and 52.4%, respectively), compared with the trunk (16.6% and 17.6%, respectively) and upper extremities (23.8 and 23.8, respectively). CONCLUSIONS: Injury rates in NCAA men's and women's tennis were similar overall. Practice injury rates in men's and women's tennis have declined, although competition rates have not changed. These findings may help inform injury prevention programmes in the future.

College Sports-Related Injuries - United States, 2009-10 Through 2013-14 Academic Years.

Sports-related injuries can have a substantial impact on the long-term health of student-athletes. The National Collegiate Athletic Association (NCAA) monitors injuries among college student-athletes at member schools. In academic year 2013-14, a total of 1,113 member schools fielded 19,334 teams with 478,869 participating student-athletes in NCAA championship sports (i.e., sports with NCAA championship competition) (1). External researchers and CDC used information reported to the NCAA Injury Surveillance Program (NCAA-ISP) by a sample of championship sports programs to summarize the estimated national cumulative and annual average numbers of injuries during the 5 academic years from 2009-10 through 2013-14. Analyses were restricted to injuries reported among student-athletes in 25 NCAA championship sports. During this period, 1,053,370 injuries were estimated to have occurred during an estimated 176.7 million athlete-exposures to potential injury (i.e., one athlete's participation in one competition or one practice). Injury incidence varied widely by sport. Among all sports, men's football accounted for the largest average annual estimated number of injuries (47,199) and the highest competition injury rate (39.9 per 1,000 athlete-exposures). Men's wrestling experienced the highest overall injury rate (13.1 per 1,000) and practice injury rate (10.2 per 1,000). Among women's sports, gymnastics had the highest overall injury rate (10.4 per 1,000) and practice injury rate (10.0 per 1,000), although soccer had the highest competition injury rate (17.2 per 1,000). More injuries were estimated to have occurred from practice than from competition for all sports, with the exception of men's ice hockey and baseball. However, injuries incurred during competition were somewhat more severe (e.g., requiring ≥7 days to return to full participation) than those acquired during practice. Multiple strategies are employed by NCAA and others to reduce the number of injuries in organized sports. These strategies include committees that recommend rule and policy changes based on surveillance data and education and awareness campaigns that target both athletes and coaches. Continued analysis of surveillance data will help to understand whether these strategies result in changes in the incidence and severity of college sports injuries.

Epidemiology of National Collegiate Athletic Association men's and women's swimming and diving injuries from 2009/2010 to 2013/2014.

BACKGROUND: Recent injury data for collegiate-level swimming and diving are limited. This study describes the epidemiology of men's and women's swimming and diving injuries reported by the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) during the 2009/2010 to 2013/2014 academic years. METHODS: Injuries and athlete-exposure (AE) data reported within 9 men's and 13 women's swimming and diving programmes were analysed. Injury rates, injury rate ratios (IRR), and injury proportions by body site, diagnosis and mechanism were reported with 95% CIs. RESULTS: The ISP captured 149 and 208 injuries for men's and women's swimming and diving, respectively, leading to injury rates of 1.54/1000 and 1.71/1000 AEs. Among females, divers had a higher injury rate (2.49/1000 AEs) than swimmers (1.63/1000 AEs; IRR=1.53; 95% CI 1.07 to 2.19). Injury rates for male divers (1.94/1000 AEs) and swimmers (1.48/1000 AEs) did not differ (IRR=1.33; 95% CI 0.85 to 2.31). Most injuries occurred to the shoulder, resulted in strains and were classified as overuse or non-contact. Female swimmers had a higher overuse injury rate (1.04/1000 AEs) than male swimmers (0.66/1000 AEs; IRR=1.58; 95% CI 1.14 to 2.19). Overuse injury rates for female divers (0.54/1000 AEs) and male divers (0.46/1000 AEs) did not differ (IRR=1.16; 95% CI 0.40 to 3.34). Injury rates in 2012/2013-2013/2014 were lower than those in 2009/2010-2011/2012 for women's swimming (IRR=0.70; 95% CI 0.52 to 0.95) and diving (IRR=0.56; 95% CI 0.30 to 1.08), respectively. No time trends existed for men's swimmers or divers. CONCLUSIONS: Shoulder, strain and overuse injuries were common in collegiate men's and women's swimming and diving. Female swimmers were more likely to suffer an overuse injury than male swimmers. In addition, divers may have higher injury rates than swimmers, although small reported numbers warrant additional research.

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.

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.

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.

Development and validation of a movement and activity in physical space score as a functional outcome measure.

OBJECTIVE: To develop and validate a functional measure, the Movement and Activity in Physical Space (MAPS) score, that encompasses both physical activity and environmental interaction. DESIGN: Observational matched-pair cohort with 2-month follow-up. SETTING: General community under free-living conditions. PARTICIPANTS: Adult participants (N=18; n=9 postsurgical, n=9 matched control; mean age ± SD, 28.9 ± 12.0y) were monitored by an accelerometer and global positioning system receiver for 3 days within 1 week (4.1 ± 2.8d) after knee surgery (T=0) and 2 months later (T+2). The healthy controls were matched for age, sex, smoking, perceived physical activity level, and occupation of a postsurgical participant. Correlation, t test (with Bonferroni adjustment: α=.05/2), analysis of variance, and intraclass correlation coefficient were used to establish validity and reliability evidence. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: MAPS scores. RESULTS: MAPS scores were moderately correlated with the Knee Injury and Osteoarthritis Outcome Score (P<.05). There was a significant group difference at T = 0 for MAPS (t(9.9)=-3.60; P=.01). Analysis of variance results for the MAPS indicated a time and group interaction (F(1,12)=4.60, P=.05). Reliability of 3 days of MAPS scores ranged from 0.75 to 0.81 (postsurgical and control), and 2-month test-retest reliability in the control group was 0.94. CONCLUSIONS: The results provide a foundation of convergent and known-group difference validity evidence along with reliability evidence for the use of MAPS as a functional outcome measure.

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.

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).

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.

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.