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Comparison of Football-Related Injuries at US Emergency Departments Between High School and Collegiate Athletes: A
John R Tyler1, Ryan Card2, Ian Rice2
1Department of Orthopaedic Surgery & Rehabilitation, Loyola University Health System, Maywood, Illinois, USA.
Background:
Contemporary, sport-specific comparisons of injury patterns and epidemiological trends between high school- and college-aged football athletes are limited and dated, particularly from a single, nationally representative data set.
Purpose:
To provide an updated, comparative assessment of the epidemiology of football-related injuries among male high school- and college-aged athletes and to characterize the burden of these injuries on emergency departments (EDs) across the United States (US).
Study Design:
Descriptive epidemiology study.
Methods:
The National Electronic Injury Surveillance System (NEISS) was queried for football-related injuries among high school-aged (14-18 years) and college-aged (19-23 years) male athletes from 2015 to 2024. Injury characteristics, anatomic location, diagnosis, and ED disposition were analyzed. Annual National Federation of State High School Associations and National Collegiate Athletic Association participation counts defined at-risk populations. The incidence was calculated as ED visits per 100 at-risk participants, and incidence rate ratios (IRRs) with 95% CIs were used to compare levels of play.
Results:
Among 40,249 unweighted NEISS cases, the weighted national estimate was 1,377,935 football-related ED visits among male athletes aged 14 to 23 years during 2015 and 2024. College-aged athletes were significantly more likely than high school-aged athletes to be evaluated with football-related injuries (21.34 vs 12.02 per 100 at-risk persons; IRR, 1.78 [95% CI, 1.77-1.78]). The head, shoulders, knees, and fingers were most frequently involved. College-aged athletes had higher rates across most diagnosis categories-including laceration (IRR, 4.35 [95% CI, 4.26-4.45]), dislocation (IRR, 3.44; 95% CI, 3.38-3.50), and nerve damage (IRR, 2.23 [95% CI, 1.97-2.53]). Injuries to the mouth (IRR, 5.34 [95% CI, 5.11-5.57]) and face (IRR, 4.55 [95% CI, 4.45-4.66]) were disproportionately higher in college-aged athletes. Most visits resulted in treatment and discharge, but admissions and observations were more frequent among college-aged athletes.
Conclusion:
Among football-related injuries evaluated in US EDs from 2015 to 2024, the incidence was higher in college-aged than high school-aged athletes, with a concentration in head and upper-extremity presentations. Collegiate players sustained higher rates across nearly all injury types and locations, emphasizing the need for targeted prevention and clinical vigilance at advanced levels of play.
