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Improving the accuracy of sports medicine surveillance: when is a subsequent event a new injury?
  1. Ian Shrier1,
  2. Ben Clarsen2,
  3. Evert Verhagen3,
  4. Kerry Gordon4,
  5. Jay Mellette4
  1. 1Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
  2. 2Oslo Sports Trauma Research Center, Oslo, Norway
  3. 3Department of Public and Occupational Health, EMGO+ Institute at the VU University Medical Center in Amsterdam, Amsterdam, The Netherlands
  4. 4Department of Performance Medicine, Cirque du Soleil, Montreal, Quebec, Canada
  1. Correspondence to Dr Ian Shrier, Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Cote Ste-Catherine Road, Montreal, Quebec, Canada H3T 1E2; ian.shrier{at}


The recent increased use of injury and illness surveillance programmes has the potential to greatly advance our knowledge about risk factors and treatment effectiveness. Maximising this potential requires that data be entered in a format that can be interpreted and analysed. One remaining challenge concerns whether and when an increase in symptoms should be documented within an existing injury record (eg, exacerbation) versus a new injury record. In this review, we address this challenge using the principles of the multistate framework for the analysis of subsequent injury in sport (M-FASIS). In brief, we argue that a new injury record should be documented whenever there is an increase in symptoms due to activity-related exposures that is beyond the normal day-to-day symptom fluctuations, regardless of whether the athlete was in a ‘healthy state’ immediately before the event. We illustrate the concepts with concrete examples of shoulder osteoarthritis, ankle sprains and ACL tears.

  • Chronic
  • Injury
  • Overuse injury
  • Recurrent
  • Surveillance

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  • Twitter Follow Benjamin Clarsen at @benclarsen and Evert Verhagen at @Evertverhagen

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.