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Abstract: Background: The purpose of this study was to describe patterns and rates of sport and active recreation injuries that result in major trauma or death and to examine trends in these rates for all sport and active recreation activities and key sporting groups, for the period July 2001–June 2007, in Victoria, Australia. Methods: All sport and active recreation related major trauma cases and deaths were extracted from the Victorian State Trauma Registry (VSTR) and the National Coroners Information System, for the period July 2001–June 2007. Participation data from the Exercise Recreation and Sports Survey (ERASS) was used to establish incidence rates for the group as a whole and for key sporting groups. Poisson regression analysis was used to examine trends in major trauma and death due to participation in sport and active recreation across the six year study period. Results: There were 1019 non-fatal major trauma cases and 218 deaths. The rate of major trauma or death from sport and active recreation injuries was 6.3 per 100,000 participants per year. There was an average annual increase of 10% per year in the major trauma rate (including deaths) across the study period, for the group as a whole (IRR 1.10, 95% CI, 1.06–1.14). There was no increase in the death rate (IRR=0.94, 95% CI, 0.87–1.02; p =0.12). Significant increases were also found for cycling (IRR 1.16, 95% CI, 1.09–1.24) off-road motor sports (IRR 1.10, 95% CI, 1.03–1.19), Australian football (IRR 1.21, 95% CI, 1.03–1.42) and swimming (IRR 1.16, 95% CI, 1.004–1.33). Conclusion: The rate of major trauma inclusive of deaths, due to participation in sport and active recreation has increased over recent years, in Victoria, Australia. Much of this increase can be attributed to cycling, off-road motor sports, Australian football and to a lesser extent swimming, highlighting the need for co-ordinated injury prevention in these areas. [Copyright &y& Elsevier]