Study Reveals Wealth of Data on Sports Injuries among U.S. High School Athletes

A recent study, presented as a poster at the AAOS 2023 Annual Meeting, provided updated epidemiological data on sports-related injuries among high school students in the United States. It noted that participation in sports has been on the rise, and although the overall injury rate has decreased, serious injuries requiring time away from sport or even surgery have been increasing in this vulnerable population. The researchers sought to identify the types and rates of injuries by sport, gender, and exposure, including data on injured body site, type of injury, time loss, and surgical requirement.

To expand on the study’s findings, Boris A. Zelle, MD, FAAOS, chief of orthopaedic trauma at UT Health San Antonio and member of the AAOS Now Editorial Board, interviewed two of the study co-authors: Sean Tabaie, MD, FAAOS, pediatric orthopaedic surgeon at Children’s National in Washington, D.C., and assistant professor at George Washington University, and Jordan Pizzarro, a third-year medical student at George Washington University School of Medicine. The study, titled “Epidemiology of Sports Injuries among High School Athletes in the United States” caused the authors to “receive a lot of feedback on their investigation,” according to Dr. Zelle.

Regarding the stimulus for this study, Dr. Tabaie noted, “I see a lot of children and families involved in numerous sports. Often the question [I receive] is, what risks am I putting my child under?” The question is difficult to answer, he acknowledged, as it may vary widely depending on multiple factors. “I think this research allows us to have baseline information to present to our patients and their families,” he shared.

Data collection
The team of researchers obtained data from the National Health School Sports-related Injury Surveillance Study and its collection tool, the High School Reporting Information Online (RIO). The RIO includes injury data from 100 nationally representative high schools for the 2015 to 2019 academic years and comprises high schools with athletic trainers who are associated with the National Athletic Trainers’ Association. These trainers act as weekly reporters of athletic exposure (AE) and injuries for five boys’ sports (football, soccer, basketball, wrestling, and baseball) and four girls’ sports (soccer, basketball, volleyball, and softball).

AE was defined by the team as one athlete participating in one practice or competition, and injury rates were calculated as the ratio of injuries per 1,000 AEs. Information on injured body site, type of injury, time loss, and surgical necessity was also acquired.

According to Ms. Pizzarro, “We were able to sift through those reports and find good data to see how injuries have changed since the last study like this was done in the early 2000s.”

Results and significant takeaways
According to the research team, the findings of the study were significant. “Overall, compared to studies done in the early 2000s, we do see that there’s a decrease in injury rates,” Ms. Pizzarro said. “But when we look at some of the other data, we see that more injuries are requiring surgery and more injuries are requiring greater time off from the sport.”

From 2015 to 2019, high school athletic trainers reported 15,531 injuries during 6,778,209 AEs, with an overall rate of 2.29 injuries per 1,000 AEs. However, an estimated 5,228,791 injuries occurred nationally, highlighting the need for injury-prevention strategies. The injury rates were highest in football (3.96 per 1,000 AEs), girls’ soccer (2.65), and boys’ wrestling (2.36). Additionally, the injury rates were higher in boys’ sports (2.52) compared with girls’ sports (1.56).

Injury rates were higher in competition compared to practice, with sprains/strains (36.8 percent) and concussions (21.6 percent) being the most common diagnoses. The most injured body sites were the head and face (24.2 percent), ankle (17.6 percent), and knee (14.1 percent), with fractures representing 3.5 percent of all injuries and being more common in boys’ sports (4.2 percent) than girls’ sports (2.0 percent).

The study also found that 39.2 percent and 34.0 percent of injuries resulted in a time loss of less than one week and one to three weeks, respectively. Seven percent of injuries led to a time loss of more than three weeks, and 20.9 percent of injuries led to medical disqualification for the season or the athlete’s career, inability to return to play before the season ended, or an athlete’s decision to not continue with the sport.

The study also reported a major increase in concussions, which prompted Dr. Zelle to ask whether this was related to greater awareness of these injuries. “Are we just more aggressive in diagnosing and treating them?” he asked.

“I think it’s true that we are better equipped to understand [the risk of sports injuries], and people are focused on looking at concussions,” Dr. Tabaie answered. “Our ability to identify them has improved, which will correlate obviously in the data showing it more often.”

Looking ahead
The study’s findings are “the foundation of what we need to build on and move forward,” Dr. Tabaie said. “I’m excited that we have this data, but I’m also excited to move forward with it and see what we can produce.” The results of the study provide an opportunity for providers to incorporate the data in their own practices, to “focus on our own patients and really be able to quantify these things in our neighborhoods and in our communities,” he added.

Ms. Pizzarro emphasized the importance of risk-mitigation and injury-prevention methods. She encouraged healthcare providers to speak with parents, coaches, and schools to help them understand what they can do from their point of view to really promote safety for athletes. “There’s a lot that each person involved in this can do to make sports better for kids,” she said.

Cailin Conner is the associate editor of AAOS Now. She can be reached at cconner@aaos.org.

Reference

1. Pizzarro JN, Chiang BJL, Monroig-Rivera CA, Mehran N, Tabaie S: Poster No. P0439. Epidemiology of sports injuries among high school athletes in the United States. AAOS 2023 Annual Meeting Proceedings. Las Vegas, Nev.