Original ContributionTackling causes and costs of ED presentation for American football injuries: a population-level study☆,☆☆
Introduction
American tackle football is the most popular high-energy impact sport in the United States, with approximately 9 million participants competing annually [1], [2]. Tackle football is associated with the highest injury rates among all organized team sports, with previous studies reporting between 300 000 and 1.2 million football-related injuries annually among high school football players alone [3], [4], [5], [6], [7], [8], [9]. Recent reports in the popular media have focused on football-related head injuries, including acute disorders such as concussions and the possible chronic effects of repeated head injury, which has been described as chronic traumatic encephalopathy [10], [11], [12]. In addition, football-related head trauma has been associated with increased long-term risks of depression, substance abuse, cognitive dysfunction, and, possibly, dementia [13], [14], [15], [16], [17], [18], [19], [20].
Although head trauma is the subject of much study in football, there are few studies that have examined the broad incidence of football-related injuries of all types among football players of different ages. Prior epidemiologic studies of football-related injury generally have been restricted to specific geographic areas, or to players/patients in pediatric age groups [6], [21], [22], [23], [24]. To date, there is limited published information quantifying hospital resource utilization and hospital charges associated with the entire range of football-related injuries.
We sought to examine factors associated with emergency department (ED) presentation and patient outcomes, including hospital charges, among patients seeking ED treatment of football-related injuries across all age groups in a large nationally representative data set.
Section snippets
Methods
The Nationwide Emergency Department Sample (NEDS) is the largest all payer ED database in the United States, which can be weighted to provide estimates of hospital-based ED visits at the level of the US national population. In 2011, the NEDS provided discharge data from 950 hospitals located throughout 30 US states, representing a 20% stratified sample of ED visits in the United States. At the population level, approximately 130 million ED visits are represented in the NEDS annually [25].
Results
A total of 397 363 patients of all ages met the study criteria in 2010 and 2011. Overall, most patients were male (380 493 [95.8%]), with the 15- to 18-year age group containing the smallest proportion of females (2.7%). Most patients had private insurance (208 383 [52.4%]). However, 35.3% of patients 18 years or younger had primary coverage through Medicaid compared with 13.6% of patients 19 years or older (P < .001). The distribution of zip code–based household income quartile did not vary within
Discussion
American tackle football is a substantial contributor to injury burden in the ED, regardless of age or injury type. Because of the violent nature of the sport, football is known to be associated with injury to players; however, little has been reported regarding the incidence of, and outcomes associated with acute injury of all types among football players of all ages. This current study provides a foundational description of the epidemiology of injuries leading to ED presentation that occur
Conclusion
In this nationally representative sample, most ED-treated injuries associated with football were not acutely life threatening and very few required major therapeutic intervention. Across all age groups, most injured patients were treated in the ED and discharged directly to home. This study provides a cross-sectional overview of ED presentation for acute football-related injury across age groups at the population level in recent years. Longitudinal studies may be warranted to examine
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All authors report no potential conflicts of interest.
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All authors have read and approved the submitted manuscript; the manuscript is not under consideration for publication elsewhere, nor has it been published elsewhere in whole or in part, except as an abstract.