Background Severe sports injury has substantial individual and societal health and financial implications. There has been limited study of the number, type, and clinical burden of severe injuries. Trauma research networks, such as the Trauma Audit Research Network (TARN) in England and Wales, may facilitate estimating the burden of severe sports injury.

Objective To estimate the number of severe sport-related injuries treated in hospitals in England and Wales between January 2012 and December 2017, and identify the 10 main contributing sports.

Design Five-year retrospective study.

Setting English and Welsh hospitals.

Patients All patients whose injury mechanism was indicated as sport, or whose incident description field featured one of 62 sporting activities, and qualified for inclusion in the TARN database. Inclusion criteria are: transfers or direct admissions whose inpatient stay is 3 days or more, admissions to High Dependency Areas and mortality after admission.

Assessment of Risk Factors Hospital-recorded age, sex and sporting activity at the time of injury.

Main Outcome Measurements A severe (TARN-recorded) injury, during in-game sporting activity. Extracted data included treatment duration, injury characteristics and sport code.

Results There were 15,799 sports injuries between 2012 and 2017. In 2012 there were 2,087 injuries (13.3% of incidents), and by 2017 there were 2,906 (18.6% of incidents). Patients were on average 37.7 (±19.5) years, and 6,396 (40.5%) were female. The average length of hospital stay was 9.5 days (SD±15.6, range 1 to 738). Horse-related activities accounted for 5,585 of injuries, followed by football (soccer) with 1,439 injuries, motor racing (n=938), cycling (n=917), motocross (n=826), off-road cycling (n=669), rugby (n=660), trampolining (n=620), running (n= 501), and skiing (n=326).

Conclusions Horse-related, football, motor racing and cycling injuries presented with the most injuries, and should be the focus of prevention efforts. Further work will examine sports participation data, and quantify severe injury risks associated with sports participation.