What is a catastrophic injury in sports?

Founded in 1979, Swope, Rodante P, A. It has grown to meet the unique needs of our clients and the challenges of today's legal environment. The firm's attorneys focus on complex litigation, insurance, bad faith, and catastrophic injury cases, including brain and spinal cord injuries. While the vast majority of catastrophic injuries in youth sports affect the head and spine, there is another type of catastrophic injury that should be mentioned.

Commotio cordis is an often fatal injury caused by blunt, non-penetrating trauma to the chest that causes an electrical alteration of the heart rhythm (for example, ventricular fibrillation). Maron et al reviewed reports compiled by a national registry of commotio cordis, 11 found that of 128 confirmed cases, 78% occurred in children under 18, with only a survival rate of 16%. Although these events may occur in non-sports activities, 84% occurred in sports activities (62% in organized sports) and 81% of sports-related incidents were due to a blunt precordial hit by a projectile (e.g. baseball, softball, hockey puck, lacrosse ball).

Most sports-related incidents (58%) occurred in baseball. Using the participation data in Table 1 as the denominator or exposure data, and the number of injuries in Table 2 as numerator data, we can calculate the direct catastrophic injury rates per 100,000 participants per year for each sport (table. As you can see, looking at rates rather than gross injury numbers changes the picture considerably. Football, which recorded more than eight times more injuries than the next leading sport (cheerleading), also has by far the most participants of any of the sports, so its injury rate is only tied to gymnastics for the second highest rate.

Ice hockey, with an average number of injuries but one of the lowest participation rates, becomes the sport with the highest catastrophic injury rate. School sports with the highest catastrophic injury rates and therefore the highest risk level for such injuries are ice hockey (2.39 per 100,000 participants per year), soccer (1.7), gymnastics (1.7), wrestling (0.9), cheerleading (0.8), and lacrosse (0.8). catastrophic injury rates of less than half per 100,000 participants per year (or less than one injury per 100,000 participants every 2 years), ranging up to 0.00, or no catastrophic injury in the last 26 years for water polo, tennis and golf. The presence of ice hockey, lacrosse and football among the sports with the highest rates of direct catastrophic injury is not surprising, given that they are contact sports, and football, in particular, is a high-speed collision sport.

Given the nature of wrestling, since throws to a mat are a normal part of the sport's activities, it's not surprising that it also ranks high on this list. Gymnastics is generally not considered a contact sport, but in some respects it could be, given the risk of falling from various types of equipment used in sports. Cheerleading is probably the most surprising sport to see so high on the list, but in recent years it has gone from being a simple leadership of cheers on the sidelines to also including a competitive aspect much closer to gymnastics in nature. In many respects, competitive cheerleading could be considered a contact sport, involving activities that require a high degree of skill but, with the exception of shoes and possibly mats, they do not use any personal protective equipment as is required in most team contact sports, a feature that it shares with wrestling and gymnastics.

The overall average for all 18 high school sports is 0.60 direct catastrophic injuries per 100,000 participants per year (Table. Given that there have been an average of nearly 6.3 million participants per year in these high school sports during this period, it's an average of 37.7 direct catastrophic injuries per year. Since it cannot be guaranteed that all direct catastrophic sports injuries will be reported to the NCCIR, these figures and rates should be considered minimal. Even so, these should be considered in the context of approximately 3 million time-wasting sports injuries per year in this age group, of which approximately 770,000 require medical visits and approximately 45,000 to 90,000 require hospitalization, 14 In some respects, car travel to and from a practice or play could be considered a more dangerous activity, compared to the risk of direct catastrophic injury during participation in practice or play, since in recent years the rate of deaths from car accidents (not including other categories of catastrophic injuries) for children aged 10 to 15 has recorded about 5.0 deaths per 100,000 per year, 15 Broader injury surveillance systems are needed for direct catastrophic sports injury coverage.

The National Center for Catastrophic Injury Research at the University of North Carolina has been doing an admirable job for many years, covering high school and college sports, and the information produced there is invaluable. But there are many sports and recreational activities that are not covered by the NCCIR, and some sports, such as gymnastics, are school sports, but most participants participate in non-school club programs. This should be the responsibility of the national organizations that supervise or promote these activities. In fact, it is an ethical responsibility of these organizations.

If they don't maintain surveillance systems on their own, they should provide financial and logistical support to those who do the work. Robust data on the numbers, rates, etiologies and circumstances of these injuries are needed before effective preventive measures can be developed and tested to reduce the incidence and severity of these injuries. Because these injuries are relatively rare, large-scale continuous surveillance systems will be needed. While participation in any sport involves an inherent risk of catastrophic injury, and many may be unavoidable, many more are considered preventable.

Research on catastrophic injuries in youth sports is scarce, but useful data is beginning to accumulate thanks to the efforts of researchers and individual organizations, such as the National Center for Catastrophic Injury Research. In 1977, the National Collegiate Athletic Association began funding for the first annual football catastrophic injury survey under the direction of the National Center for Catastrophic Sports Injury Research. Catastrophic injuries were defined as soccer injuries that resulted in brain or spinal cord injuries or fractures of the head. All cases involved some disability at the time of injury.

Early data collection only involved spinal cord injuries, but head injuries were included in 1984.From 1984 to 1999, there were 63 catastrophic head injuries in high school and 6 in college (Table. All 69 injuries involved incomplete recovery. Using the participation numbers mentioned above, the catastrophic head injury rate from 1984 to 1999 was 0.27 injuries per 100,000 high school participants. The rate for college players was 0.5 injuries per 100,000 participants.

In addition to injuries with incomplete recovery, a series of serious head injuries each year resulted in a full recovery. In comparison, during this same time period (1984 to 199), there were 104 spinal injuries in high school participants and 15 in college participants. The 119 resulted in an incomplete recovery. Catastrophic sports injuries are rare but tragic events.

Direct catastrophic (traumatic) injury is the result of participating in the skills of a sport, such as a collision in soccer. Football is associated with the highest number of direct catastrophic injuries in all major team sports in the United States. Pole vaulting, gymnastics, ice hockey and soccer have the highest incidence of direct catastrophic injuries in sports involving men. In most sports, the catastrophic injury rate is higher in college than in high school.

Cheerleaders are associated with the highest number of direct catastrophic injuries for all sports in which women participate. Indirect (non-traumatic) injury is caused by systemic failure as a result of exertion while playing a sport. Cardiovascular conditions, heat illness, exertional hyponatremia, and dehydration can cause indirect catastrophic injury. Understanding common injury mechanisms and direct catastrophic injury prevention strategies is critical to caring for athletes.

While a doctor will not be available at every practice or competition, a good “first line of defense” is the presence of a certified athletic trainer to provide immediate care and help reduce the risk of exacerbating serious injuries and increase the chances of a better outcome. From 1982 to 1999, there were 20 deaths and 19 injuries due to permanent disability in various sports. Cheerleaders accounted for more than 50% of female participants' catastrophic injuries in the past 17 years. There are also some articles that cover head and spinal cord injuries in recreational sports activities that do not differentiate between children and older age groups.

Table 3 also shows that for the three categories of direct catastrophic injuries (fatalities, non-fatal and serious), men have significantly higher rates than women. An online portal has been developed to facilitate confidential and secure reporting of catastrophic events. This review of the literature on catastrophic injuries in youth sports summarizes what is currently known about the occurrence of these injuries in various youth and high school sports, and summarizes suggested means of preventing them. While these types of injuries are rare, they can cause permanent neurological deficits or even death, which can be devastating for athletes and their families.

Since the vast majority of direct catastrophic injuries occur in American football, attention should be paid to prevention in this sport. As shown in Table 1.1, head injuries accounted for 491 (69%), cervical spine injuries 116 (16.3%) and other injuries 105 (14.7%) of these deaths. Most catastrophic injuries related to diving and swimming in the United States occur when a person dives into shallow water. As with other sports, there is a definite need for education and certification of coaches, and for education of participants and parents about the risks of sports and how injuries can be prevented.

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Arnold Gentner
Arnold Gentner

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