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Objectives: To investigate the epidemiologic characteristics of sports- and recreation-related eye injuries among children in the United States., Methods: Data from the National Electronic Injury Surveillance System were analyzed in a retrospective study of children ≤17 years of age treated in US emergency departments for sports- and recreation-related eye injuries from 1990 to 2012., Results: From 1990 through 2012, an estimated 441 800 (95% confidence interval: 378 868-504 733) children were treated in US emergency departments for sports- and recreation-related eye injuries, averaging 26.9 injuries per 100 000 children. Children 10 to 14 and 15 to 17 years old had the highest rate of eye injury. Three-fourths of injuries were sustained by boys. The most common types of injury were corneal abrasion (27.1%), conjunctivitis (10.0%), and foreign body in the eye (8.5%). Most eye injuries were treated and released (94.6%); however, 4.7% were hospitalized. The most common sports and recreation activities and equipment associated with eye injury were basketball (15.9%), baseball and softball (15.2%), and nonpowder guns (10.6%). The overall rate of eye injury decreased slightly during the study period; however, the rate of eye injury associated with nonpowder guns increased by 168.8%, and nonpowder gun-related eye injuries accounted for 48.5% of hospitalizations., Conclusions: Pediatric sports- and recreation-related eye injuries remain common. Increased prevention efforts are needed, especially for eye injuries associated with nonpowder guns. Increased child, parent, and coach education, as well as adoption of rules that mandate the use of eye protective equipment should be undertaken., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2018 by the American Academy of Pediatrics.)

Objective: To determine if injury rates among female field hockey players differ before and after implementation of a national mandate for protective eyewear (MPE)., Methods: We analyzed girls' field hockey exposure and injury data collected from national (High School Reporting Information Online [RIO]) and regional (Fairfax County Public Schools) high school sports injury databases in 2 seasons before (2009/10 and 2010/11) and 2 seasons after (2011/12 and 2012/13) a national MPE., Results: The incidence of eye/orbital injuries was significantly higher in states without MPE (0.080 injuries per 1000 athletic exposures [AEs]) than in states with MPE (before the 2011/12 mandate) and the postmandate group (0.025 injuries per 1000 AEs) (odds ratio 3.20, 95% confidence interval 1.47-6.99, P = .003). There was no significant difference in concussion rates for the 2 groups (odds ratio 0.77, 95% confidence interval 0.58-1.02, P = .068). After the 2011/12 MPE, severe eye/orbital injuries (time loss >21 days) were reduced by 67%, and severe/medical disqualification head/face injuries were reduced by 70%. Concussion rates for field hockey (0.335 per 1000 AEs) rank third among girls' sports included in the High School RIO surveillance program., Conclusions: Among female high school field hockey players, MPE is associated with a reduced incidence of eye/orbital injuries and fewer severe eye/orbital and head/face injuries. Concussion rates did not change as a result of the national MPE. Concussion remains the most common injury involving the head and face among female field hockey players, prompting further inquiry into potential effects of adopting protective headgear/helmets., (Copyright © 2015 by the American Academy of Pediatrics.)

Background: Little research has examined concussion outcomes in terms of impact location (ie, the area on the head in which the impact occurred). This study describes the epidemiology of concussions resulting from player-to-player collision in high school football by impact location., Methods: National High School Sports-Related Injury Surveillance Study data (2008/2009-2012/2013) were analyzed to calculate rates and describe circumstances of football concussion (eg, symptomology, symptom resolution time, return to play) resulting from player-to-player collisions by impact location (ie, front-, back-, side-, and top-of-the-head)., Results: Most concussions resulting from player-to-player collisions occurred from front-of-the-head (44.7%) and side-of-the-head (22.3%) impacts. Number of symptoms reported, prevalence of reported symptoms, symptom resolution time, and length of time to return to play were not associated with impact location. However, a larger proportion of football players sustaining concussions from top-of-the-head impacts experienced loss of consciousness (8.0%) than those sustaining concussions from impacts to other areas of the head (3.5%) (injury proportion ratio 2.3; 95% confidence interval 1.2-4.2; P = .008). Players had their head down at the time of impact in a higher proportion of concussions caused by top-of-the-head impacts (86.4%) than concussions from impacts to other areas of the head (24.0%) (injury proportion ratio 3.6; 95% confidence interval 3.2-4.0; P < .001)., Conclusions: Among high school football players who sustained concussions due to player-to-player collisions, concussion outcomes were generally independent of impact location. Recommended strategies for reducing the proportion of top-of-the-head impacts include improved education regarding tackling with proper "head-up" technique., (Copyright © 2014 by the American Academy of Pediatrics.)

Objectives: The objective of this study was to describe shoulder injuries in a nationally representative sample of high school athletes playing 9 sports. A national estimate of shoulder injuries among high school athletes was subsequently calculated., Methods: Injury data were collected in 9 sports (boys' football, soccer, basketball, wrestling, and baseball; girls' soccer, volleyball, basketball, and softball) during the 2005-2006 through 2011-2012 academic years from a nationally representative sample of high schools via High School Reporting Information Online., Results: During the 2005-2006 through 2011-2012 academic years, high school athletes in this study sustained 2798 shoulder injuries during 13,002,321 athlete exposures, for an injury rate of 2.15 per 10,000 athlete exposures. This corresponds to a nationally estimated 820,691 injuries during this time period. Rates of injury were higher in competition as compared with practice (rate ratio = 3.17 [95% confidence interval: 2.94-3.41]). The highest rate of injury was in football (4.86) and the lowest in girls' soccer (0.42). The most common types of injury were strain/sprain (37.9%) and dislocation/separation (29.2%). Boys were more likely than girls to sustain their injuries after contact with another person or with the playing surface. Surgical repair was required for 7.9% of the injuries. Time loss from athletic participation varied among sports, with 40.7% of athletes returning within 1 week, whereas 8.2% were medically disqualified for their season/career., Conclusions: High school shoulder injury rates and patterns varied by sport and gender. Prospective epidemiologic surveillance is warranted to discern trends and patterns to develop evidence-based interventions to prevent shoulder injuries.

Objective: To determine if injury rates differ among high school field hockey players in states that mandated protective eyewear (MPE) versus states with no protective eyewear mandate (no MPE)., Methods: We analyzed field hockey exposure and injury data collected over the 2009-2010 and 2010-2011 scholastic seasons from national and regional databases., Results: Incidence of all head and face injuries (including eye injuries, concussion) was significantly higher in no-MPE states compared with MPE states, 0.69 vs 0.47 injuries per 1000 athletic exposures (incidence rate ratio [IRR] 1.47; 95% confidence interval [CI]: 1.04-2.15, P = .048). Players in the no-MPE group had a 5.33-fold higher risk of eye injury than players in the MPE group (IRR 5.33; 95% CI: 0.71-39.25, P = .104). There was no significant difference in concussion rates for the 2 groups (IRR 1.04; 95% CI: 0.63-1.75, P = .857). A larger percentage of injuries sustained by athletes in the no-MPE group required >10 days to return to activity (32%) compared with athletes in the MPE group (17%), but this difference did not reach statistical significance (P = .060)., Conclusions: Among high school field hockey players, playing in a no-MPE state results in a statistically significant higher incidence of head and face injuries versus playing in an MPE state. Concussion rates among players in MPE and no-MPE states were similar, indicating that addition of protective eyewear did not result in more player-player contact injuries, challenging a perception in contact/collision sports that increased protective equipment yields increased injury rates.

Objectives: To describe the prevalence of computerized neurocognitive testing for the assessment of high school athletes who sustain concussions, and to describe associations between using computerized neurocognitive tests, timing of return-to-play, and medical provider managing the athlete., Methods: Concussions recorded in the High School Reporting Information Online injury surveillance system during the 2009-2010 academic year were included. Measures of association between use of computerized neurocognitive testing and outcomes were analyzed. A questionnaire was sent to athletic trainers (ATs) querying the use of computerized neurocognitive testing. χ(2) analyses were conducted for categorical variables. Logistic regression analyses were used to adjust for potential confounders. Statistical significance was set at P < .05., Results: High School Reporting Information Online recorded 1056 concussions. Athletes who underwent computerized neurocognitive testing were less likely to be returned to play within 10 days of injury (38.5% vs 55.7%, P < .001) and more likely to be returned to play by a physician (60.9% vs 45.6%, P < .001). We had a response rate of 97.3% for the survey. Of respondents, 39.9% used computerized neurocognitive testing; 93.0% of those used ImPACT. Tests were most often interpreted by ATs (78.9%) and/or physicians (78.8%), as opposed to neuropsychologists (16.9%)., Conclusions: Approximately 40% of US high schools that employ an AT use computerized neurocognitive tests when managing sport-related concussions. Tests are most often interpreted by ATs and physicians, as opposed to neuropsychologists. Computerized neurocognitive tests are significantly associated with the timing of return-to-play.

Objective: The objective of this study was to calculate injury rates and describe the epidemiology of holiday-related injuries among children who were aged < or =19 years and presented to US emergency departments (EDs) from 1997 through 2006., Methods: Data on holiday-related injuries obtained from the US Consumer Product Safety Commission's National Electronic Injury Surveillance System were analyzed., Results: From 1997 through 2006, an estimated 5,710,999 holiday-related injuries sustained by children who were aged < or =19 years presented to US EDs. The greatest number of injuries occurred on Labor Day followed by Memorial Day, Fourth of July, and Halloween. Children who were younger than 5 years sustained a greater proportion of injuries than other age groups. The face, finger/hand, and head were the most commonly injured body parts. Lacerations, contusion/abrasions, fractures, and sprain/strains were the most common diagnoses. Overall, the majority of injuries that occurred on holidays were classified as sports and recreation-related. In addition, home structure-related and home furnishing-related injuries were prevalent. Injuries that were associated with fireworks were more likely to occur on the Fourth of July than any other holiday, yet fireworks accounted for only a small proportion of Fourth of July injuries., Conclusions: Most injuries that were sustained on holidays and required ED treatment were not holiday-specific but were associated with more general activities. Parents should be aware that holidays present a risk not only for holiday-specific injuries but also for more general, "everyday" injuries.

Objectives: The goals were to calculate injury rates among high school baseball players and to characterize the general epidemiological features of high school baseball injuries and, more specifically, injuries attributed to being hit by a batted ball., Methods: We analyzed baseball exposure and injury data collected over the 2005-2006 and 2006-2007 school years from a nationally representative sample of 100 US high schools by using an injury surveillance system, Reporting Information Online., Results: Nationally, an estimated 131555 high school baseball-related injuries occurred during the 2005-2006 and 2006-2007 academic years, for an injury rate of 1.26 injuries per 1000 athletic exposures. The most commonly injured body sites were the shoulder (17.6%), ankle (13.6%), head/face (12.3%), hand/finger (8.5%), and thigh/upper leg (8.2%). The most common injury diagnoses were ligament sprains (incomplete tears) (21.0%), muscle strains (incomplete tears) (20.1%), contusions (16.1%), and fractures (14.2%). Although the majority of injuries resulted in a time loss of <7 days, 9.7% resulted in medical disqualification for the season, and 9.4% required surgery. Of the 431 reported baseball injuries, 50 (11.6%) were attributed to being hit by a batted ball. Greater proportions of injuries attributed to being hit by a batted ball were to the head/face (48.0%) and mouth/teeth (16.0%), compared with injuries not attributed to being hit by a batted ball (8.2% and 1.3%, respectively). A greater proportion of injuries attributed to being hit by a batted ball required surgery (18.0%), compared with other baseball-related injuries (6.8%)., Conclusions: Although high school baseball is relatively safe, targeted, evidence-based interventions could reduce the rate of high school baseball-related injuries. On the basis of our findings, we strongly recommend that helmets with face shields or at least mouth guards and eye protection be used by pitchers, infielders, and batters at the high school level.

Objectives: The goals were to describe the epidemiological features of pediatric nonautomobile motorized vehicle-related injuries sustained between 1990 and 2003 and to compare all-terrain vehicle-related injuries with other types of nonautomobile motorized vehicle-related injuries., Methods: An analysis of nationally representative pediatric nonautomobile motorized vehicle-related injury data from the US Consumer Product Safety Commission National Electronic Injury Surveillance System was performed., Results: Nationally, an estimated 1,203,800 children were treated in hospital emergency departments for nonautomobile motorized vehicle-related injuries between 1990 and 2003. These children had a mean age of 12.7 years (range: 1 month to 19 years), and 77.0% were male. The majority of injuries were associated with all-terrain vehicles (44.8%), 2-wheeled off-road vehicles (21.1%), and go-carts/buggies (13.7%). The most common diagnoses were contusions/abrasions (28.3%), fractures (24.2%), and lacerations (20.0%). Overall, the number of injuries increased 86% from 70,500 injuries in 1990 to 130,900 injuries in 2003. The numbers of all-terrain vehicle-related, 2-wheeled off-road vehicle-related, 2-wheeled on-road vehicle-related, and go-cart/buggy-related injuries all increased significantly from 1990 to 2003. There were greater proportions of all-terrain vehicle-associated injuries among children > or = 16 years of age (48.0%) and children 12 to 15 years of age (46.6%) than among children < 12 years of age (40.3%). Conversely, the proportion of other nonautomobile motorized vehicle-related injuries among children < 12 years of age (47.2%) was greater than that among children 12 to 15 years of age (30.3%) and children > or = 16 years of age (23.0%)., Conclusions: Although most public health and legislative attention to date has been focused on all-terrain vehicles, parents, children, and public officials should be educated about the injury risk that all types of nonautomobile motorized vehicles pose to children.