Incidence of sport-related traumatic brain injury and risk factors of severity: a population-based epidemiologic study

Selassie, Anbesaw W.; Wilson, Dulaney A.; Pickelsimer, Elisabeth; Voronca, Delia; Williams, Nolan; Edwards, Jonathan

doi:10.1016/j.annepidem.2013.07.022

Cited by 110 publications

(83 citation statements)

References 50 publications

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“…A previous population-based study found ∼61% of SRRCs occur in youth 0 to 18 years. 4 There are numerous studies demonstrating that many children and adolescents do not report concussion symptoms to any health care providers, but it is unclear how many people who experience symptoms have a true concussion diagnosis. 17,22,23,25,35,36 We applied rates from studies of middle and high school students underreporting concussions across younger age groups because there is little information on SRRC reporting in younger children.…”

Section: Discussionmentioning

confidence: 99%

“…Our method of determining SRRCs was more inclusive than many previous studies, which excluded specific causes or required sports-and recreationrelated E-codes for inclusion. 4,11,12 Because MarketScan is dependent on International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes and the presence of E-codes for injuries is variable, we used an exclusion method for classification of SRRCs in MarketScan. Sports and recreation, motor vehicle collisions, and falls account for ∼80% of concussions in children.…”

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confidence: 99%

“…1,2 The incidence of sports-and recreation-related concussions (SRRCs) in the United States is unknown; however, most epidemiologic studies indicate that a large number of SRRCs occur each year. [3][4][5][6][7] More than 44 million youth participate in sports annually, and thus understanding the frequency of SRRCs in children and adolescents is important on a population level. 1,8 One challenge in calculating the incidence of SRRCs is that injured youth may not receive treatment, or may receive care from a variety of providers including certified athletic trainers (ATCs), primary care, and emergency medicine physicians.…”

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Sports- and Recreation-Related Concussions in US Youth

et al. 2016

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The incidence of sports-and recreation-related concussions (SRRCs) in the United States is unknown. More than 44 million youth participate in sports annually, thus understanding the frequency of SRRCs in children is important on a population level. Our objective was to determine the number of SRRCs occurring annually among US youth ≤18 years old. METHODS:We identified SRRCs using 3 national databases: MarketScan, National Electronic Injury Surveillance System, and National High School Sports Related Injury Surveillance System, Reporting Injury Online. We determined the number of SRRCs seen in health care settings (outpatient, inpatient, and emergency department) and SRRCs reported to certified high school athletic trainers (ATCs). We used these data and findings in recently published literature to generate a national estimate of SRRCs. RESULTS:We estimate that between 1.1 and 1.9 million SRRCs occur annually in US children aged ≤18 years. Most children with SRRCs, 511 590 to 1 240 972, were not seen in health care settings. Of children with SRRCs seen in health care settings, most were seen as outpatients with 377 978 visits, compared with between 115 479 and 166 929 ED visits, and between 2886 and 4936 hospitalizations. CONCLUSIONS:This study provides the most accurate and precise estimate to date of the number of concussions among US children annually. SRRCs are a common injury in children. Providers in all health care settings need to be trained in concussion care. There is a need for better surveillance to enhance our understanding of the epidemiology of concussions in youth. Dr Bryan conducted the data gathering and analysis with Dr Rowhani-Rahbar and led the manuscript writing; Dr. Rowhani-Rahbar conducted the data gathering and analysis with Dr Bryan and contributed to the manuscript preparation and intellectual content; Dr Comstock provided data and feedback on manuscript preparation; Dr Rivara conceived of the study and supervised throughout data gathering, analysis, and manuscript preparation; and all authors approved the fi nal manuscript as submitted. WHAT'S KNOWN ON THIS SUBJECT: Sports-and recreation-related concussions (SRRCs) are a common source of morbidity in children. Many of these injuries are not treated within health care settings. It is unknown how many SRRCs occur annually in the US. DOI WHAT THIS STUDY ADDS:We estimate between 1.1 and 1.9 million SRRCs occur annually in US children ≤18 years old. The magnitude of this number emphasizes the need for better national injury surveillance of the incidence of SRRCs.by guest on May 10, 2018 http://pediatrics.aappublications.org/ Downloaded from BRYAN et alConcussions, a form of traumatic brain injury (TBI), are common in children, with sports and recreation as a leading cause in this age group. 1, 2 The incidence of sports-and recreation-related concussions (SRRCs) in the United States is unknown; however, most epidemiologic studies indicate that a large number of SRRCs occur each year. [3][4][5][6][7] More than 44 million youth participate in ...

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Section: Discussionmentioning

confidence: 99%

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Sports- and Recreation-Related Concussions in US Youth

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“…Previous studies have described the incidence of sports-related TBI in adult ED populations. 10,23,46 Similarly, a large study in the Pediatric Emergency Care Applied Research Network, conducted between 2004 and 2006, recently reported that the overall incidence of sports-related TBI was 1%, with significant variation by type of sports. 20 However, the characteristics of inpatient hospital LOS, complications, discharge, and mortality rates in a large, nationally representative cohort have yet to be described.…”

Section: Discussionmentioning

confidence: 99%

Pediatric sports-related traumatic brain injury in United States trauma centers

Winkler

Yue

Burke

et al. 2016

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Neurosurg Focus 40 (4):E3, 2016S portS-related traumatic brain injury (TBI) is an important public health concern that is increasingly in the spotlight of both the lay press and the general public. Recent estimates suggest that 300,000 to 3.8 million sports-related TBIs occur in the United States annually, 11,17,32,40,49 resulting in more than 500,000 emergency department (ED) visits and over 60,000 hospitalizations. 31,44 In children older than 1 year, TBI is the leading cause of death and disability, 27 and roughly 60%-80% of sportsrelated TBI ED visits are by pediatric patients-predomiAbbreviAtioNs CCI = Charlson Comorbidity Index; ED = emergency department; FIC = fall or interpersonal contact; GCS = Glasgow Coma Scale; ICD-9 = International Classification of Diseases, Ninth Revision; ICU = intensive care unit; ISS = Injury Severity Score; LOS = length of stay; NSP = National Sample Program; NTDB = National Trauma Data Bank; TBI = traumatic brain injury. obJeCtive Traumatic brain injury (TBI) in children is a significant public health concern estimated to result in over 500,000 emergency department (ED) visits and more than 60,000 hospitalizations in the United States annually. Sports activities are one important mechanism leading to pediatric TBI. In this study, the authors characterize the demographics of sports-related TBI in the pediatric population and identify predictors of prolonged hospitalization and of increased morbidity and mortality rates. MethoDs Utilizing the National Sample Program of the National Trauma Data Bank (NTDB), the authors retrospectively analyzed sports-related TBI data from children (age 0-17 years) across 5 sports categories: fall or interpersonal contact (FIC), roller sports, skiing/snowboarding, equestrian sports, and aquatic sports. Multivariable regression analysis was used to identify predictors of prolonged length of stay (LOS) in the hospital or intensive care unit (ICU), medical complications, inpatient mortality rates, and hospital discharge disposition. Statistical significance was assessed at a < 0.05, and the Bonferroni correction (set at significance threshold p = 0.01) for multiple comparisons was applied in each outcome analysis. resUlts From 2003 to 2012, in total 3046 pediatric sports-related TBIs were recorded in the NTDB, and these injuries represented 11,614 incidents nationally after sample weighting. Fall or interpersonal contact events were the greatest contributors to sports-related TBI (47.4%). Mild TBI represented 87.1% of the injuries overall. Mean (± SEM) LOSs in the hospital and ICU were 2.68 ± 0.07 days and 2.73 ± 0.12 days, respectively. The overall mortality rate was 0.8%, and the prevalence of medical complications was 2.1% across all patients. Severities of head and extracranial injuries were significant predictors of prolonged hospital and ICU LOSs, medical complications, failure to discharge to home, and death. Hypotension on admission to the ED was a significant predictor of failure to discharge to home (OR 0.05, 95% CI 0.03-0.07, p < 0.001). ...

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“…Previous studies have reported on the incidence of sports-related TBI in various ED populations. 10,17,39 However, the absence of inpatient and acute outcome data has precluded an analysis of hospital LOS, discharge disposition, and mortality rates after sports-related TBI. In the present analysis of an NTDB data set collected over a 10-year interval, we characterized the demographic profiles, hospital and ICU LOSs, medical complications, mortality rates, and discharge disposition across multiple broad categories of sports disciplines in adults admitted for sports-related TBI to Level I and Level II US trauma centers.…”

Section: Discussionmentioning

confidence: 99%

Adult sports-related traumatic brain injury in United States trauma centers

Winkler

Yue

Burke

et al. 2016

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Neurosurg Focus 40 (4):E4, 2016T raumaTic brain injury (TBI) is an alteration in brain function or other evidence of brain abnormality, resulting from an external force applied to the head. Traumatic brain injury occurs in several settings common to daily life, including recreational activities. 21,25,30 In the United States, more than 2.5 million people seek medical care for TBI annually.13 Underreporting of sports-related injuries, lack of consensus definitions, or limited recognition of milder injuries likely leads to gross underestimation of the true incidence of TBI.36 Approximately 70%-90% of all TBIs are comparatively mild and frequently given the colloquial term "concussion. obJeCtive Sports-related traumatic brain injury (TBI) is an important public health concern estimated to affect 300,000 to 3.8 million people annually in the United States. Although injuries to professional athletes dominate the media, this group represents only a small proportion of the overall population. Here, the authors characterize the demographics of sports-related TBI in adults from a community-based trauma population and identify predictors of prolonged hospitalization and increased morbidity and mortality rates. MethoDs Utilizing the National Sample Program of the National Trauma Data Bank (NTDB), the authors retrospectively analyzed sports-related TBI data from adults (age ≥ 18 years) across 5 sporting categories-fall or interpersonal contact (FIC), roller sports, skiing/snowboarding, equestrian sports, and aquatic sports. Multivariable regression analysis was used to identify predictors of prolonged hospital length of stay (LOS), medical complications, inpatient mortality rates, and hospital discharge disposition. Statistical significance was assessed at a < 0.05, and the Bonferroni correction for multiple comparisons was applied for each outcome analysis. resUlts From 2003 to 2012, in total, 4788 adult sports-related TBIs were documented in the NTDB, which represented 18,310 incidents nationally. Equestrian sports were the greatest contributors to sports-related TBI (45.2%). Mild TBI represented nearly 86% of injuries overall. Mean (± SEM) LOSs in the hospital or intensive care unit (ICU) were 4.25 ± 0.09 days and 1.60 ± 0.06 days, respectively. The mortality rate was 3.0% across all patients, but was statistically higher in TBI from roller sports (4.1%) and aquatic sports (7.7%). Age, hypotension on admission to the emergency department (ED), and the severity of head and extracranial injuries were statistically significant predictors of prolonged hospital and ICU LOSs, medical complications, failure to discharge to home, and death. Traumatic brain injury during aquatic sports was similarly associated with prolonged ICU and hospital LOSs, medical complications, and failure to be discharged to home. CoNClUsioNs Age, hypotension on ED admission, severity of head and extracranial injuries, and sports mechanism of injury are important prognostic variables in adult sports-related TBI. Increasing TBI awareness and helmet use-...

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Incidence of sport-related traumatic brain injury and risk factors of severity: a population-based epidemiologic study

Cited by 110 publications

References 50 publications

Sports- and Recreation-Related Concussions in US Youth

Sports- and Recreation-Related Concussions in US Youth

Pediatric sports-related traumatic brain injury in United States trauma centers

Adult sports-related traumatic brain injury in United States trauma centers

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