Injury PreventionEmergency visits for sports-related injuries*
Introduction
Emergency department use statistics can be used to describe the most serious injuries that are caused during sport and recreation activities not resulting in hospitalization or death. Because a relatively small proportion of sports-related injuries result in hospitalization or death, the ED has comprehensive information on the majority of patients requiring medical attention. Special studies of encounter statistics for visits to EDs for injuries have provided information on the cause and place of injury.1, 2, 3, 4 External cause of injury codes from the International Classification of Diseases, ninth revision, Clinical Modification (ICD-9-CM) supplementary chapter on external cause of injury5 have been used to determine the extent of sports-related injuries.6 Unfortunately, much of the information on what the person was doing when the injury occurred cannot be extracted because the ICD-9-CM does not have codes that capture a full range of activities. For example, although injuries caused in bicycle or boating incidents are well defined, other activities, such as playing team sports or combative sports, are not explicitly covered by the classification scheme. Through a narrative text entry on the 1997 and 1998 National Hospital Ambulatory Medical Care Survey (NHAMCS) data files, the researcher has the capability of searching the database for key words or phrases that may be important for public health surveillance of injuries. It also allows researchers to apply their own coding schemes to the data, and thus the evaluation of both traditional and new coding schemes may be undertaken.
Previous research on sports-related injuries has focused on population-based surveys, such as the National Health Interview Survey. However, these studies have demonstrated recall bias when injuries occurred.7, 8 Furthermore, use of E-codes alone in these studies limits information on the kinds of activities in which the person participates when an injury occurs.
Injury surveillance research has discussed the advantages and limitations of various methods for examining sport and recreation injury incidence and epidemiology.9, 10 The current study is not excluded from many of the disadvantages, including the inability to provide appropriate exposure estimates. Event-based studies may estimate the rate of basketball injury visits per capita but not the rate per person who plays basketball. Notwithstanding, there are some advantages to event-based studies. Event-based medical encounter studies of injuries are not subject to the extent of recall bias experienced in population-based studies of injuries because the information on the injury is recorded into the medical record directly after the injury as opposed to up to 2 months later. In addition, medical information is obtained directly from the attending physicians and nurses, and therefore the nature of the injuries should be more specific. Use statistics also help when hospitals are planning for ED staffing and training of emergency medical physicians and nurses. Therefore, encounter statistics allow for another investigative perspective into injury prevention, control, and treatment research.
Population estimates of sports-related injuries have shown that sports-related injuries occur more often among children and adolescents than among adults. It was estimated that in 1988, 32.3% of all serious injury episodes by 5- to 17-year-olds were a result of sporting and recreational activities.11 Sporting and recreational activities represented 27.7% of all injury-related hospitalizations.11 In the study by Bijur et al,11 both the injury episodes and the nature of the injuries were based on subject recall. Because the data were coded by using external cause of injury categories only, estimates of injuries caused by specific activities could not be determined.
The purpose of this study is to analyze the narrative text entries abstracted from medical records by activity categories to identify and estimate national statistics on emergency visits for injuries that occurred while the patient was engaged in sporting and recreational activities, specifically highlighting injuries by school-age children, adolescents, and young adults. Although definitions vary across research studies,12, 13 for the purpose of this study, a sport or recreational activity is defined as an activity involving increased physical exertion for the purpose of competition or recreation. This a broad definition that includes competitive sports, as well as recreational games and adventure activities.
Section snippets
Materials and methods
In a secondary analysis of data from the 1997 and 1998 NHAMCS ED files, records were reviewed to identify sports-related injury encounters. The NHAMCS is a general purpose national probability sample survey of hospital EDs and outpatient departments conducted by the Centers for Disease Control and Prevention (CDC’s) National Center for Health Statistics. The survey first included the narrative text on cause of injury in its data files in 1997. The survey, which was initiated in 1992, has always
Results
There were an average annual estimated 2.6 million emergency visits for sports-related injuries by persons between the ages of 5 and 24 years (95% confidence interval [CI] 2.0 to 3.1 million). They accounted for more than 68% of the total 3.7 million sport injuries presenting to the ED by persons of all ages. Figure 1 shows the distribution of ED injury visits according to whether the visits were for injuries from sports-related activities, nonsports-related activities, and visits where the
Discussion
Narrative text is useful in identifying sports-related injuries, as well as injuries caused from other types of activities. This study showed that approximately 3.8 million emergency visits occur in US hospitals annually from persons engaged in sport or recreational activities, most of which are for patients between 5 and 24 years of age. An expense estimate of $179 for each emergency injury visit (on the basis of unpublished 1995 cost data for ED visits with diagnoses between ICD-9 codes
Acknowledgements
We acknowledge the development of the activity codes that were used in this study by Matthew King of the Social Program Evaluation Group, Queens University, Ontario, Canada, and Dr. William Pickett, Queens University Teaching Health Unit.
References (18)
- et al.
Injury visits to hospital emergency departments: United States, 1992-95. National Center for Health Statistics
Vital Health Stat
(1998) National Hospital Ambulatory Medical Care Survey, 1997 Summary. Advance data from vital and health statistics; No. 304
(1999)Injury-Related Visits to Hospital Emergency Departments: United States, 1992. Advance data from vital and health statistics; No. 261
(1995)- et al.
Child and Adolescent Emergency Department Visit Databook
(1997) International Classification of Diseases, ninth revision, Clinical Modification.
(1991)- et al.
Injury Chartbook. Health, United States, 1996-97
(1997) - et al.
The epidemiology of nonfatal injuries among US children and youth
Am J Public Health
(1995) - et al.
Effects of recall on estimating annual nonfatal injury rates for children and youth
Am J Public Health
(1994) - et al.
Athletic injury reporting: development of universal systems
Sports Med
(1997)
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Address for reprints: Catharine W. Burt, EdD, NCHS/Room 952, 6525 Belcrest Rd, Hyattsville, MD 20782; 301-458-4126, fax 301-458-4032; E-mail [email protected].