Microbial and chemical contamination during and after flooding in the Ohio River-Kentucky, 2011.

Surface water contaminants in Kentucky during and after 2011 flooding were characterized. Surface water samples were collected during flood stage (May 2-4, 2011; n = 15) and after (July 25-26, 2011; n = 8) from four different cities along the Ohio River and were analyzed for the presence of microbial indicators, pathogens, metals, and chemical contaminants. Contaminant concentrations during and after flooding were compared using linear and logistic regression. Surface water samples collected during flooding had higher levels of E. coli, enterococci, Salmonella, Campylobacter, E. coli O157:H7, adenovirus, arsenic, copper, iron, lead, and zinc compared to surface water samples collected 3-months post-flood (P < 0.05). These results suggest that flooding increases microbial and chemical loads in surface water. These findings reinforce commonly recommended guidelines to limit exposure to flood water and to appropriately sanitize contaminated surfaces and drinking wells after contamination by flood water.

Assessing Female Suicide From a Health Equity Viewpoint, U.S. 2004-2018.

INTRODUCTION: Geographic and urbanization differences in female suicide trends across the U.S. necessitates suicide prevention efforts on the basis of geographic variations. The purpose of this study was to assess female suicide rates by mechanism within Census divisions and by urbanicity to help inform geographically tailored approaches for suicide prevention strategies. METHODS: Data from 2004 to 2018 were obtained from the National Vital Statistics System (analyzed in 2021). Annual counts of female suicides were tabulated for firearm, suffocation, and drug poisoning and stratified by the U.S. Census division and urbanicity. Age-adjusted rates were calculated to describe female suicide incidence by geographic areas and urbanicity. Data were analyzed annually and by 5-year timeframes. Trends in annual female suicide rates by mechanism for 3 urbanization levels were identified using Joinpoint Regression. Annual percent change estimates were calculated for age-adjusted female suicide rates between 2004 and 2018. RESULTS: Female suicide rates by mechanism were not homogeneous within Census divisions or by urbanization levels. Suicide rates by mechanism across Census divisions within the same urbanization level varied (range=3.38-11.15 [per 100,000 person per year]). From 2014 to 2018 in large metropolitan areas in the northern divisions, rates for suffocation were higher than for firearms and drug poisoning. During the same period, in all urbanization levels in southern divisions, rates for firearms were higher than for suffocation and drug poisoning. CONCLUSIONS: Female suicide mechanisms vary by urbanization level, and this variation differs by region. These results could inform female suicide prevention strategies on the basis of mechanism, urbanization, and geographic region.

Epidemiology of US high school sports-related fractures, 2005-2009.

OBJECTIVE: To describe the epidemiology of fractures among US high school athletes participating in 9 popular sports. DESIGN: Descriptive epidemiologic study. SETTING: Sports injury data for the 2005-2009 academic years were collected using an Internet-based injury surveillance system, Reporting Information Online (RIO). PARTICIPANTS: A nationally representative sample of 100 US high schools. ASSESSMENT OF RISK FACTORS: Injuries sustained as a function of sport and sex. MAIN OUTCOME MEASURES: Fracture injury rates, body site, outcome, surgery, and mechanism. RESULTS: Fractures (n = 568 177 nationally) accounted for 10.1% of all injuries sustained by US high school athletes. The highest rate of fractures was in football (4.61 per 10 000 athlete exposures) and the lowest in volleyball (0.52). Boys were more likely than girls to sustain a fracture in basketball (rate ratio, 1.35,; 95% confidence interval, 1.06-1.72) and soccer (rate ratio, 1.34; 95% confidence interval, 1.05-1.71). Overall, the most frequently fractured body sites were the hand/finger (28.3%), wrist (10.4%), and lower leg (9.3%). Fractures were the most common injury to the nose (76.9%), forearm (56.4%), hand/finger (41.7%), and wrist (41.6%). Most fractures resulted in >3 weeks' time lost (34.3%) or a medical disqualification from participation (24.2%) and were more likely to result in >3 weeks' time lost and medical disqualification than all other injuries combined. Fractures frequently required expensive medical diagnostic imaging examinations such as x-ray, computed tomographic scan, and magnetic resonance imaging. Additionally, 16.1% of fractures required surgical treatment, accounting for 26.9% of all injuries requiring surgery. Illegal activity was noted in 9.3% of all fractures with the highest proportion of fractures related to illegal activity in girls' soccer (27.9%). CONCLUSIONS: Fractures are a major concern for US high school athletes. They can severely affect the athlete's ability to continue sports participation and can impose substantial medical costs on the injured athletes' families. Targeted, evidence-based, effective fracture prevention programs are needed.

Compliance with return to play guidelines following concussion in US high school athletes, 2005-2008.

PRIMARY OBJECTIVE: To determine whether US concussed high school athletes complied with recommended return-to-play guidelines during the 2005-2008 school years. RESEARCH DESIGN: Prospective cohort study in 100 nationally-representative US high schools. METHODS AND PROCEDURES: Certified athletic trainers submitted injury reports for concussed athletes in five boys' (football, soccer, basketball, wrestling, baseball) and four girls' (soccer, basketball, volleyball, softball) sports via High School RIO (Reporting Information Online). Concussions were retrospectively graded and it was determined whether athletes followed American Academy of Neurology (AAN) or Prague return-to-play guidelines. MAIN OUTCOMES AND RESULTS: There were 1308 concussions reported during 5 627 921 athlete-exposures (23.2 concussions per 100 000 athlete-exposures), reflecting an estimated 395 274 concussions sustained nationally. At least 40.5% and 15.0% of concussed athletes returned to play prematurely under AAN and Prague return-to-play guidelines, respectively. In football, 15.8% of athletes sustaining a concussion that resulted in loss-of-consciousness returned to play in <1 day. Males (12.6%) were more likely than females (5.9%) to return 1-2 days after sustaining an initial grade II concussion. CONCLUSIONS: Too many adolescent athletes are failing to comply with recommended return-to-play guidelines. Sports medicine professionals, parents, coaches and sports administrators must work together to ensure athletes follow recommended guidelines.

Effects of field location, time in competition, and phase of play on injury severity in high school football.

This study evaluated the effects of competitive intensity, represented by the variables time in competition, phase of play, and field location, on injury severity in U.S. high school football. The injury rate was higher in competition than practice (RR = 4.75, 95% CI: 4.34-5.20). Mild and moderate injuries were frequently lower leg/foot/ankle sprains/strains and concussions. Severe injuries were frequently knee Sprains/strains and arm fractures. Severe injuries composed a greater proportion of injuries sustained during the beginning and middle of competition compared with injuries sustained during the end/overtime (IPR = 1.83, 95% CI: 1.25-2.69). Compared with injuries sustained during general play, a greater proportion of kickoff/punt injuries were severe (IPR = 1.69, 95% CI: 1.07-2.68) or were concussions (IPR = 1.86, 95% CI: 1.05-3.30). Identifying factors contributing to severe injury is a crucial first step toward developing targeted evidence-based interventions aimed at reducing the incidence of severe injuries among the millions of high school football players.

Pediatric martial arts injuries presenting to Emergency Departments, United States 1990-2003.

Although an estimated 6.5 million United States (US) children aged 6-17 practiced a martial art in 2004, there have been no nationally representative studies comparing pediatric injuries among the three most popular disciplines, karate, taekwondo, and judo. Describe pediatric martial arts injuries presenting to a representative sample of US Emergency Departments (EDs) from 1990 to 2003. We reviewed all martial arts injuries captured by the US Consumer Product Safety Commission's (CPSC), National Electronic Injury Surveillance System (NEISS). An estimated 128,400 children

Effectiveness of Using Cellular Phones to Transmit Real-Time Shelter Morbidity Surveillance Data After Hurricane Sandy, New Jersey, October to November, 2012.

Timely morbidity surveillance of sheltered populations is crucial for identifying and addressing their immediate needs, and accurate surveillance allows us to better prepare for future disasters. However, disasters often create travel and communication challenges that complicate the collection and transmission of surveillance data. We describe a surveillance project conducted in New Jersey shelters after Hurricane Sandy, which occurred in November 2012, that successfully used cellular phones for remote real-time reporting. This project demonstrated that, when supported with just-in-time morbidity surveillance training, cellular phone reporting was a successful, sustainable, and less labor-intensive methodology than in-person shelter visits to capture morbidity data from multiple locations and opened a two-way communication channel with shelters. (Disaster Med Public Health Preparedness. 2015;10:525-528).

Epidemiology of 10,000 high school football injuries: patterns of injury by position played.

BACKGROUND: With more than 1.1 million high school athletes playing annually during the 2005-06 to 2009-10 academic years, football is the most popular boys' sport in the United States. METHODS: Using an internet-based data collection tool, RIO, certified athletic trainers (ATs) from 100 nationally representative US high schools reported athletic exposure and football injury data during the 2005-06 to 2009-10 academic years. RESULTS: Participating ATs reported 10,100 football injuries corresponding to an estimated 2,739,187 football-related injuries nationally. The injury rate was 4.08 per 1000 athlete-exposures (AEs) overall. Offensive lineman collectively (center, offensive guard, offensive tackle) sustained 18.3% of all injuries. Running backs (16.3%) sustained more injuries than any other position followed by linebackers (14.9%) and wide receivers (11.9%). The leading mechanism of injury was player-player contact (64.0%) followed by player-surface contact (13.4%). More specifically, injury occurred most commonly when players were being tackled (24.4%) and tackling (21.8%). CONCLUSIONS: Patterns of football injuries vary by position. Identifying such differences is important to drive development of evidence-based, targeted injury prevention efforts.

A multisport epidemiologic comparison of anterior cruciate ligament injuries in high school athletics.

BACKGROUND: The knee joint is the second most commonly injured body site after the ankle and the leading cause of sport-related surgeries. Knee injuries, especially of the anterior cruciate ligament (ACL), are among the most economically costly sport injuries, frequently requiring expensive surgery and rehabilitation. OBJECTIVE: To investigate the epidemiology of ACL injuries among high school athletes by sport and sex. DESIGN: Descriptive epidemiology study. MAIN OUTCOME MEASURE(S): Using an Internet-based data-collection tool, Reporting Information Online (RIO), certified athletic trainers from 100 nationally representative US high schools reported athlete-exposure and injury data for athletes from 9 sports during the 2007/08-2011/12 academic years. The outcome of interest in this study was ACL injuries. RESULTS: During the study period, 617 ACL injuries were reported during 9 452 180 athlete exposures (AEs), for an injury rate of 6.5 per 100 000 AEs. Nationally, in the 9 sports studied, an estimated 215 628 ACL injuries occurred during the study period. The injury rate was higher in competition (17.6) than practice (2.4; rate ratio [RR] = 7.3, 95% confidence interval [CI] = 6.08, 8.68). Girls' soccer had the highest injury rate (12.2) followed by boys' football (11.1), with boys' basketball (2.3) and boys' baseball (0.7) having the lowest rates. In sex-comparable sports, girls had a higher rate (8.9) than boys (2.6; RR = 3.4, 95% CI = 2.64, 4.47). Overall, 76.6% of ACL injuries resulted in surgery. The most common mechanisms of injury were player-to-player contact (42.8%) and no contact (37.9%). CONCLUSIONS: Anterior cruciate ligament injury rates vary by sport, sex, and type of exposure. Recognizing such differences is important when evaluating the effectiveness of evidence-based, targeted prevention efforts.

Human aflatoxin exposure in Kenya, 2007: a cross-sectional study.

Aflatoxins contaminate approximately 25% of agricultural products worldwide. They can cause liver failure and liver cancer. Kenya has experienced multiple aflatoxicosis outbreaks in recent years, often resulting in fatalities. However, the full extent of aflatoxin exposure in Kenya has been unknown. Our objective was to quantify aflatoxin exposure across Kenya. We analysed aflatoxin levels in serum specimens from the 2007 Kenya AIDS Indicator Survey - a nationally representative, cross-sectional serosurvey. KAIS collected 15,853 blood specimens. Of the 3180 human immunodeficiency virus-negative specimens with ≥1 mL sera, we randomly selected 600 specimens stratified by province and sex. We analysed serum specimens for aflatoxin albumin adducts by using isotope dilution MS/MS to quantify aflatoxin B1-lysine, and normalised with serum albumin. Aflatoxin concentrations were then compared by demographic, socioeconomic and geographic characteristics. We detected serum aflatoxin B1-lysine in 78% of serum specimens (range =

Mercury exposure among artisanal gold miners in Madre de Dios, Peru: a cross-sectional study.

INTRODUCTION: Exposure to mercury, a toxic metal, occurs primarily from inhaling mercury vapors or consuming methylmercury-contaminated fish. One third of all anthropogenic mercury emissions worldwide are from artisanal gold mining, which uses mercury to extract gold. Although recent reports suggest that the Madre de Dios region in Peru (with >30,000 artisanal miners) has extensive mercury contamination, residents had never been assessed for mercury exposure. Thus, our objective was to quantify mercury exposure among residents of an artisanal mining town in Madre de Dios and to assess risk factors for exposure. METHODS: We conducted a cross-sectional assessment of 103 residents of an artisanal gold mining town in July 2010. Each participant provided a urine and blood sample and completed a questionnaire assessing potential exposures and health outcomes. We calculated geometric mean (GM) urine total mercury and blood methylmercury concentrations and compared log-transformed concentrations between subgroups using linear regression. RESULTS: One third (34.0 %) of participants were gold miners. All participants had detectable urine total mercury (GM, 5.5 µg/g creatinine; range, 0.7-151 µg/g creatinine) and 91 % had detectable blood methylmercury (GM, 2.7 µg/L; range, 0.6-10 µg/L); 13 participants (13 %) reported having kidney dysfunction or a neurological disorder. Urine total mercury concentrations were higher among people who heated gold-mercury amalgams compared with people who never heated amalgams (p < 0.05); methylmercury concentrations were higher among fish consumers compared with nonfish consumers (p < 0.05). CONCLUSION: Our findings suggest that mercury exposure may be widespread in Huaypetue.

The Epidemiology of Pediatric Basketball Injuries Presenting to US Emergency Departments: 2000-2006.

BACKGROUND: There is limited published research on the epidemiology of basketball injuries treated in US emergency departments (EDs). HYPOTHESIS: Age and sex patterns exist for the most common pediatric basketball injuries treated in EDs. STUDY DESIGN: Descriptive epidemiology study. METHODS: Data from the National Electronic Injury Surveillance System and the National Sporting Goods Association were used to calculate national injury incidence rates and 95% confidence intervals of pediatric basketball injuries. RESULTS: An estimated 325 465 annual visits were made to US EDs for pediatric basketball-related injuries from 2000 to 2006. The 5 most common injuries were ankle sprains (21.7%), finger sprains (8.0%), finger fractures (7.8%), knee sprains (3.9%), and facial lacerations (3.9%). Among persons aged 12 to 17 years, girls had a higher rate of knee sprains than boys (P < 0.001), but this association did not exist among those aged 7 to 11 years (P = 0.27). Boys had a higher rate of facial lacerations than girls (P < 0.01). Among persons aged 12 to 17 years, girls had a higher rate of finger sprains (P < 0.01). For both boys and girls, the rate of the 5 most common basketball injuries was higher among those aged 12 to 17 years compared with those aged 7 to 11 years (P < 0.01). CONCLUSIONS: The annual number of basketball-related pediatric ED visits approaches a third of a million and demonstrates the extent of the public health problem that injuries in this sport pose. Distinct sex and age patterns were observed. CLINICAL RELEVANCE: The study findings provide important information on basketball injury rates that may be used for targeting prevention interventions by sex and age group.

Incidence of thyroid disease following exposure to polybrominated biphenyls and polychlorinated biphenyls, Michigan, 1974-2006.

Thyroid hormones, which influence body metabolism and development, could be affected by persistent organic pollutants. We sought to examine the relationship between polybrominated biphenyls (PBBs) and polychlorinated biphenyls (PCBs) and thyroid disease. We employed incidence density sampling to perform a nested case control analysis of the Michigan Long-Term PBB Cohort. Cohort members (n=3333) were exposed to PBBs through contaminated cattle feed in 1973-1974 and to PCBs through daily life. Those with detectable serum PBB and PCB concentrations at enrollment were categorized into tertiles of PBB and PCB exposure. Case-patients were cohort members answering "Yes" to "Has a healthcare provider ever told you that you had a thyroid problem?" during follow-up interviews; control-patients were cohort members answering "No". We used odds ratios (OR) with 95% confidence intervals (CI) to compare odds of thyroid disease by PBB and PCB exposure and by various risk factors. Total cumulative thyroid disease incidence after 33 years was 13.9% among women and 2.6% among men. After adjusting for body mass index, we found no statistically significant differences in odds of any type of thyroid disease among women or men with elevated PBB or PCB exposure. Compared to control-patients, women with thyroid disease had increased odds of being overweight/obese (OR=2.82, 95% CI: 1.94-4.11) and developing infertility (OR=1.71, 95% CI: 1.08-2.69), diabetes (OR=1.61, 95% CI: 1.04-2.51), or arthritis (OR=1.71, 95% CI: 1.18-2.50) during follow-up. Additional research should explore potential associations between PBBs/PCBs and thyroid disease among children exposed in utero.

Football-related injuries among 6- to 17-year-olds treated in US emergency departments, 1990-2007.

Football is one of the most popular youth sports in the United States despite the high rate of injuries. Previously published studies have investigated football-related injuries that occurred in organized play but have excluded those that occurred during unorganized play. Through use of the National Electronic Injury Surveillance System database, cases of football-related injuries were identified for analysis. Sample weights were used to calculate national estimates. An estimated 5 252 721 children and adolescents 6 to 17 years old were treated in US emergency departments for football-related injuries. The annual number of cases increased by 26.5% over the 18-year study period. The 12- to 17-year-old age group accounted for 77.8% of all injuries and had nearly twice the odds of sustaining a concussion. The findings suggest the need for increased prevention efforts to lower the risk of football-related injury in children and adolescents.

Shoulder injuries in US high school baseball and softball athletes, 2005-2008.

OBJECTIVE: The objective of this study was to determine factors that are involved in shoulder injury rates among high school athletes who participate in organized baseball and softball. METHODS: Baseball- and softball-related injury data were collected during the 2005-2008 academic years from approximately 74 nationally representative high schools via High School Reporting Information Online. RESULTS: Certified athletic trainers reported 91 baseball shoulder injuries and 40 softball shoulder injuries during 528147 and 399522 athlete exposures, respectively. The injury rate was 1.72 injuries per 10000 athlete exposures for baseball and 1.00 injuries per 10000 athlete exposures for softball. Muscle strain/incomplete tears were the most common injuries in both baseball (30.8%) and softball (35.0%). In practices, throwing, not including pitching, caused more than half of softball injuries (68.2%) as compared with competition injuries (23.5%; injury proportion ratio [IPR]: 2.90 [95% confidence interval (CI): 1.17-7.15]; P = .015), whereas pitching was the most common mechanism in causing shoulder injuries during baseball practice (41.9%) compared with competitions (25.6%; IPR: 1.64 [95% CI: 0.88-3.04]; P = .17). Eighty-one percent of the baseball shoulder injuries and 82.5% of the softball shoulder injuries were new. Ten percent of baseball athletes and 5.3% of softball athletes sustained injuries that required surgery (IPR: 1.40 [95% CI: 0.32-6.10]; P = .93). Injuries that were sustained while the athlete was on the pitcher's mound were significantly more likely to result in surgery than any other field position (IPR: 2.64 [95% CI: 1.65-4.21]; P = .0061). Injured baseball players were more than twice as likely to be pitchers. CONCLUSIONS: Although rates and patterns of shoulder injuries are similar between baseball and softball players, injury rates and patterns differ between field positions within each sport, as well as by injury severity and the athletes' year in school.

Heat illness among high school athletes--United States, 2005-2009.

INTRODUCTION: Heat illness is a leading cause of death and disability among U.S. high school athletes. METHODS: To examine the incidence and characteristics of heat illness among high school athletes, CDC analyzed data from the National High School Sports-Related Injury Surveillance Study for the period 2005-2009. RESULTS: During 2005-2009, the 100 schools sampled reported a total of 118 heat illnesses among high school athletes resulting in ≥1day of time lost from athletic activity, a rate of 1.6 per 100,000 athlete-exposures, and an average of 29.5 time-loss heat illnesses per school year. The average corresponds to a weighted average annual estimate of 9,237 illnesses nationwide. The highest rate of time-loss heat illness was among football players, 4.5 per 100,000 athlete-exposures, a rate 10 times higher than the average rate (0.4) for the eight other sports. Time-loss heat illnesses occurred most frequently during August (66.3%) and while practicing or playing football (70.7%). No deaths were reported. CONCLUSIONS: Consistent with guidelines from the National Athletic Trainers' Association, to reduce the risk for heat illness, high school athletic programs should implement heat-acclimatization guidelines (e.g., set limits on summer practice duration and intensity). All athletes, coaches, athletic trainers, and parents/guardians should be aware of the risk factors for heat illness, follow recommended strategies, and be prepared to respond quickly to symptoms of illness. Coaches also should continue to stress to their athletes the importance of maintaining proper hydration before, during, and after sports activities. IMPACT OF INDUSTRY: By implementing preventive recommendations and quickly recognizing and responding to heat illness, coaches, athletic trainers, and the sporting community can prevent future deaths.

Patients with ice hockey injuries presenting to US emergency departments, 1990-2006.

CONTEXT: Although the number of US ice hockey participants doubled from 1990 to 2006, no nationally representative studies have examined US ice hockey injuries among participants of all ages during this period. OBJECTIVE: To describe patients with ice hockey injuries presenting to a representative sample of US emergency departments (EDs) from 1990 through 2006. DESIGN: Prospective injury surveillance study. SETTING: The US Consumer Product Safety Commission collects data from 100 nationally representative EDs via the National Electronic Injury Surveillance System (NEISS). PATIENTS OR OTHER PARTICIPANTS: Individuals injured while playing ice hockey and presenting to a NEISS-affiliated ED from 1990 through 2006. MAIN OUTCOME MEASURE(S): Incidence and patterns of ice hockey-related injuries. RESULTS: From 1990 through 2006, 8228 patients with ice hockey-related injuries presented to NEISS-affiliated EDs, representing an estimated 302 368 ice hockey-related injuries sustained nationally during this time. Injuries occurred predominantly among males (93.5%). More than half of the injured were aged 9 to 14 years (28.9%) or 15 to 18 years (30.1%), and injury incidence in these age groups increased over the study period (P  =  .009 and P < .001, respectively). The most commonly injured body sites were the face (19.1%), wrist/hand/finger (14.1%), shoulder/upper arm (13.8%), and lower leg/ankle/foot (11.1%). Lacerations (27.0%), contusions/abrasions (23.6%), fractures (17.3%), and sprains/strains (16.9%) were the most common injuries. Falls (16.5%), contact with boards (13.6%), and contact with stick (13.0%) were the most common injury mechanisms. Compared with those aged 9 to 18 years, those aged 2 to 8 years and those older than 18 years sustained larger proportions of face (injury proportion ratio [IPR]  =  2.66; 95% confidence interval [CI]  =  2.29, 3.08) and mouth (IPR  =  4.34; 95% CI  =  2.87, 6.56) injuries. Concussions were more common among those aged 2 to 18 years (9.0%) than in those who were older than 18 years (3.7%) (IPR  =  2.47; 95% CI  =  1.75, 3.49). CONCLUSIONS: Ice hockey injury patterns vary by age and sex. Our findings indicate that many trips to the ED might be prevented by using protective equipment appropriately.

An epidemiologic comparison of injuries presenting to a pediatric emergency department and local urgent care facilities.

PROBLEM: The objective of this study was to compare the epidemiology of injuries presenting to emergency department (ED) and urgent care (UC) facilities of a single, NEISS-affiliated hospital. METHOD: Patient medical records (n=36,811) were used to compare injury incidence, injury characteristics, and demographic characteristics between the ED, on-site UC, and off-site UC during 2006. RESULTS: ED presentations were more likely to be open wounds and motor vehicle-related compared to on-site UC presentations. ED presentations were more likely to be system wide/late effects, be made by an African American, or be paid through Medicaid compared to off-site UC presentations. On-site UC presentations were more likely to be made by an African American or be paid through Medicaid compared to off-site UC presentations. DISCUSSION: ED and UC injury characteristics and patient demographics differ. With no nationally-representative UC injury surveillance, current research likely underestimates injury incidence and presents skewed profiles. IMPACT ON INDUSTRY: This article adds insight into the generalizability of ED-based injury surveillance to UC injuries.

Patterns of recurrent injuries among US high school athletes, 2005-2008.

BACKGROUND: High school sports participants sustain millions of injuries annually; many are recurrent injuries that can be more severe than new injuries. HYPOTHESIS: Recurrent injury patterns differ from new injury patterns by sport and gender. STUDY DESIGN: Descriptive epidemiology study. METHODS: High school sports injury data for the 2005 through 2008 academic years were collected via High School Reporting Information Online (RIO) from a nationally representative sample of 100 US high schools. RESULTS: From 2005 through 2008, certified athletic trainers reported 13 755 injuries during 5,627,921 athlete exposures (24.4 injuries per 10,000 athlete exposures). Recurrent injuries accounted for 10.5% of all injuries. Football players had the highest rate of recurrent injury (4.36 per 10,000 athlete exposures). Girls had higher rates of recurrent injuries than boys in soccer (injury rate ratio = 1.39; 95% confidence interval, 1.07-1.82). Recurrent injuries most often involved the ankle (28.3%), knee (16.8%), head/ face (12.1%), and shoulder (12.0%), and were most often ligament sprains (incomplete tears) (34.9%), muscle strains (incomplete tears) (13.3%), and concussions (11.6%). A greater proportion of recurrent injuries than new injuries resulted in the student choosing to end participation (recurrent = 2.4%, new = 0.7%). Recurrent shoulder injuries were more likely to require surgery than new shoulder injuries (injury proportion ratio = 4.51; 95% confidence interval, 2.82-7.20). CONCLUSION: Recurrent injury rates and patterns differed by sport. Because recurrent injuries can have severe consequences on an athlete's health and future sports participation, injury prevention must be a priority. Knowledge of injury patterns can drive targeted preventive efforts.

Epidemiology of severe injuries among United States high school athletes: 2005-2007.

BACKGROUND: Over 7 million students participate in high school athletics annually. Despite numerous health benefits, high school athletes are at risk for injury. HYPOTHESIS: Severe injury rates and patterns differ by gender and type of exposure. Study Design Descriptive epidemiology study. METHODS: Sports-related injury data were collected during the 2005-2007 academic years from 100 nationally representative United States high schools via RIO (Reporting Information Online). Severe injury was defined as any injury that resulted in the loss of more than 21 days of sports participation. RESULTS: Participating certified athletic trainers (ATCs) reported 1378 severe injuries during 3 550 141 athlete-exposures (0.39 severe injuries per 1000 athletic exposures). Football had the highest severe injury rate (0.69), followed by wrestling (0.52), girls' basketball (0.34), and girls' soccer (0.33). The rate in all boys' sports (0.45) was higher than all girls' sports (0.26) (rate ratio [RR], 1.74; 95% confidence interval [CI], 1.54-1.98; P < .001). However, among directly comparable sports (soccer, basketball, and baseball/softball), girls sustained a higher severe injury rate (0.29) than boys (0.23) (RR, 1.28; 95% CI, 1.08-1.52; P = .006). More specifically, girls' basketball had a higher rate (0.34) than boys' basketball (0.24) (RR, 1.43; 95% CI, 1.10-1.86; P = .009). Differences between boys' and girls' soccer and baseball/softball were not statistically significant. The severe injury rate was greater in competition (0.79) than practice (0.24) (RR, 3.30; 95% CI, 2.97-3.67; P < .001). Nationally, high school athletes sustained an estimated 446 715 severe injuries from 2005-2007. The most commonly injured body sites were the knee (29.0%), ankle (12.3%), and shoulder (10.9%). The most common diagnoses were fractures (36.0%), complete ligament sprains (15.3%), and incomplete ligament sprains (14.3%). Of severe sports injuries, 0.3% resulted in medical disqualification for the athletes' career, and an additional 56.8% resulted in medical disqualification for the entire season. One in 4 (28.3%) severe injuries required surgery, with over half (53.9%) being knee surgeries. CONCLUSION: Severe injury rates and patterns varied by sport, gender, and type of exposure. Because severe injuries negatively affect athletes' health and often place an increased burden on the health care system, future research should focus on developing interventions to decrease the incidence and severity of sports-related injuries.