Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives

Abstract

Objective: To summarize 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for 15 sports and to identify potential modifiable risk factors to target for injury prevention initiatives.

Background: In 1982, the NCAA began collecting standardized injury and exposure data for collegiate sports through its Injury Surveillance System (ISS). This special issue reviews 182 000 injuries and slightly more than 1 million exposure records captured over a 16-year time period (1988-1989 through 2003-2004). Game and practice injuries that required medical attention and resulted in at least 1 day of time loss were included. An exposure was defined as 1 athlete participating in 1 practice or game and is expressed as an athlete-exposure (A-E).

Main results: Combining data for all sports, injury rates were statistically significantly higher in games (13.8 injuries per 1000 A-Es) than in practices (4.0 injuries per 1000 A-Es), and preseason practice injury rates (6.6 injuries per 1000 A-Es) were significantly higher than both in-season (2.3 injuries per 1000 A-Es) and postseason (1.4 injuries per 1000 A-Es) practice rates. No significant change in game or practice injury rates was noted over the 16 years. More than 50% of all injuries were to the lower extremity. Ankle ligament sprains were the most common injury over all sports, accounting for 15% of all reported injuries. Rates of concussions and anterior cruciate ligament injuries increased significantly (average annual increases of 7.0% and 1.3%, respectively) over the sample period. These trends may reflect improvements in identification of these injuries, especially for concussion, over time. Football had the highest injury rates for both practices (9.6 injuries per 1000 A-Es) and games (35.9 injuries per 1000 A-Es), whereas men's baseball had the lowest rate in practice (1.9 injuries per 1000 A-Es) and women's softball had the lowest rate in games (4.3 injuries per 1000 A-Es).

Recommendations: In general, participation in college athletics is safe, but these data indicate modifiable factors that, if addressed through injury prevention initiatives, may contribute to lower injury rates in collegiate sports.

Figures

Figure 1. Game and practice injury rates, 15 sports, National Collegiate Athletic Association, 1988–1989 through 2003–2004. Game time trend P = .78. Average annual change = −0.3% (95% confidence interval = −2.5, 1.9). Practice time trend P = .70. Average annual change = −0.2% (95% confidence interval = −1.4, 0.9)

Figure 2. Distribution (percentage) of injuries by injury mechanism for practices and games, 15 sports, National Collegiate Athletic Association, 1988–1989 through 2003–2004

Figure 3. Distribution (percentages) of injuries by body part for games and practices for 15 sports, National Collegiate Athletic Association, 1988–1989 through 2003–2004

Figure 4. Injury rates for select conditions (concussions, ankle ligament sprains, and anterior cruciate ligament injuries) for games and practices combined for 15 sports, National Collegiate Athletic Association, 1988–1989 through 2003–2004. Ankle ligament sprains time trend P = .68. Average annual change = −0.1% (95% confidence interval = −0.8, 0.5). Anterior cruciate ligament (ACL) injury time trend P = .02. Average annual change = 1.3% (95% confidence interval = 0.2, 2.4). Concussion time trend P < .01. Average annual change = 7.0% (95% confidence interval = 5.4, 8.7)

Figure 5. Overall (A) game and (B) practice injury rates for 15 sports, National Collegiate Athletic Association, 1988–1989 to 2003–2004. Although data for 15 total sports are presented, fall and spring football are reported separately for practices; because no “official games” are played during spring football, only fall football is listed for games