Amidst a flurry of new sports and recreation injury studies, the National Center for Health Statistics (NCHS) has found that one-half of Americans with such injuries went to a doctor's office for treatment in 2011-2014 -- far more than emergency departments (ED).

That's according to a report published Friday, which found treatment at a doctor's office (50%) exceeded emergency departments (36.6%) and other sites. "More research should focus on the doctor's office – what types of injuries are presented [and] prevention strategies," NCHS researcher Yahtyng Sheu, PhD, told MedPage Today, "rather than just focus on the ED."

The report also found that males suffered 61.3% of all the injuries, and that falls were the leading injury cause, followed by overexertion and contact.

The report is important, Sheu and others said, because it accounts for injuries in addition to those reported to emergency rooms and hospitals -- a common limitation for sports and recreation injury studies. "These injury episodes were medically-attended, for which a healthcare professional was contacted, either in person or by telephone, for advice or treatment," the report noted.

It featured the first national estimates of sports and recreation injuries not limited to ER data in 15 years, and included injuries sustained in "general exercise" and yoga. Data for the analysis came from the CDC's regular National Health Interview Survey.



The report has its limits. Sheu cautioned against comparing data from the new report to the previous set (covering 1997-1999) because researchers followed different methodologies. The new report also does not provide injury risk per sport because the researchers did not take participation numbers into account.

"Our data doesn't mean that general exercise is more likely to cause injury," Sheu said. "We don't know how many people actually participated in general exercise."

Additionally, the report didn't distinguish between provider types, such as whether office visits were in primary care versus orthopedic specialty practices. "Whether a doctor is trained for treating or diagnosing related injury is something we may need to look at," Sheu said.

(Data in the report do show which age groups were more likely to suffer injuries across sports; for example, 5-14-year-olds were more likely to get injured playing football than 15-24-year-olds.

In addition to the lack of sports participation rates, other study limitations include the data potentially being subject to recall bias "due to the retrospective reporting method and use of proxy," the authors wrote.

Sprains and Strains
The NCHS survey analysis agreed with several other studies reported recently in one respect: sprains/strains are the most likely sports injury diagnosis.

But consensus stops there. While the NCHS's study identified falls as the most likely injury cause and males as being more likely to suffer injuries than females, the other new studies showed females are more vulnerable and contact is the most likely injury cause.

A University of Colorado School of Medicine study led by Jill Tirabassi, MD (now at the University of Massachusetts Medical School), echoed other recent analyses showing that girls are more likely to get injured than boys while playing the same sport.

High school girls suffered "medical disqualification" (MDQ) injuries -- those ending participants' seasons or careers -- more often than boys in soccer (RR 1.6; 95% CI 1.3-1.9), cross country (RR 2.6; 95% CI 1.0-7.5), track (RR 2.6; 95% CI 1.7-4.0) and basketball (RR 1.6; 95% CI 1.3-2.0).

Football, lacrosse, and wrestling athletes were the most likely to suffer season- or career-ending injuries among boys, while gymnastics, soccer, and basketball were the most likely girls' sports to manifest these injuries. For both sexes, contact was the most common cause of major injuries.

"Interestingly, we found no significant change in MDQ injury rates over time," the authors wrote. "Given the seriousness of MDQ injuries, it is concerning that trends over time have remained so stable. There is an urgent need for future research focused on the development, implementation, and evaluation of effective prevention programs aimed at driving down rates of MDQ injuries." Researchers need to delve into sport-specific injury patterns, the authors added, "to develop more effective, targeted prevention efforts."
The study relied on data from the High School Reporting Information Online (RIO) database.

Limitations included reliance on National Athletic Trainers Association-affiliated trainers to help collect data from the schools. "While this ensured that medically trained professionals recorded injuries, thus increasing the quality and consistency of the data," the authors wrote, "it also means that High School RIO data may not be generalizable to all U.S. high schools." Researchers also likely underestimated injury frequency.

"Despite these limitations," the authors noted, "this study presents the broadest discussion of MDQ injuries across U.S. high school sports to date."

Another new study -- of yoga injuries reported from 2001-2014 in the U.S., by Thomas Swain, MPH, and Gerald McGwin, of the University of Alabama at Birmingham -- also reported sprains and strains as the most common injury. (The researchers found, too, that yoga injury rates are increasing, especially in participants 65 and up -- who are also more prone to injury than others.)

The findings regarding sprains and strains match those reported in a study of soccer injuries by Nicholas A. Smith and colleagues at Nationwide Children's Hospital in Columbus, Ohio. Analyzing data from emergency departments from 1990 to 2014, researchers also found contact to be the leading injury cause (followed secondarily by falling, 38.5% of all injuries, versus 28.7%). Like the NCHS analysis, the soccer study found more injuries among males (55%).

Outside the U.S., a new study linking sports participation level with anterior crucial ligament injury risk also found contact to be the leading injury mechanism, and girls to be more injury-prone than boys while playing the same sport.