Original Contribution
Tackling causes and costs of ED presentation for American football injuries: a population-level study,☆☆

https://doi.org/10.1016/j.ajem.2016.02.057Get rights and content

Abstract

Background

American tackle football is the most popular high-energy impact sport in the United States, with approximately 9 million participants competing annually. Previous epidemiologic studies of football-related injuries have generally focused on specific geographic areas or pediatric age groups. Our study sought to examine patient characteristics and outcomes, including hospital charges, among athletes presenting for emergency department (ED) treatment of football-related injury across all age groups in a large nationally representative data set.

Methods

Patients presenting for ED treatment of injuries sustained playing American tackle football (identified using International Classification of Diseases, Ninth Revision, Clinical Modification code E007.0) from 2010 to 2011 were studied in the Nationwide Emergency Department Sample. Patient-specific injuries were identified using the primary International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code and categorized by type and anatomical region. Standard descriptive methods examined patient demographics, diagnosis categories, and ED and inpatient outcomes and charges.

Results

During the study period 397 363 football players presented for ED treatment, 95.8% of whom were male. Sprains/strains (25.6%), limb fractures (20.7%), and head injuries (including traumatic brain injury; 17.5%) represented the most presenting injuries. Overall, 97.9% of patients underwent routine ED discharge with 1.1% admitted directly and fewer than 11 patients in the 2-year study period dying prior to discharge. The proportion of admitted patients who required surgical interventions was 15.7%, of which 89.9% were orthopedic, 4.7% neurologic, and 2.6% abdominal. Among individuals admitted to inpatient care, mean hospital length of stay was 2.4 days (95% confidence interval, 2.2-2.6) and 95.6% underwent routine discharge home. The mean total charge for all patients was $1941 (95% confidence interval, $1890-$1992) with substantial injury type–specific variability. Overall, at the US population, estimated total charges of $771 299 862 were incurred over the 2-year period.

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. 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 associations between the patterns of injury observed in this study and long-term outcomes among American tackle football players.

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.

    ☆☆

    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.

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