Racket and paddle sports-related injuries treated in United States emergency departments, 2000-2023

The objective of this study is to investigate the characteristics and trends of injuries related to racket and paddle sports (RPS) treated in United States (US) emergency departments (EDs).

Using a retrospective cohort study design, data from the National Electronic Injury Surveillance System were analyzed regarding ED visits from January 1, 2000, through December 31, 2023, by individuals 6 years and older who were injured while playing tennis, paddleball/squash/racquetball, badminton, table tennis, or pickleball. National estimated injury frequencies and annual population-based rates were calculated.

An estimated 792,773 RPS injuries among individuals 6 years and older were seen in US EDs from 2000 to 2023. Injuries were more common among males (59.0%) and individuals >39 years old (56.1%). The average age was 43.9 (standard deviation: 23.3) years. Injuries related to tennis were the most frequent (61.7%), followed by paddleball/squash/racquetball (15.6%), pickleball (13.1%), badminton (5.4%), and table tennis (4.2%). Falls were the most common mechanism of injury (36.5%), while a medical event was the mechanism for 25.5% of older adults >64 years old. Sprain/strain was the most common diagnosis (33.0%), followed by fracture (15.4%) and soft tissue injury (11.3%). Overall, 8.7% of injuries resulted in hospital admission. The RPS injury rate per 100,000 US population 6 years and older increased with fluctuation over time by 20.9% from 12.9 in 2000 to 15.6 in 2023, with males experiencing higher rates than females. The rate of RPS injuries among individuals >64 years old increased 55.7% from 10.6 in 2011 to 37.7 in 2023 (P < 0.0001). Additionally, the rate of hospital admission among individuals 6 years and older fluctuated during the study years with a 300.0% increase from 0.7 in 2012 to 2.8 in 2023, with the rate for individuals >64 years old similarly increasing 271.0% from 3.1 in 2013 to 11.5 in 2023. Patients >64 years old were more likely to be admitted than younger patients (RR: 6.32, 95% CI: 4.97-8.04). The admission rate was higher for pickleball injuries (RR: 2.57, 95% CI: 2.03-3.26) compared with injuries associated with other RPS. The admission rate was also higher for RPS-related medical events than other mechanisms of injury (RR: 10.99, 95% CI: 8.22-14.70).

RPS injury-related ED visits increased modestly over the past two decades, while hospital admissions rose substantially, driven primarily by injuries involving older adults and pickleball. As RPS participation continues to grow, targeted, sport-specific, age-specific, and mechanism-informed prevention strategies are warranted to reduce serious morbidity while supporting safe lifelong sport participation.