"Par for the Cortex": Epidemiology and Management of Golf-Related Neurological Injuries

Neurological injuries from recreational golfing, although infrequent, can occur through various mechanisms including impacts with golf equipment and vehicles, leading to head and spine injuries that necessitate careful evaluation and management.

We conducted a retrospective review of a prospectively maintained single-institution database for patients with golf-related neurological injuries. Statistical analysis compared mean ages, sex, length of hospital stays (length of stay (LOS), injury severity scores (ISSs), and mechanisms of injury (MOI) using analysis of variance, χ², and correlation tests.

Twenty-nine total cases (72.4% male) were identified between 2006 and 2024 with an average age of 17.7 years. Median Glasgow Coma Scale at presentation was 15 (range 8-15). The median LOS was 1 day (range 0-17). There was a moderately positive correlation between LOS and age (r = 0.41). MOI were classified as patient vs golf ball (GB, 17.2%), patient vs golf club (GC, 58.6%), and golf vehicle related injury (GV, 24.1%). This resulted in 28 head injuries (96.6%) and 2 spine injuries (6.9%). The most common injuries included skull fractures (79.3%), cerebral contusions (34.5%), and subdural hematoma (34.5%), with 5 patients requiring neurosurgical management (17.2%). One patient (GV injury) died during his hospital stay. The mean LOS demonstrated a significant difference among MOI (F-ratio = 5.37[>3.38]). The mean ISS was 3.6 in patient vs GB injuries, 3.7 in patient vs GC injuries, and 13.7 in GV related injuries, with a statistically significant difference between ISS and MOI (F-ratio = 6.17, 95% CI: 1.2-6.6, P = .006). Post-hoc analysis showed that ISS was significantly higher in patients with GV related injuries compared with patients injured by GB and GC (95% CI: 0.2 to 5.4, P = .037, and 95% CI: 1.2-6.6, P = .006, respectively).

Although neurological injuries from golfing accidents are usually treated conservatively, recognizing skull fractures and intracranial hemorrhage is crucial. Golf is generally a safe sport from a neurological perspective; however, a notable number of patients still present with traumatic neurological injuries.