Progress in Cheerleading Safety: Update on the Epidemiology of Cheerleading Injuries Presenting to US Emergency Departments, 2010-2019

Abstract

Background: Although the athleticism required of cheerleaders has increased, the risks of cheerleading have been less studied as compared with other sports. Purpose: To update our understanding of the epidemiology of cheerleading-related injuries. Study Design: Descriptive epidemiology study. Methods: We analyzed the National Electronic Injury Surveillance System (NEISS) for cheerleading-related injuries presenting to nationally representative emergency departments (EDs) in the United States from January 2010 through December 2019. Extracted data included patient age and sex, injury characteristics (diagnosis, body region injured, time of year, and location where injury occurred), and hospital disposition. Using patient narratives, we recorded the cheerleading skills, settings, and mechanisms that led to injury. NEISS sample weights were used to derive national estimates (NEs) from actual case numbers. Results: From 2010 to 2019, a total of 9868 athletes (NE = 350,000; 95% CI, 250,000-450,000) aged 5-25 years presented to US EDs for cheerleading injuries. The annual number of injuries decreased by 15%, from 982 (NE = 35,000; 95% CI, 27,000-44,000) to 897 (NE = 30,000; 95% CI, 18,000-42,000) ( P = .048), corresponding to a 27% decline in the injury rate per 100,000 cheerleaders ( P < .01). The annual number of injuries caused by performing stunts decreased by 24%, from 240 (NE = 8700; 95% CI, 6700-11,000) to 216 (NE = 6600; 95% CI, 4000-9200) ( P = .01), with a 36% decline in the corresponding injury rate per 100,000 cheerleaders ( P < .01). Despite these decreases, annual incidence of concussions/closed head injuries increased by 44%, from 128 (NE = 3800; 95% CI, 2900-4700) to 171 (NE = 5500; 95% CI, 3400-7700) ( P = .02), and patients requiring hospital admission increased by 118%, from 18 (NE = 330; 95% CI, 250-410) to 24 (NE = 720; 95% CI, 440-1000) ( P < .01). The hospital admission rate increased by 9.0% ( P = .02). Conclusion: The number of cheerleading-related injuries presenting to US EDs decreased from 2010 to 2019. However, the incidence of concussions/closed head injuries and hospital admissions increased, suggesting that further measures are needed to improve safety for cheerleaders.

Understanding the Cheerleader as an Orthopaedic Patient: An Evidence-Based Review of the Literature

“…26,114,127 Similar to the risk of sustaining a catastrophic injury, the risk of sustaining a concussion in cheerleading has increased as the sport has evolved in difficulty and complexity. 103,134,172 This increase may also be related to greater reporting and awareness of concussions in recent years, as seen with other sports. 119 The national incidence of concussion has increased by >900% since 2000, from approximately 600 concussions that year (2.7% of all cheerleading injuries presenting to US emergency departments) to approximately 5500 concussions (18%) in 2019.…”

“… 9 , 103 , 134 , 172 Of note, cheerleading’s concussion rate has continued to increase while the sport’s overall injury rate has decreased. 172 , 173 …”

“…Contrary to common perceptions, bases have a higher rate of stunt-related injury (34%-46%) compared with flyers (30%-39%). 26 , 132 , 172 Injuries to bases most frequently occur to the head and neck (21%), knee (10%), and lower back (9%) as a result of improper technique in tossing, lifting, or catching. 132 Injuries to flyers most often occur to the head and neck (49%), followed by the upper extremity (20%), and result from falls.…”

“…119 The national incidence of concussion has increased by >900% since 2000, from approximately 600 concussions that year (2.7% of all cheerleading injuries presenting to US emergency departments) to approximately 5500 concussions (18%) in 2019. 9,103,134,172 Of note, cheerleading's concussion rate has continued to increase while the sport's overall injury rate has decreased. 172,173 Concussions are the most common head injury in cheerleading, and 96% are secondary to stunt-related incidents.…”

“…7 Each year, approximately 35,000 cheerleading-related injuries, most commonly involving the extremities, are treated in emergency departments across the United States. 172 Specifically, cheerleading accounts for 65% of all catastrophic injuries-defined as severe spinal, spinal cord, or cerebral injuries-occurring in female athletes. 9,102 Such catastrophic injuries present acutely, but most injuries sustained in cheerleading are chronic and related to overuse.…”