Original research
A population-based study of sport and recreation-related head injuries treated in a Canadian health region

https://doi.org/10.1016/j.jsams.2011.12.005Get rights and content

Abstract

Objectives

To report the rates of SR-related HIs presenting to EDs in a Canadian population-based sample.

Methods

Using administrative data, sport and recreation-related emergency department presentations for persons 0–35 years of age, from April 1997 through March 2008, were obtained from the Edmonton Zone (formerly the Capital Health Region), Alberta Health Services through the Ambulatory Care Classification System.

Results

Of the 3,230,890 visits to the emergency departments of the five hospitals in Edmonton, 63,219 sport and recreation-related injury records and 4935 sport and recreation-head injury records were identified. Head injuries were most frequently treated for the activities of hockey (20.7%), cycling (12.0%), and skiing/snowboarding/sledding. Males accounted for 71.9% (n = 3546) and patients less than 18 years of age sustained 3446 (69.8%) sport and recreation-head injuries.

Conclusions

Sport and recreation-related head injuries most frequently treated in emergency departments involve common activities such as hockey, cycling, skiing/snowboarding/sledding, and soccer. Males and those less than 18 years of age sustain the majority of sport and recreation-related head injuries treated in emergency departments. These findings underscore the importance of sport-specific policies and safety promotion for the prevention of head injuries, in sports and recreational activities.

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)

  • J. Cunningham et al.

    Concussive symptoms in emergency department patients diagnosed with minor head injury

    J Emerg Med

    (2011)
  • W.P. Meehan et al.

    Pediatric concussions in United States Emergency Departments in the years 2002 to 2006

    J Pediatr

    (2010)
  • I.G. Stiell 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...
  • J.A. Langlois et al.

    The epidemiology and impact of traumatic brain injury: a brief overview

    J Head Trauma Rehabil

    (2006)
  • K.M. Guskiewicz et al.

    Recurrent concussion and risk of depression in retired professional football players

    Med Sci Sports Exerc

    (2007)
  • K.M. Guskiewicz et al.

    Association between recurrent concussion and late-life cognitive impairment in retired professional football players

    Neurosurgery

    (2005)
  • A.C. McKee et al.

    Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury

    J Neuropathol Exp Neurol

    (2009)
  • T. Covassin et al.

    Epidemiological considerations of concussions among intercollegiate athletes

    Appl Neuropsychol

    (2003)
  • K.D. Kelly et al.

    Sport and recreation-related head injuries treated in the emergency department

    Clin J Sport Med

    (2001)
  • J.S. Delaney et al.

    Concussions among university football and soccer players

    Clin J Sport Med

    (2002)
  • C.A. Emery et al.

    Survey of sport participation and sport injury in Calgary and area high schools

    Clin J Sport Med

    (2006)
  • C. Emery et al.

    Sport participation, sport injury, risk factors and sport safety practices in Calgary and area junior high schools

    Paediatr Child Health

    (2009)
  • Alberta Centre for Injury Control & Research. Database held by Alberta Centre for Injury Control &...
  • Canadian Association of Emergency Physicians. Implementation Guidelines for The Canadian Emergency Department Triage &...
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