A Review of Sports-Related, Life-Threatening Injuries Presenting to Emergency Departments, 2009-18

In the United States, 3.7 million people present to an emergency department (ED) annually with an injury related to sports or athletic activity. A prior study a decade ago revealed that 14% of life-threatening injuries presenting to EDs were sports related, with this percentage being higher in the pediatric population. However, with changes in sports participation and regulatory changes over the past decade, it is unclear whether the proportion of life-threatening sports-related injuries has changed.

We conducted a cross-sectional study using the National Hospital Ambulatory Medical Care Survey (NHAMCS), consisting of patients from years 2009-2018. Life-threatening injuries were defined as International Classification of Diseases 9 and 10 codes for skull fracture, cervical spine fractures, intracranial hemorrhage, traumatic pneumothorax/hemothorax, liver lacerations, spleen lacerations, traumatic aortic aneurysm or rupture, gastric/duodenal rupture, heat stroke, and commotio cordis. Injuries were classified as sports related based on external cause of injury codes. We examined the relationship between demographic variables and sports-related injuries using Pearson chi-square analysis.

From the years 2009-2018 there were 256,564 observed ED visits. Of these, 646 were for life-threatening injuries, representing a national estimate of 3,456,166 patients over the 10-year period. Thirteen percent were sports related. Of the life-threatening injuries, 77.5% were injuries to the head and neck, and 9.1% of these were sports related. The proportion of life-threatening injuries due to sports and recreation was higher among pediatric patients than adult patients (30.4% vs 9.9%, P<0.001). The proportion of sports-related life-threatening injuries to the head and neck was also higher among pediatric patients than adult patients (23.3% vs 6.4%, P<0.001) CONCLUSION: A substantial proportion of life-threatening injuries occur during sports and recreation, especially among pediatric patients. Compared to a similar study a decade ago, there is a similar proportion of life-threatening injuries that are sports related, however; there does seem to be a decrease in the proportion of life-threatening sports-related injuries to the head and neck. Sports medicine physicians and sports organizations should continue to find effective ways to prevent life-threatening injuries in sports.