Epidemiology of Severe Injuries Among US High School Athletes, 2005/06-2012/13

Introduction: Approximately 7.7 million US high school students played sports during 2012/13. Because sports participation increases injury risk, describing severe injury rates and patterns is important for injury prevention efforts.

Methods: The High School Reporting Information Online database of athlete exposure (AE) and injury incidence data from a large national sample of US high schools were evaluated for 22 sports from 2005/06-2012/13.  Injuries resulting in medical disqualification (MDQ) for the athlete’s season or career, or which motivated voluntary withdrawal from sports were qualified as severe.

Results: During the study period, 3,725 severe injuries occurred during 25,268,873 AEs (1.47 injuries/10,000 AEs).  Severe injuries accounted for 7.4% of all injuries.  MDQs for the season (83.6%) were predominant followed by voluntarily withdrawals (15.1%) and MDQs for the athlete’s career (1.3%). Rates were higher in competition (3.23) vs. practice (0.87) (RR=3.71, 95%CI=3.48–3.96). Boys had higher rates (1.80) than girls (0.97) (RR=1.85, 95%CI=1.72–1.99) overall, but girls had higher rates in gender-comparable sports (1.13 vs. 0.75; RR=1.51, 95%CI=1.35-1.68). Rates were highest in football (3.22), boys’ wrestling (2.51) and girls’ gymnastics (1.98). Commonly injured body parts were knee (31.3%), head/face (12.4%), and shoulder (8.8%).  Ligament sprains (28.5%), fractures (28.4%), and concussions (11.5%) were common diagnoses.  Most injuries (82.0%) were new; 38.0% required surgery. 

Conclusion: Rates of severe injuries differed by gender, exposure, and sport. Severe injuries which cause significant time loss from sports can pose psychological/financial burdens. Descriptions of severe injury patterns are important to drive effective injury prevention efforts.