Traumatic brain injuries (TBIs) resulting from participation in sports and recreation activities have received increased public awareness with many states and the federal government considering or implementing laws regulating the response to suspected brain injury. Whereas public health programs promote the many benefits of sports and recreation activities, those benefits are tempered by the risk for injury. During 2001–2005, an estimated 207,830 Emergency Department (ED) visits for concussions and other TBIs related to sports and recreation activities were reported annually, with 65% of TBIs occurring among children aged 5–18 years. Compared with adults, younger persons are at increased risk for TBIs with increased severity and prolonged recovery. To assess and characterize TBIs from sports and recreation activities among children and adolescents, CDC analyzed data from the National Electronic Injury Surveillance System–All Injury Program (NEISS-AIP) for the period 2001–2009. This report summarizes the results of that analysis, which indicated that an estimated 173,285 persons aged at or under 19 years were treated in EDs annually for nonfatal TBIs related to sports and recreation activities. From 2001 to 2009, the number of annual TBI-related ED visits increased significantly, from 153,375 to 248,418, with the highest rates among males aged 10–19 years. By increasing awareness of TBI risks from sports and recreation, employing proper technique and protective equipment, and quickly responding to injuries, the incidence, severity, and long-term negative health effects of TBIs among children and adolescents can be reduced.
NEISS-AIP is operated by the U.S. Consumer Product Safety Commission and contains data on initial visits for all injuries in patients treated in U.S. hospital EDs. NEISS-AIP data are drawn from a nationally representative subsample of 66 of 100 NEISS hospitals that are selected as a stratified probability sample of hospitals in the United States and its territories that have a minimum of six beds and a 24-hour ED. NEISS-AIP provides data on approximately 500,000 injury-related cases each year.
For this analysis, sports and recreation–related injuries included those injuries among children and adolescents aged 19 years or under that occurred during organized and unorganized sports and recreation activities (e.g., bicycling, skating, or playground activities). Each case was initially classified into one of 39 mutually exclusive sports and recreation–related groups on the basis of an algorithm using both the consumer products involved (e.g., bicycles, swing sets, or in-line skating equipment) and the narrative description of the incident obtained from the medical record. For the analysis, 30 of the categories were examined separately and the remaining nine were combined into the “other specified” category. Persons with sports and recreation–related injuries were classified as having a TBI if the primary body part injured was the head and the principal diagnosis was either concussion or internal organ injury. Sports and recreation–related cases were excluded if the injury was violence-related (e.g., intentional self-harm, assault, or legal intervention). Additionally, data regarding persons who were dead on arrival or who died in the ED were excluded.
Each case of sports and recreation–related injury was assigned a sample weight based on the inverse probability of selection; these weights were added to provide national estimates of sports and recreation–related injuries. National estimates were based on weighted data for 453,655 ED visits for all sports and recreation–related injuries (of which 36,230 were TBIs) during 2001–2009. Confidence intervals were calculated using a direct variance estimation procedure that accounted for the sample weights and complex sample design. Significance of trends over time was assessed using weighted least squares regression analysis.
During 2001–2009, an estimated 2,651,581 children aged 19 years or under were treated annually for sports and recreation–related injuries. Approximately 6.5%, or 173,285 of these injuries, were TBIs. Approximately 71.0% of all sports and recreation–related TBI ED visits were among males; 70.5% were among persons aged 10–19 years. An estimated 2.5% of children and adolescents with sports and recreation–related injuries were hospitalized or transferred to other facilities, compared with an estimated 6.6% of those with sports and recreation–related TBIs. From 2001 to 2009, the estimated number of sports and recreation–related TBI visits to EDs increased 62%, from 153,375 to 248,418, and the estimated rate of TBI visits increased 57%, from 190 per 100,000 population to 298. During this same period, the estimated number of ED visits for TBIs that resulted in hospitalization ranged from 9,300 to 14,000 annually but did not show a significant trend over time.
Overall, the activities associated with the greatest estimated number of TBI-related ED visits were bicycling, football, playground activities, basketball, and soccer. Activities for which TBI accounted for >10% of the injury ED visits for that activity included horseback riding (15.3%), ice skating (11.4%), golfing (11.0%), all-terrain vehicle riding (10.6%), and tobogganing/sledding (10.2%).
Activities associated with the greatest estimated number of sports and recreation–related TBI ED visits varied by age group and sex. For males and females aged ≤9 years, TBIs most commonly occurred during playground activities or when bicycling. For persons aged 10–19 years, males sustained TBIs most often while playing football or bicycling, whereas females sustained TBIs most often while playing soccer or basketball, or while bicycling.
