To investigate the epidemiology of youth soccer-related injuries treated in emergency departments in the United States.
A retrospective analysis was conducted of soccer-related injuries among children 7 through 17 years of age from 1990 through 2014 with data from the National Electronic Injury Surveillance System. Injury rates were calculated from soccer participation data.
An estimated 2 995 765 (95% confidence interval [CI], 2 309 112–3 682 418) children 7 through 17 years old were treated in US emergency departments for soccer-related injuries during the 25-year study period, averaging 119 831 (95% CI, 92 364–147 297) annually. The annual injury rate per 10 000 soccer participants increased significantly, by 111.4%, from 1990 to 2014. Patients 12 to 17 years old accounted for 72.7% of injuries, 55.5% of patients were male, and most injuries occurred in a place of sport or recreation (68.5%) or school (25.7%). Struck by (38.5%) and fell (28.7%) were the leading mechanisms of injury. Injuries most commonly were diagnosed as sprain or strain (34.6%), fracture (23.2%), and soft tissue injury (21.9%), and occurred to the upper extremity (20.7%), ankle (17.8%), and head or neck (17.7%). Concussions or other closed head injuries accounted for 7.3% of the injuries, but the annual rate of concussions/closed head injuries per 10 000 participants increased significantly, by 1595.6%, from 1990 to 2014.
This study is the first to comprehensively investigate soccer-related injuries and calculate injury rates based on soccer participation data among children at the national level. The increasing number and rate of pediatric soccer-related injuries, especially soccer-related concussions/closed head injuries, underscore the need for increased efforts to prevent these injuries.
We thank Drs. Berz, Quinn, and Myer for their comments. They point out potential confounders and reasons for the observed increase in soccer-related concussions/closed head injuries in our study. These comments agree with those that we outlined in our discussion of the findings in the article. We concur with their concern that youth engage in a physically active lifestyle. We believe that the numbers reported in our study warrant the conclusion that there is a “need for increased efforts to prevent these injuries.” This can be accomplished without sacrificing the benefits of physical activity.
Nicholas A. Smith
Thiphalak Chounthirath
Huiyun Xiang
We read with interest “Soccer-Related Injuries Treated in Emergency Departments: 1990-2014”.1 We applaud the authors’ intent to identify longitudinal injury trends in youth soccer and improve athlete safety. We are concerned, however, that important confounders may have influenced the reported 1600% concussion rate increase that would dissuade soccer participation. There has also been sensationalized media response to the study citing ‘skyrocketing’ injury trends in youth soccer.2 We would like, therefore, to provide a perspective that is consistent with the authors’ aims, but one which also helps balance the evidence.
During the study investigation period, youth soccer has become the sport of choice for youth across the country, young athletes are involved with year-round practice and competition, and Youth National Teams for boys and girls have emerged. As a result increased exposure per athlete likely drove the study’s reported increase in soccer injuries per individual.1 It was an important strength of the current investigation to control for increased participation, but the relative change in exposures from isloated school sponsored soccer to current trends of year round participation are not captured in the participation only based denominator of incidence rates.
In addition, with greater awareness, changes in definition, and enhanced laws that govern return to play,3 changes to Emergency Department (ED) utilization for concussion managment were not controlled for. In just one decade, there was a 92% increases in ED visits for sports-related TBI, while the severity rate was much lower.4 The rate of hospitalization remained static, even with the large increases in patients presenting and the injury severity of those admitted being significantly lower.4 These data indicate that families are now more likely than ever to visit the ED for perceived emergent complaints, particularly for concussion concerns. ED usage as a primary entry point for concussions compound the effects of increased concussion recognition likely driving a factorial effect on relative ED incidence rates.
So is there really a 100% increase in youth soccer concussion 16 times over? A cited report using similar methods over the investigation period suggested that “true injury rates may actually be decreasing” in soccer.5 Based on these factors we are skeptical that the increase in concussion incidence rates are of the magnitude and arguably the direction that was reported in soccer over the last 25 years.
While we share the authors’concerns about sport-related concussion, and the potential long term consequences not insignificant, we are very concerned by the overall rapid decrease in our population’s physical inactivity levels, now the fourth leading cause of death worldwide. Beyond the issue of the true incidence of youth soccer-related injuries, and concussions in particular, we argue that there are many reasons to be optimistic about the brain health of our young athletes based on better recognition of concussions, enhanced emphasis on safety, and new research and prevention priorities. With a contemporary emphasis on safety, we can keep the benefits of participation in sport at the forefront of conversation, and we can confidently dissuade frightened parents from choosing inactivity for their children.