Original researchA population-based study of sport and recreation-related head injuries treated in a Canadian health region
Introduction
Each year in the United States, 1.1 million traumatic brain injuries are treated in emergency departments (EDs),1 yet anywhere from 1.6 to 3.8 million head injuries (HIs) from sports and recreation (SR) activities are estimated to occur annually, including those for which no treatment is sought.2 SR-related HIs are a major public health concern because of the frequency of HIs occurring in SR-activities for those under 18 years of age, and the potential long-term effects such as depression,3 mild cognitive impairment,4 and chronic traumatic encephalopathy.5 Numerous studies have documented sport-specific incidence of HI; however, most examine high school varsity, college/university, or professional athletes.6 Few Canadian studies have investigated SR-HI injuries,7, 8 and few Canadian studies have used population-based sampling or included children younger than 14 years of age when investigating SR-injuries.7, 9, 10 The primary objective of this study was to report the rates of SR-related HIs presenting to EDs in a Canadian population-based sample.
Section snippets
Methods
Using administrative data from Edmonton, Alberta, Canada, we examined data from persons seen in five EDs from April 1997 to March 2008. The population for the health region increased from 888,395 in 1997 to 1,092,179 in 2008.11 There are five hospitals (two tertiary-care, three community-care) with EDs within the City of Edmonton and the adjoining community of St. Albert. Data from the regional paediatric hospital was combined with data from one of the tertiary-care hospitals. Within the
Results
From April 1st, 1997 to March 31st, 2008, there were 3,230,890 ED visits to the five EDs; of which, 131,210 (4.1%) were documented in the ACCS as a SR-related injury. The supplementary search for external causes identified 6464 SR-injuries records that were added to the analysis, including 747 SR-HIs. In the final analysis, there were 63,219 SR-injuries that occurred more than 14 days apart for 50,461 unique patients. Records identified as a SR-related HI accounted for 7.8% (n = 4935) of the
Discussion
Using a population-based cohort of patients 0–35 years of age seen in EDs within a Canadian health region, we reported that 39% of HIs were due to a wide range of SR-activities. This proportion is higher than that reported by a previous study in the same health region where 24% of HIs were due to SR-activities7; however, the present study included more severe HIs (i.e., haemorrhage). Other studies, which have limited inclusion to school aged children15 and minor head injuries16 have reported
Conclusions
The vast majority of SR-HIs treated in EDs were individuals less than 18 year of age. For SR-injuries treated in EDs, hockey, cycling, and skiing/snowboarding/sledding were the most frequent SR-activities to receive a HI diagnosis. Additional population based research on SR-HIs is warranted for children less than 14 years of age. Further policy work is encouraged to protect this vulnerable population.
Practical implications
- •
Our findings emphasize the importance of primary prevention strategies in activities such as cycling and winter sports such as skiing/snowboarding, skating/hockey, and sledding.
- •
Sports and recreational leagues and organizations should be strongly encouraged to increase the education and training of coaches, officials, volunteers, and players regarding the risks, signs and symptoms, treatment, and prevention of head injuries.
Acknowledgements
The authors would like to thank the Edmonton Zone, Alberta Health Services (formerly the Capital Health Region) for providing the data for this research, as well as Brian Humeniuk at Alberta Health Services for extracting the data from the ACCS. AWH was supported by a graduate studentship from the Western Regional Training Centre for Health Services Research. CAJ is supported by a Population Health Investigator Award from the Alberta Heritage Foundation, and a New Investigator Award from the
References (30)
- et al.
Concussive symptoms in emergency department patients diagnosed with minor head injury
J Emerg Med
(2011) - et al.
Pediatric concussions in United States Emergency Departments in the years 2002 to 2006
J Pediatr
(2010) - et al.
The Canadian CT Head Rule for patients with minor head injury
Lancet
(2001) - Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Traumatic brain injury...
- et al.
The epidemiology and impact of traumatic brain injury: a brief overview
J Head Trauma Rehabil
(2006) - et al.
Recurrent concussion and risk of depression in retired professional football players
Med Sci Sports Exerc
(2007) - et al.
Association between recurrent concussion and late-life cognitive impairment in retired professional football players
Neurosurgery
(2005) - et al.
Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury
J Neuropathol Exp Neurol
(2009) - et al.
Epidemiological considerations of concussions among intercollegiate athletes
Appl Neuropsychol
(2003) - et al.
Sport and recreation-related head injuries treated in the emergency department
Clin J Sport Med
(2001)
Concussions among university football and soccer players
Clin J Sport Med
Survey of sport participation and sport injury in Calgary and area high schools
Clin J Sport Med
Sport participation, sport injury, risk factors and sport safety practices in Calgary and area junior high schools
Paediatr Child Health
Cited by (17)
Sports-related brain injury in the general population: An epidemiological study
2014, Journal of Science and Medicine in SportCitation Excerpt :Previous studies on the epidemiology of brain injuries sustained during sport have revealed that males and those under 18 years of age are at increased risk of sports-related TBI.3,13 Generally, the highest rates of TBIs occur in hockey, rugby, equestrian activities, cycling, winter sports and football.3,13,14 However, the findings of previous studies are limited as recruitment has been restricted to particular populations (such as school children or professional athletes) or specific sporting activities (such as football players).
Making sense of head injuries in young athletes
2013, Journal for Nurse PractitionersCitation Excerpt :The level of medical support present at sporting events varies, depending on the level of play. In recreational or youth sports, the availability of medically qualified persons making RTP decisions is rare.15 These decisions commonly fall on the medically unqualified coaches and parents.18
Incidence, Awareness, and Reporting of Sport-Related Concussions in Manitoba High Schools
2019, Canadian Journal of Neurological SciencesCanadians Reporting Sport-Related Concussions: Increasing and Now Stabilizing
2022, Clinical Journal of Sport MedicineMulticentre study of hospitalised patients with sports-and recreational cycling–related traumatic brain injury in hong kong
2021, Hong Kong Medical JournalNeurosurgical management of head injuries incurred during sports: a single centre experience
2020, British Journal of Neurosurgery