Emergency visits for sports-related injuries

Abstract

Study Objective: We sought to estimate the effect and magnitude of patients with sports-related injuries presenting to hospital emergency departments in the United States and to examine differences in patient and visit characteristics between sports- and nonsports-related injuries. Methods: Data from the 1997 and 1998 National Hospital Ambulatory Medical Care Survey, a national probabilistic sample of 496 US hospital EDs, were combined to examine emergency visits for sports-related injuries. Data from 16,997 sample ED encounter records for injuries that included narrative cause of injury text were analyzed. Narrative text entries were coded to 1 of 84 sport and recreational activity codes. Sample weights were applied to provide annual national estimates. Estimates of sports-related injury visits were based on 1,775 records with an assigned sports-related activity code. Results: There were an average annual estimated 2.6 million emergency visits for sports-related injuries by persons between the ages of 5 and 24 years. They accounted for over 68% of the total 3.7 million sport injuries presented to the ED by persons of all ages. As a proportion of all kinds of injuries presenting to the ED, sports-related injuries accounted for more than one fifth of the visits by persons 5 to 24 years old. The use rate was 33.9 ED visits per 1,000 persons in this age group (95% confidence interval 30.3 to 37.5). The sports-related injury visit rate for male patients was more than double the rate for female patients (48.2 versus 19.2 per 1,000 persons between 5 and 24 years of age). Visits from sports-related activities for this age group were more frequent for basketball and cycling compared with other categories (eg, baseball, skateboarding, gymnastics). Compared with nonsports-related injuries for this age group, sports-related injuries were more likely to be to the brain or skull and upper and lower extremities. Patients with sports-related injuries were more likely to have a diagnosis of fracture and sprain or strain and less likely to have an open wound. They were also more likely to have diagnostic and therapeutic services provided, especially orthopedic care. Conclusion: Sports-related activities by school-age children and young adults produce a significant amount of emergency medical use in the United States. The ED is an appropriate venue to target injury prevention counseling. [Burt CW, Overpeck MD. Emergency visits for sports-related injuries. Ann Emerg Med. March 2001;37:301-308.]

Introduction

Emergency department use statistics can be used to describe the most serious injuries that are caused during sport and recreation activities not resulting in hospitalization or death. Because a relatively small proportion of sports-related injuries result in hospitalization or death, the ED has comprehensive information on the majority of patients requiring medical attention. Special studies of encounter statistics for visits to EDs for injuries have provided information on the cause and place of injury.1, 2, 3, 4 External cause of injury codes from the International Classification of Diseases, ninth revision, Clinical Modification (ICD-9-CM) supplementary chapter on external cause of injury⁵ have been used to determine the extent of sports-related injuries.⁶ Unfortunately, much of the information on what the person was doing when the injury occurred cannot be extracted because the ICD-9-CM does not have codes that capture a full range of activities. For example, although injuries caused in bicycle or boating incidents are well defined, other activities, such as playing team sports or combative sports, are not explicitly covered by the classification scheme. Through a narrative text entry on the 1997 and 1998 National Hospital Ambulatory Medical Care Survey (NHAMCS) data files, the researcher has the capability of searching the database for key words or phrases that may be important for public health surveillance of injuries. It also allows researchers to apply their own coding schemes to the data, and thus the evaluation of both traditional and new coding schemes may be undertaken.

Previous research on sports-related injuries has focused on population-based surveys, such as the National Health Interview Survey. However, these studies have demonstrated recall bias when injuries occurred.7, 8 Furthermore, use of E-codes alone in these studies limits information on the kinds of activities in which the person participates when an injury occurs.

Injury surveillance research has discussed the advantages and limitations of various methods for examining sport and recreation injury incidence and epidemiology.9, 10 The current study is not excluded from many of the disadvantages, including the inability to provide appropriate exposure estimates. Event-based studies may estimate the rate of basketball injury visits per capita but not the rate per person who plays basketball. Notwithstanding, there are some advantages to event-based studies. Event-based medical encounter studies of injuries are not subject to the extent of recall bias experienced in population-based studies of injuries because the information on the injury is recorded into the medical record directly after the injury as opposed to up to 2 months later. In addition, medical information is obtained directly from the attending physicians and nurses, and therefore the nature of the injuries should be more specific. Use statistics also help when hospitals are planning for ED staffing and training of emergency medical physicians and nurses. Therefore, encounter statistics allow for another investigative perspective into injury prevention, control, and treatment research.

Population estimates of sports-related injuries have shown that sports-related injuries occur more often among children and adolescents than among adults. It was estimated that in 1988, 32.3% of all serious injury episodes by 5- to 17-year-olds were a result of sporting and recreational activities.¹¹ Sporting and recreational activities represented 27.7% of all injury-related hospitalizations.¹¹ In the study by Bijur et al,¹¹ both the injury episodes and the nature of the injuries were based on subject recall. Because the data were coded by using external cause of injury categories only, estimates of injuries caused by specific activities could not be determined.

The purpose of this study is to analyze the narrative text entries abstracted from medical records by activity categories to identify and estimate national statistics on emergency visits for injuries that occurred while the patient was engaged in sporting and recreational activities, specifically highlighting injuries by school-age children, adolescents, and young adults. Although definitions vary across research studies,12, 13 for the purpose of this study, a sport or recreational activity is defined as an activity involving increased physical exertion for the purpose of competition or recreation. This a broad definition that includes competitive sports, as well as recreational games and adventure activities.