Cricket injury in New Zealand: a study of injury insurance claims from 2008 to 2018.

OBJECTIVES: This study aimed to quantify injury claims in organised community cricket in New Zealand over a 10-year period, 1 July, 2008 to June 30, 2018. DESIGN: Retrospective analysis of administrative insurance claims data from the Accident Compensation Corporation (ACC), New Zealand. METHODS: Injury claims relating to cricket in males and females in New Zealand were identified from coded data and relevant text searches of routinely collected claims data. Summary statistics for key variables (age, body part, injury type, and injury factors) are presented together with annual injury claim incidence rates (ICR) calculated using population-based denominators. RESULTS: There were 62,776 claims for cricket injury occurring at a place of recreation/sports. Most claims were in males (91.4%) and those aged 15-19 year old age group. There was an increase in the total number of injury claims over the 10-year period (1.5%, p = 0.04), but the ICR was consistent (males: varying between 258.8-304.8, and females: 22.6-28.3 claims annually per 100,000 population). Soft tissue injury claims were the most common injury type. Lumbosacral claims were most common for bowlers (78%). Lower limb injury claims were the predominant claim from batting (36%) and fielding (42%), with knee injury claims (34%) being the most common lower-limb injury location. CONCLUSIONS: Lumbosacral, shoulder and knee injuries were common amongst all playing positions and worthy of preventative attention. Strategies targeting prevention of these injuries may reduce the ICR within the ACC.

Injury Risk in New Zealand Rugby Union: A Nationwide Study of Injury Insurance Claims from 2005 to 2017.

OBJECTIVES: The Accident Compensation Corporation is a compulsory, 24-h, no-fault personal injury insurance scheme in New Zealand. The purpose of this large-scale retrospective cohort study was to use Accident Compensation Corporation records to provide information about rugby injury epidemiology in New Zealand, with a focus on describing differences in risk by age and gender. METHODS: A total of 635,657 rugby injury claims were made to the Accident Compensation Corporation for players aged 5-40 years over the period 2005-2017. Information about player numbers and estimates of player exposure was obtained from New Zealand Rugby, the administrative organisation for rugby in New Zealand. RESULTS: Over three quarters of claims (76%) were for soft-tissue injuries, with 11% resulting from fractures or dislocations, 6.7% from lacerations, 3.1% from concussions and 2.0% from dental injuries. Body regions injured included shoulder (14%), knee (14%), wrist/hand (13%), neck/spine (13%), head/face (12%), leg (11%) and ankle (10%). The probability of a player making at least one injury claim in a season (expressed as a percentage) was calculated under the assumption that the incidence of claims follows a Poisson distribution. Players aged 5-6 years had a probability of making at least one claim per season of 1.0%, compared to 8.3% for players aged 7-12 years, 35% for age 13-17 years, 53% for age 18-20 years, 57% for age 21-30 years and 47% for age 31-40 years. The overall probability of making at least one claim per season across all age groups was 29%. The relative claim rate for adults (players aged 18 years and over) was 3.92 (90% confidence interval 3.90-3.94) times that of children. Ten percent of players were female, and they sustained 6% of the injuries. Overall, the relative claim rate for female players was 0.57 times that of male players (90% confidence interval 0.56-0.58). The relative claim rate of female to male players tended to increase with age. There were very few female players aged over 30 years; however, those who did play had higher claim rates than male players of the same age group (1.49; 90% confidence interval 1.45-1.53). CONCLUSIONS: Injuries resulting from rugby are distributed across the body, and most of the claims are for soft-tissue injuries. Rates of injury increase rapidly through the teenage years until the early 20 s; for male players they then decrease until the mid-30 s. For female players, the injury rate does not decrease as players move into their 30 s. Combining Accident Compensation Corporation injury claim data with national player registration data provides useful information about the risks faced by New Zealand's community rugby players, and the insights derived are used in the development of rugby injury prevention programme content.

Correction to: Injury Risk in New Zealand Rugby Union: A Nationwide Study of Injury Insurance Claims from 2005 to 2017.

Page 11, column 2, section 4.2 Injury Epidemiology, paragraph 4.

Neck back and spine injuries in amateur rugby league: a review of nine years of Accident Compensation Corporation injury entitlement claims and costs.

Rugby league is a popular participation sport, but there have been concerns raised regarding the possible high number of severe neck, back and spine injuries. Therefore an epidemiological overview of rugby league neck, back and spine injuries and associated costs of these injuries was undertaken in one country over nine years. The New Zealand national Accident Compensation Corporation data for moderate to serious injury entitlement claims (MSC) over nine years were analysed for the number, type and cost of neck, back and spine rugby league injuries resulting in medical treatment. There were 206 (3%) neck, back and spine MSC claims totalling NZD$1,585,927 (4%) of the total injury entitlement costs for rugby league over the nine-year period. The rate of MSC neck, back and spine rugby league injuries was 26 per 1000 total rugby league claims. Although the rate of neck, back and spine injuries varied over the nine years from 22 to 40 per 1000 injury claims, there was a significant increase over the duration of the study in the number of neck, back and spine MSC claims (χ2=849, df=8, p<0.001), and the cost per MSC injury claim (χ2=19,054, df=8, p<0.001). The frequency, severity and first 12 months cost of neck, back and spine injuries in rugby league is an issue that needs to be addressed. Unfortunately the ACC data base does not provide information on how or why the injuries occurred. A prospective injury epidemiology study needs to be conducted that will allow collection of information surrounding the mechanisms of injury and possible causative risk factors such as tackling technique. In the meantime it is suggested that coaches should ensure tackling technique is correctly taught to all rugby league players to reduce the risk of neck, back and spine injury. Team medical personnel should be trained in dealing with neck and spine injuries as well as head related injuries, and emergency procedures in dealing with players with a suspected neck or back injury should be practiced at clubs.

Efficacy of injury prevention related coach education within netball and soccer.

In 2004, Netball New Zealand and New Zealand Football adapted a generic 10-point action plan for sports injury prevention, SportSmart, to create NetballSmart and SoccerSmart, as part of their coach education programmes. A small-size descriptive study was conducted in both sports, to assess the efficacy of integrating sports injury prevention into coach education. NetballSmart was evaluated at the end of 2005, via a telephone survey of 217 coaches (53% response rate) who had attended a NetballSmart course earlier in the year. SoccerSmart was evaluated at the start of 2007, via an Internet questionnaire completed by 71 coaches (20% response rate) who had attended a SoccerSmart course in 2006. The evaluations focused on the quality and use of the course resource material, as well as assessing the extent to which coaches had incorporated injury prevention behaviours into player practices. After attending a NetballSmart course, 89% of coaches changed the way they coached, with 95% reported using knowledge from the course and passing it on to players. Ninety-six percent of football/soccer coaches also changed the way they coached, with most change relating to warm-up/cool-down and stretch (65%), technique (63%), fitness (60%) and nutrition/hydration (58%) practices. Although this was a descriptive study in nature, with a small sample size, we conclude that integration of injury prevention content within coach education courses and resources may be a viable and effective strategy to help community coaches--and therefore community players--help reduce their risk of injury.

Incidence of anterior cruciate ligament injury and other knee ligament injuries: a national population-based study.

There has been an intensive research effort directed at determining the cause of non-contact anterior cruciate ligament (ACL) injury over the past decade, but few studies have reported data on the incidence of ACL and other knee ligament injury in the general population. New Zealand's no-fault injury compensation data provides a national injury resource of data on claims for knee ligament injury. The goal of this paper was to provide a descriptive epidemiology of knee ligament injury in this country. Data were obtained for knee ligament injuries between 1 July 2000 and 30 June 2005. Injuries were categorised as non-surgical (NS), ACL surgeries (ACLS) and other knee ligament surgeries (OKLS). Incidence rates per 100,000 person-years were computed using population estimates. Costs and number of treatment/rehabilitation visits were obtained as an indication of severity. The incidence rate per 100,000 person-years was 1147.1 for NS, 36.9 for ACLS and 9.1 for OKLS. Males had a higher incidence rate than females for NS, ACLS, and OKLS. The mean (and median) number of treatment visits were NS: 6.6 (4), ACLS: 27.1 (24), and OKLS: 31.3 (24). The mean (median) treatment costs of these injuries were NS $885 ($129), ACLS $11,157 ($8574), and OKLS $15,663 ($8054). Analysis of injury descriptions for ACLS injuries indicated that 58% involved a non-contact mechanism of injury. These data underscore the high level of short-term disability associated with knee ligament injuries, especially ACL injuries that require surgery.

Evaluation of RugbySmart: a rugby union community injury prevention programme.

RugbySmart, a rugby union injury prevention programme, was launched in New Zealand in 2001. It was compulsory for all coaches and referees to complete RugbySmart requirements annually in order to continue coaching or refereeing. After 5 years of implementation the programme partners, Accident Compensation Corporation and New Zealand Rugby Union, evaluated RugbySmart to determine its effectiveness in reducing injuries. The purpose was to evaluate the effect of RugbySmart on reducing injury rates per 100,000 players and resulting injury prevention behaviours. The RugbySmart programme was associated with a decrease in injury claims per 100,000 players in most areas the programme targeted; the programme had negligible impact on non-targeted injury sites. The decrease in injury claims numbers was supported by results from the player behaviour surveys pre- and post-RugbySmart. There was an increase in safe behaviour in the contact situations of tackle, scrum and ruck technique.

The incidence of injuries traveling to and from school by travel mode.

OBJECTIVE: To assess the absolute and relative risks of youth school-related travel using the New Zealand's no fault accident liability scheme and Census at School datasets. METHODS: Injury risk associated with traveling to and from school was assessed by combining census data from the Accident Compensation Commission database, New Zealand's no fault liability accident scheme database and the Census at School survey. Population injury and cost was assessed for incidents during a 2-year period (1 July 2003 to 30 June 2005) and during normal school travel hours (7.30 a.m.-9.00 a.m., 3.00 p.m.-4.30 p.m., weekdays) for youth 5-17 years of age. RESULTS: Overall, 7573 cases were identified as being school travel-related, representing 1.6% of total, and 11.4% school travel period injuries. Walking (30.7%), cycling (30.3%), and motor vehicles (27.7%) provided the majority of injuries. Risk of injury per million trips was highest for cycling (46.1), walking (10.3), and motor vehicle travel (6.1). CONCLUSION: These data provide the first comprehensive examination of absolute risk of travel to and from school and by transport mode, showing that school-related travel is a relatively safe activity contributing to a minority of all injuries sustained by youth.

Concussion sideline management intervention for rugby union leads to reduced concussion claims.

The effectiveness of a concussion management education programme (CMEP) in rugby in reducing the number and cost of concussion/brain injury (CBI) moderate to serious claims (MSC) was assessed. A RugbySmart educational video and a sideline concussion check (SCC) tool comprised the CMEP. Over 30,000 SCC, providing information on management of suspected concussion among community level rugby players prior to seeking medical treatment, were distributed from July 2003 to June 2005. Each year approximately 10,000 coaches and 2,000 referees participated in RugbySmart. From 2003 to 2005 new rugby CBI MSC reduced by 10.7% (actual) and 58.2% (forecast). Rugby player numbers, new non-sport CBI MSC and new sport MSC all increased by 13.6%, 16.9% and 24.6% respectively in the same period. The median number of days between CBI injury and the player seeking medical treatment decreased from six days to four days. Cost savings after CMEP were 690 USD dollars, 690 (actual) to 3,354,780 USD dollars (forecast). The two-year cost of CMEP was 54,810 USD dollars returning 12.60 USD dollars (actual) and 61.21 USD dollars (forecast) for every 1 USD dollar invested (ROI). CMEP provided community coaches and managers with education on minimum best practice for managing suspected concussion, contributed towards ROI and savings for CBI MSC in rugby.

Effect of nationwide injury prevention programme on serious spinal injuries in New Zealand rugby union: ecological study.

OBJECTIVE: To investigate the effect of RugbySmart, a nationwide educational injury prevention programme, on the frequency of spinal cord injuries. DESIGN: Ecological study. SETTING: New Zealand rugby union. PARTICIPANTS: Population at risk of injury comprised all New Zealand rugby union players. INTERVENTION: From 2001, all New Zealand rugby coaches and referees have been required to complete RugbySmart, which focuses on educating rugby participants about physical conditioning, injury management, and safe techniques in the contact phases of rugby. MAIN OUTCOME MEASURES: Numbers of all spinal injuries due to participation in rugby union resulting in permanent disablement in 1976-2005, grouped into five year periods; observed compared with predicted number of spinal injuries in 2001-5. RESULTS: Eight spinal injuries occurred in 2001-5, whereas the predicted number was 18.9 (relative rate=0.46, 95% confidence interval 0.19 to 1.14). Only one spinal injury resulted from scrums over the period; the predicted number was 9.0 (relative rate=0.11, 0.02 to 0.74). Corresponding observed and predicted rates for spinal injuries resulting from other phases of play (tackle, ruck, and maul) were 7 and 9.0 (relative rate=0.83, 0.29 to 2.36). CONCLUSIONS: The introduction of the RugbySmart programme coincided with a reduction in the rate of disabling spinal injuries arising from scrums in rugby union. This study exemplifies the benefit of educational initiatives in injury prevention and the need for comprehensive injury surveillance systems for evaluating injury prevention initiatives in sport.

A cost-outcome approach to pre and post-implementation of national sports injury prevention programmes.

In New Zealand (NZ), the Accident Compensation Corporation (ACC) has developed a pre and post-implementation cost-outcome formulae for sport injury prevention to provide information regarding the success of a prevention programme. The ACC provides for the cost of all personal injuries in NZ and invests in prevention programmes to offset 1.6 million annual claims that cost $NZD 1.9 billion. The ACC invests in nine national community sport injury prevention programmes that represent 40% of sport claims and costs. Pre-implementation is used to determine the decision whether to invest in implementation and to determine the level of such investment for the injury prevention programme. Post-implementation is calculated two ways: unadjusted, assuming ceteris paribus; and adjusted assuming no prevention programme was in place. Post-implementation formulae provide a return on investment (ROI) for each dollar invested in the programme and cost-savings. The cost-outcome formulae approach allows ACC to manage expectations of the prevention programme as well as when it will provide a ROI, allowing it to take a long-term view for investment in sport injury prevention. Originally developed for its sport injury prevention programmes, the cost-outcome formulae have now been applied to the other prevention programmes ACC invests in such as home, road and workplace injury prevention.