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The Epidemiology of Catastrophic Head and Neck Injuries in High School and College Non-Football Sports: A 4-Decade
Courtney M Meyer1, Kristen L Kucera2, Samantha E Scarneo-Miller3
1University of South Carolina, Columbia, South Carolina, USA.
Background:
Catastrophic head and neck injuries (CHNIs) in sport are rare but can have disabling or fatal outcomes. Prior studies have focused on football, equipment-laden sports, or different injury severities, not CHNI in nonfootball sports.
Purpose:
To describe the epidemiology of CHNI across levels (high school vs collegiate) in nonfootball sports and evaluate differences in injury rates (IRs) by sport, sex, and decade.
Study Design:
Descriptive epidemiological study.
Methods:
This study utilized 40 academic years (1982-1983 to 2021-2022) of surveillance data from the National Center for Catastrophic Sports Injury Research. Descriptive statistics summarized athlete, event, and injury characteristics. IRs were calculated from available institutional participation data for high school and collegiate levels. Athlete-exposure was defined as 1 athlete participating in 1 sport season. IRs per 100,000 athlete seasons (AS), IR ratios (IRRs), and 95% CIs were computed using negative binomial regression.
Results:
A total of 470 eligible CHNI events were included, capturing 17 unique sports. Most injuries transpired in those who were male (69.4%; n = 326), ranged in age from 12 to 25, and competed at the high school level (76.2%; n = 358). Of injuries, 12.6% were fatal (n = 59), 38.7% were permanently disabling (n = 182), and 44.9% were temporarily disabling (n = 211). Of all male patients (n = 326), traumatic brain injury (33.4%; n = 109) and spinal fractures (34.1%; n = 111/326) were reported most frequently, while traumatic injuries (n = 144) including brain (34.0%; n = 49) and other traumatic injuries (ie, nerve injury, facial fractures, etc [30.6%; n = 44]) occurred most frequently in female patients. CHNI occurred at a lower rate in female than male patients (IR, 0.12 vs 0.48 per 100,000 AS; IRR, 0.25; 95% CI, 0.18-0.33; P < .001) and in collegiate than high school athletes (IR, 0.11 vs 0.53 per 100,000 AS; IRR, 0.20; 95% CI, 0.15-0.27; P < .001). Sports with the highest CHNI rates included gymnastics (IR, 1.66) and ice hockey (IR, 1.52). Rates declined each decade, with the largest difference in rate occurring between 1982 and 1992 (IR, 0.59; IRR, 8.93; 95% CI, 2.23-35.68) and between 2012 and 2022 (IR, 0.06).
Conclusion:
CHNI rates in nonfootball sports declined over 4 decades and were higher among athletes who were male, competing at the high school level, or participating in gymnastics or ice hockey. Over half of the athletes sustaining CHNI experienced outcomes of permanent disability or fatality.
