Epidemiologic comparison of ankle injuries presenting to US emergency departments versus high school and collegiate athletic training settings

Alexandria J Wiersma, Lina Brou, Sarah K Fields, R Dawn Comstock, Zachary Y Kerr, Alexandria J Wiersma, Lina Brou, Sarah K Fields, R Dawn Comstock, Zachary Y Kerr

Abstract

Background: Ankle sprains account for a large proportion of injuries presenting to both United States (US) emergency departments (EDs) as well as high school (HS) and collegiate school athletic training settings. The epidemiologic differences across these settings by both sport and diagnosis have not been well differentiated. Ankle injury data from 3 national surveillance datasets. Athletic training setting data from the National High School Sports-Related Injury Surveillance System and the National Collegiate Athletic Association Injury Surveillance Program was from academic years 2009/10 through 2013/14 and the US Consumer Product Safety Commission's National Electronic Injury Surveillance System (ED setting) data was from calendar years 2009 through 2013. Data was analyzed for patients 14-22 years old participating in 12 sports (male football, baseball, basketball, lacrosse, soccer, and wrestling, and female softball, basketball, lacrosse, soccer, volleyball, and field hockey). We calculated sport-specific injury rates, proportions, and rate ratios (RRs) with 95% confidence intervals (CI).

Results: During the study period, the surveillance systems captured 20,261 ankle injuries presenting to EDs plus 5546 HS and 2725 collegiate injuries presenting to school athletic training settings. Rates were higher in collegiate compared to HS athletes presenting in the athletic training setting. Football accounted for the largest proportion of ankle injuries presenting to HS (31.2%) and college (41.0%) athletic training settings; male basketball accounted for the largest proportion presenting to EDs among both HS (41.0%) and college (65.8%) aged patients. Sprains/strains accounted for over 80% of injuries in all three settings. Fractures accounted for a larger proportion of ankle injuries presenting to EDs (9.5%) compared to HS (3.8%) and college (0.8%) athletic training settings. There was no change in injury rates during the study period across the three settings.

Conclusions: Injury rates and patterns varied by sport and presentation setting, with athletic trainers evaluating more ankle injuries overall in the collegiate setting compared to the high school setting. Ankle injuries presenting to EDs were more commonly fractures, suggesting that more severe injuries present to this setting. Understanding the epidemiology of such patterns will help readers interpret differences in publications reporting data from varied clinical settings.

Keywords: Ankle; Collegiate athletes; Emergency department; Injury surveillance; Pediatrics; Sports.

Conflict of interest statement

Ethics approval and consent to participate

The institutional review board of Nationwide Children’s Hospital and the Research Review Board of the NCAA approved the study. Individual athlete consent to participate is not acquired in the three national surveillance systems which supplied data for this study.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
a Rates of ankle injuries per 10,000 athletic exposures seen by athletic trainers in the high school athletic training setting. b rates of ankle injuries per 10,000 athletic exposures seen by athletic trainers in the collegiate athletic training setting. c rates of ankle injuries among individuals treated in United States emergency departmentss per 10,000 total population
Fig. 2
Fig. 2
Percentage of all ankle injuries resulting in surgical repair by sport and level of play

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