Emergency Department Visits From 2014 to 2018 for Head Injuries in Youth Non-Tackle Football Compared With Other Sports

Abstract

Background: Non-tackle football (ie, flag, touch, 7v7) is purported to be a lower-risk alternative to tackle football, particularly in terms of head injuries. However, data on head injuries in non-tackle football are sparse, particularly among youth participants. Purpose: To describe the epidemiology of emergency department visits for head injuries due to non-tackle football among youth players in the United States and compare the data with basketball, soccer, and tackle football. Study Design: Descriptive epidemiology study. Methods: Injury data from 2014 to 2018 were obtained from the National Electronic Injury Surveillance System database. Injury reports coded for patients aged 6 to 18 years and associated with basketball, football, or soccer were extracted. Data were filtered to include only injuries to the head region, specifically, the head, ear, eyeball, mouth, or face. Football injuries were manually assigned to “non-tackle” or “tackle” based on the injury narratives. Sports & Fitness Industry Association data were used to estimate annual sport participation and calculate annual injury rates per 100,000 participant-years. Results: A total of 26,770 incident reports from 2014 to 2018 were analyzed. For head region injuries in non-tackle football, the head was the most commonly injured body part, followed by the face; the most common diagnosis was a laceration, followed by concussion and internal injury (defined as an unspecified head injury or internal head injury [eg, subdural hematoma or cerebral contusion]). The most common contacting object was another player. The projected national rate of head region injuries was lowest for non-tackle football across the 4 sports. In particular, the projected rate of injuries to the head for non-tackle football (78.0 per 100,000 participant-years) was less than one-fourth the rates for basketball (323.5 per 100,000 participant-years) and soccer (318.2 per 100,000 participant-years) and less than one-tenth the rate for tackle football (1478.6 per 100,000 participant-years). Conclusion: Among youth in the United States aged 6 to 18 years who were treated in the emergency department for injuries related to playing non-tackle football, the most common diagnosis for injuries to the head region was a laceration, followed by a concussion. Head region injuries associated with non-tackle football occurred at a notably lower rate than basketball, soccer, or tackle football.

Neuropsychological Profiles of Athletes and Views of Parents Choosing Flag Versus Tackle Football Participation

“…This is important as flag football participation has increased over the past decade with the promotion of its safety as an alternative to tackle football, even as data on head impact exposure between tackle and flag football continue to be limited and contradictory, suggesting that each type of football has its own inherent risks. 10 , 12 , 13 , 16 , 17 , 20 While we do not have a league-specific injury pattern data that could affect participation enrollment in this study, we presumed that these patterns would correlate with national data. Furthermore, injury rates for most of the leagues that we recruited from have been described previously by Peterson et al 12 as our study recruited from the same locations.…”

“…We believe that these results could be indicators of factors that can help prevent a child from becoming injured on the field if, for example, they had to switch suddenly between tasks like blocking or catching or if they simply had to pay attention to other players and assess their surroundings. Zendler et al 20 found that, even in nontackle football injuries, the most common contacting object was still another player. Furthermore, Radelet et al 6 , 13 also examined youth football injuries but did not attribute injuries to tackling over blocking or incidental person-to-person contact.…”

“…They found youth tackle football players experienced a higher impact rate, but flag players had increased odds of experiencing high magnitude rotational acceleration injuries. 13 Zendler et al 20 examined injuries reported in the National Electronic Injury Surveillance System (NEISS) and found higher rates of injuries in youth tackle football (6- to 18-year-olds), but had the limitation that the NEISS only reports injuries seen in an emergency department and may underestimate injuries presenting to an athletic trainer, primary care physician, or specialty clinic. 20 In contrast, Peterson et al 12 reported double the rate of concussions for youth (7- to 13-year-olds) flag football players compared with tackle football players in the same study.…”

“… 13 Zendler et al 20 examined injuries reported in the National Electronic Injury Surveillance System (NEISS) and found higher rates of injuries in youth tackle football (6- to 18-year-olds), but had the limitation that the NEISS only reports injuries seen in an emergency department and may underestimate injuries presenting to an athletic trainer, primary care physician, or specialty clinic. 20 In contrast, Peterson et al 12 reported double the rate of concussions for youth (7- to 13-year-olds) flag football players compared with tackle football players in the same study. Regardless, although flag football is considered a limited-contact sport, especially compared with tackle football, it is clearly not a noncontact sport and may be just as, if not more, dangerous than tackle football.…”

“…Regardless, although flag football is considered a limited-contact sport, especially compared with tackle football, it is clearly not a noncontact sport and may be just as, if not more, dangerous than tackle football. 13 , 17 , 20 The study by Peterson et al 12 has been criticized by reviewers and the popular press for failing to account for potential intrinsic differences between tackle and flag football players that may drive their choice to play one type over another and subsequently impact reported injury rates.…”