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Background The injury rate is a common measure of injury occurrence in epidemiological surveillance and is used to express the incidence of injuries as a function of both the population at risk as well as at-risk exposure time. Traditional approaches to surveillance-based injury rates use a frequentist perspective; here, we discuss the Bayesian perspective and present a practical framework on how to apply a Bayesian analysis to estimate injury rates. We estimated finescale injury rates across a broad range of categories for men’s and women’s soccer, applying a Bayesian methodology and using injury surveillance data captured within the National Collegiate Athletic Association Injury Surveillance Program from 2014/15–2018/19. Results Through an iterative process of assessing model fidelity, we found that a negative binomial model was an effective choice for modeling surveillance-based injury rates. We also found differences between schools to be a key driver of variation in injury rates. Conclusions Our findings indicate that the Bayesian framework naturally characterizes injury rates by modeling injury counts as outcomes of an underlying data-generation process that explicitly incorporates inherent uncertainty, complementing traditional frequentist approaches. Key benefits of the Bayesian approach in this context are the ability to test model suitability in a variety of methods, and to be able to generate plausible estimates with sparse data.

The National Collegiate Athletic Association held the first women's soccer championship in 1982; sponsorship and participation have greatly increased since.CONTEXTThe National Collegiate Athletic Association held the first women's soccer championship in 1982; sponsorship and participation have greatly increased since.Routine examinations of athlete injuries are important for identifying emerging temporal patterns.BACKGROUNDRoutine examinations of athlete injuries are important for identifying emerging temporal patterns.Exposure and injury data collected in the National Collegiate Athletic Association Injury Surveillance Program during the 2014-2015 through 2018-2019 seasons were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates.METHODSExposure and injury data collected in the National Collegiate Athletic Association Injury Surveillance Program during the 2014-2015 through 2018-2019 seasons were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates.The overall injury rate was 8.33 per 1000 athlete-exposures. Lateral ligament complex tears (ankle sprains) (8.6%), concussions (8.3%), and quadriceps tears (5.0%) were the most commonly reported injuries. Rates of lateral ligament complex tears followed an increasing trajectory during the study period, whereas quadriceps tear rates fluctuated during the early years, and concussion rates decreased then increased.RESULTSThe overall injury rate was 8.33 per 1000 athlete-exposures. Lateral ligament complex tears (ankle sprains) (8.6%), concussions (8.3%), and quadriceps tears (5.0%) were the most commonly reported injuries. Rates of lateral ligament complex tears followed an increasing trajectory during the study period, whereas quadriceps tear rates fluctuated during the early years, and concussion rates decreased then increased.The findings of this study were mostly consistent with existing evidence; notable temporal patterns were observed with regard to lateral ligament complex tears and concussions.SUMMARYThe findings of this study were mostly consistent with existing evidence; notable temporal patterns were observed with regard to lateral ligament complex tears and concussions.

ObjectiveTo evaluate the evidence regarding the association between lateral ankle sprain (LAS) history and the subsequent LAS risk, as well as sex differences in the observed associations.Data SourcesPubMed, CINAHL, and SPORTDiscus were searched through July 2020 for articles on LAS history and incidence during the study period.Study SelectionStudies were included if they were prospective in nature and the authors reported the number of participants with and those without a history of LAS at study initiation as well as the number of participants in each group who sustained an LAS during the investigation.Data ExtractionData were study design parameters as well as the number of participants with and those without an LAS history and the number of subsequent LASs that occurred in both groups. Risk ratios (RRs) with 95% CIs compared the risk of LAS during the study period between those with and those without an LAS history for each investigation.Data SynthesisA total of 19 studies involving 6567 patients were included. The follow-up periods ranged from 14 weeks to 2 years. Assessment scores indicated the studies were of moderate to high quality. A significantly higher risk of LAS during the study period was observed among those with a history of LAS in 10 of 15 studies (RR range = 1.29–6.06). Similar associations were seen in 4 of 6 studies of all-male samples (RR range = 1.38–8.65) and 1 of 4 studies with an all-female sample (RR = 4.28).ConclusionsStrong evidence indicates that a previous LAS increased the risk of a subsequent LAS injury. Men with a history of LAS appeared to be at a higher risk of sustaining a subsequent LAS, but women were not. However, further data are needed to draw definitive conclusions from the limited number of sex-specific studies.

Walking Football is a growing adapted sport offering a viable alternative to traditional exercise for middle-aged and older adults. While rule modifications aim to reduce injury risk, this has yet to be established. This study conducted injury surveillance in community-based Walking Football to determine injury incidence and characteristics in training and matches. A four-month observational cohort study remotely tracked injuries and exposure time across seven Walking Football clubs in England using a sub-elite injury surveillance framework. Injuries were classified as medical attention (requiring on-field attention without subsequent absence) or time-loss (≥1 day of participation absence). Injury incidence was calculated per 1000 h of play. Across 6364.55 h of exposure, 45 injuries were reported: 30 (66.7%) medical attention and 15 (33.3%) time-loss injuries. Injury incidence was 5.3 [1.5–11.5] per 1000 h in training (medical attention: 3.3 [0.8–7.3]; time-loss: 2.0 [0.5–4.5]) and 37.6 [8.7–83.9] per 1000 h in matches (medical attention: 28.9 [5.8–66.6]; time-loss: 8.7 [0–23.2]). Match injury incidence was significantly higher than training (rate ratio: 7.1 [1.3–31.4]). Findings suggest that injury incidence in community-based Walking Football is low, supporting its safety and potential as a sustainable physical activity strategy for middle-aged and older adults.

Relationships between the constructs of concussion-related knowledge, attitudes, and norms and their influence on observed care-seeking behaviors have previously been examined. Current models posit that these constructs serve as potential mediators of care-seeking behaviors; however, the dynamics between them have yet to be reconciled. A cross-sectional, online survey explored relationships among the latent constructs of concussion-related knowledge, attitudes, and norms in parents of middle school children who participate in sports in multiple settings. A just-identified and two overidentified path models were explored and compared in an effort to understand such relationships. A total of 426 parents of United States middle school students were surveyed and included in analyses (mean age = 38.7±9.9 years; 55.6% female; 51.4% white/non-Hispanic; 56.1% with at least a bachelor's degree). All parents had middle school aged children who participated in sport in both the club and school settings. The best fitting model was a just-identified model with concussion-related norms influencing concussion-related knowledge and attitudes, and concussion-related knowledge influencing attitudes. This model accounted for 14% of the variance in attitude and 12% of the variance in knowledge. Study findings suggest that the constructs of concussion-related knowledge, attitudes and norms are directly related to one another, yet the dynamics of such relationships may be complex. As such, a parsimonious interpretation of these constructs may not be appropriate. Future research should work to further reconcile the dynamics between these constructs, and the impact these dynamics may have in influencing care-seeking behaviors beyond serving as mediators.

Middle school (MS) is an intermediary level of education between elementary and secondary school that typically includes students aged 10–15 years. There is limited research within the MS sport setting, particularly related to sport-related injury prevention. This qualitative study aimed to better understand the sport culture within MS sports and the communication strategies used among invested groups (i.e., athletes, parents, staff inclusive of coaches and school nurses). Semi-structured interviews were conducted with 19 athletes, 20 parents, and 18 staff (e.g., coaches, school nurses) from seven MS in two school districts during the 2018/19 and 2019/20 school years. Topics focused on understanding school- and sport-related factors related to education, safety, and communication. Analysis used a consensual qualitative research tradition, in which the research team discussed individually developed themes and categories from transcribed interviews, with the goal of coming to a consensus and creating a codebook. Throughout the coding process, the research team would reconvene to discuss coding decisions until consensus was reached. This study focuses on the themes of sport culture and communication. Dominant categories identified within sport culture related to participants noting why they were interested in MS sports, and their struggles with their perceived roles and engagement (e.g., helping parents stay engaged, finding coaches, oversight of school nurses). Competitiveness and safety could have conflicting roles and priority. Dominant categories identified within communication centered around limited communication between coaches and parents. Technological assistance (e.g., phone apps, websites) was available, but often varied by school and sport. Concussions were seldom discussed unless during the preseason meeting or when one occurred. Findings highlight that the MS sport settings may struggle with incorporating primary prevention into their cultures and ensuring reliable communication among individuals. Novel and tailored approaches to injury prevention are needed to help ensure buy-in and proper implementation.

ContextBasketball has remained a popular sport for players and spectators in the United States since before the first National Collegiate Athletic Association men's championship tournament in 1939.BackgroundRoutine examinations of men's basketball injuries are important for identifying emerging temporal patterns.MethodsExposure and injury data collected in the National Collegiate Athletic Association Injury Surveillance Program during 2014–2015 through 2018–2019 athletic seasons were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differences in injury rates.ResultsThe overall injury rate was 7.28 per 1000 athlete exposures, with competition rates twice those of practices (injury rate ratio = 2.07; 95% CI = 1.93, 2.22). Injuries to the ankle (22.2%), knee (13.0%), head/face (11.3%), and hand/wrist (10.1%) accounted for most reported injuries, with sprains (30.4%), contusions (14.3%), and strains (13.9%) most commonly reported. Ankle sprain rates initially trended upward and decreased between 2017–2018 and 2018–2019; concussion rates remained relatively stable during 2014–2015 through 2018–2019.ConclusionsFindings suggest that common injury rates are trending downward relative to previous study findings.

Identifying the associations between head impact biomechanics and clinical recovery may inform better head impact monitoring procedures and identify athletes who may benefit from early treatments aimed to enhance recovery. The purpose of this study was to test whether head injury biomechanics are associated with clinical recovery of symptom severity, balance, and mental status, as well as symptom resolution time (SRT) and return-to-participation (RTP) time. We studied 45 college American football players (n = 51 concussions) who sustained an incident concussion while participating in a multi-site study. Player race/ethnicity, prior concussion, medical history, position, body mass index, event type, and impact location were covariates in our multivariable analyses. Multivariable negative binomial regression models analyzed associations between our study outcomes and (1) injury-causing linear and rotational head impact severity, (2) season repetitive head impact exposure (RHIE), and (3) injury day RHIE. Median SRT was 6.1 days (IQR 5.8 days, n = 45) and median RTP time was 12.3 days (IQR 7.8 days, n = 36) across our study sample. RTP time was 86% (Ratio 1.86, 95% CI [1.05, 3.28]) longer in athletes with a concussion history. Offensive players had SRTs 49% shorter than defensive players (Ratio 0.51, 95% CI [0.29, 0.92]). Per-unit increases in season RHIE were associated with 22% longer SRT (Ratio 1.22, 95% CI [1.09, 1.36]) but 28% shorter RTP time (Ratio 0.72, 95% CI [0.56, 0.93]). No other head injury biomechanics predicted injury recovery.

Background While head injuries and concussions are major concerns among soccer players, the multifactorial nature of head injury observations in this group remains relatively undefined. We aim to extend previous analyses and examine sex-differences in the incidence of head injuries, odds of head injuries within an injured sample, and severity of head injuries, among collegiate soccer players between 2004 and 2009. Methods Data collected within the National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS) between the years of 2004 and 2009, were analyzed in this study. Unadjusted rate ratios (RR), compared incidence rates between categories of sex, injury mechanism, setting and competition level. We also examined sex-differences in head injury incidence rates, across categories of the other covariates. Multivariable logistic regression and negative binomial regression modeling tested the relation between sex and head injury corollaries, while controlling for contact, setting, and competition level. Results Between 2004 and 2009, head injuries accounted for approximately 11% of all soccer-related injuries reported within the NCAA-ISS. The rate of head injuries among women was higher than among men (RR = 1.23, 95% CI = [1.08, 1.41]). The rate of head injuries due to player-to-player contact was comparable between women and men (RR = 0.95, 95% CI = [0.81, 1.11]). Whereas, the rate of injury due to contact with apparatus (ball/goal) was nearly 2.5 times higher (RR = 2.46, 95% CI = [1.76, 3.44]) and the rate due to contact with a playing surface was over two times higher (RR = 2.29, 95% CI = [1.34, 3.91]) in women than in men. In our multifactorial models, we also observed that the association between sex and head injury corollaries varied by injury mechanism. Conclusions Sex-differences in the incidence, odds (given an injury), and severity (concussion diagnosis, time-loss) of head injuries varied by injury mechanism (player-to-player contact vs. all other mechanisms) in this sample.