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The aims of this study were: 1) to describe the total muscular injuries, and specifically HSIs, and their corresponding missed matches; 2) to analyse their economic impact; and 3) to estimate the loss of incomes due to TV rights, in first division clubs from LaLigaTM depending on the expected and actual ranking position during the 2018/2019 season. To do that, a cross-sectional study for season 18/19 and for all players of the 20 Spanish professional football clubs was performed. The economic impact of injuries was estimated considering the missed matches and salary cost of all players and the audio-visual income loss was estimated considering the Spanish Royal Decree of Law (RDL 5/2015). The high number of muscular (270) and hamstring injuries (57) implies a high cost for professional first division football clubs, specifically € 365,811 per month for the former and € 47,388 per month for the latter. In addition, reaching a worse than expected position in LaLigaTM ranking involved a loss of 45,2 million € in TV rights incomes. The high cost of muscle injuries in first division teams justifies the need for multidisciplinary teams that are capable of reducing the number of injuries as well as recovery times., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Nieto Torrejón et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Aims: To estimate the burden and inequity of unintentional childhood injury for children in Aotearoa., Methods: We used administrative data from the Accident Compensation Corporation (ACC) and the Ministry of Health to estimate the direct, indirect and intangible costs of unintentional injuries in children aged under 15 and the inequity of the impact of childhood injury on discretionary household income. We used an incidence approach and attributed all costs arising from injuries to the year in which those injuries were sustained., Results: 257,000 children experienced unintentional injury in 2014, resulting in direct and indirect costs of almost $400 million. The burden of lost health and premature death was the equivalent of almost 200 full lives at perfect health. Pacific children had the highest incidence rates. Māori had the lowest rates of ACC claims but the highest rate of emergency department attendance. Children living with the highest levels of socioeconomic deprivation had the highest rate of hospital admission following injury. The proportional loss in discretionary income arising from an injury was higher for Māori and Pacific compared to non-Māori, non-Pacific households., Conclusion: The burden of unintentional childhood injury is greater than previously reported and has a substantial and iniquitous societal impact. There should be a focus on addressing inequities in incidence and access to care in order to reduce inequities in health and financial impact., Competing Interests: Nil.

Context: Knee injuries are common during sport participation. However, little is known about the overall management and estimated direct costs of care associated with these injuries when under the care of athletic trainers., Objective: To describe the treatment characteristics and direct costs of care for athletic training services provided for patients with knee injuries., Design: Descriptive study., Setting: Ninety-five athletic training facilities across 24 states., Patients or Other Participants: A total of 117 athletic trainers (females = 56.4%, age = 29.4 ± 8.7 years, years certified = 4.7 ± 6.0, years employed at site = 1.6 ± 4.1)., Main Outcome Measure(s): Complete patient cases were identified using International Classification of Disease-10 diagnostic codes between 2009 and 2020. Summary statistics were calculated for patient demographics, treatment characteristics, and direct costs of care. Treatment characteristics included the type of athletic training service, duration, amount (eg, number of visits), and direct costs of care., Results: A total of 441 patient cases were included. The most common injuries reported were cruciate ligament sprain (18.1%, n = 80), medial collateral ligament sprain (15.4%, n = 68), and knee pain (14.1%, n = 62). Injuries occurred most frequently during football (35.4%, n = 156), basketball (14.7%, n = 65), and soccer (12.7%, n = 56). A total of 8484 athletic training services were recorded over 4254 visits, with therapeutic exercise (29.8%, n = 2530), hot or cold pack (25.8%, n = 2189), and therapeutic activities (11.2%, n = 954) being the most frequently reported services. The median duration of care was 23 days and number of visits was 8. The median total cost of care was $564 per injury and $73 per visit., Conclusions: Patients with knee injuries demonstrated greater time loss than those with other lower extremity injuries. Thus, it is unsurprising that knee injuries were associated with a longer duration and higher cost of care than other lower extremity injuries such as ankle sprains. Future researchers should examine the effectiveness of common treatment strategies and aim to identify treatments that can reduce costs and improve patient outcomes., (© by the National Athletic Trainers' Association, Inc.)

Sports-related injuries increase healthcare cost burden, and in some instances have harmful long term physical and psychological implications. There is currently a lack of comprehensive data on temporal injury trends across professional North American sports. The purpose of this study was to compare temporal trends, according to incidence and time-loss injuries, by body part in professional baseball, basketball, football, and ice hockey. Public injury data from Major League Baseball, National Basketball Association, National Football League, and National Hockey League from 2007 to December 2019 were extracted and used. A mean of 62.49 injuries per 100 players per season was recorded for all professional sports. The groin/hip/thigh reported the greatest season proportional injury incidence for baseball, football, and ice hockey, with the groin/hip/thigh as the third highest injury incidence in basketball. When stratifying by more specific body part groupings, the knee demonstrated the greatest injury proportional incidence for basketball, football, and ice hockey, with the knee as the third highest proportional injury incidence for baseball. There was an increased in basketball ankle injuries following 2011-2012 season. Football and ice hockey reported the greatest concussion proportion incidence, with football demonstrating an increase in concussions over time, and a substantial increase in concussions from the 2014 to 2015 season. These publicly extracted data and findings can be used as a shared resource for professional baseball, basketball, football, and ice hockey for future individual and across sport collaborations concerning resource allocation and decision making in order to improve player health.

This study aimed to describe the sport injuries of elite collegiate athletes, and to examine the influence of career length, past injuries, and psychological factors on the treatment period and willingness to pay (WTP) for treatment.A survey was conducted among students of the Department of Physical Education, Korea National Sport University. Results were interpreted through frequency analysis and multiple linear regression analysis.All students currently in training (n = 624, mean age 21 ± 2 years) participated in this study. 12-month prevalence of sports injuries was 56%. The locations of the most common and severe injuries were the knee, ankle, and back. The most frequent types of common injury were sprain, ruptured ligament, and bruising. The location of injuries varied according to the sports discipline. The treatment period was influenced by sports discipline, career length, location, and type of injury, and fear of further injuries. Treatment period was associated with the reason for fear of injuries, and WTP was influenced by fear of further injuries.Our study suggests that specific management plans for athletes based on disciplines, past injuries, and their emotional responses to previous injuries are required for rehabilitation and return to sports following treatment.

Background: Soccer injuries constitute an important public health problem and cause a high economic burden. Nevertheless, comprehensive data regarding injury costs in nonprofessional soccer are missing. The aim of this study was to determine which groups of nonprofessional soccer athletes, injury types, and injury situations caused high injury costs., Methods: A cross-sectional, retrospective telephone survey was carried out with a random sample of persons who had sustained a soccer injury between July 2013 and June 2014 and who had reported this accident to the Swiss National Accident Insurance Fund (Suva). One year after the corresponding accident, every injury was linked to its costs and to the answers obtained in the interview about injury setting, injury characteristics, and injury causes. Finally, the costs of 702 injuries were analyzed., Results: The average cost of an injury in nonprofessional soccer amounted to €4030 (bias-corrected and accelerated 95% confidence interval (BCa 95%CI): 3427-4719). Persons aged 30 years and older experienced 35% of soccer injuries but accounted for 49% of all costs. A total of 58% of all costs were the result of injuries that occurred during amateur games. In particular, game injuries sustained by players in separate leagues for players aged 30+/40+ years led to high average costs of €8190 (BCa 95%CI: 5036-11,645). Knee injuries accounted for 25% of all injuries and were responsible for 53% of all costs. Although contact and foul play did not lead to above-average costs, twisting or turning situations were highly cost relevant, leading to an average sum of €7710 (BCa 95%CI: 5376-10,466) per injury., Conclusion: Nonprofessional soccer players aged 30 years and older and particularly players in 30+/40+ leagues had above-average injury costs. Furthermore, the prevention of knee injuries, noncontact and nonfoul play injuries, and injuries caused by twisting and turning should be of highest priority in decreasing health care costs., (Copyright © 2018. Production and hosting by Elsevier B.V.)

In recent years, the outbreak of many school sports injury accidents aroused widespread public concern about liability determination of accident. Previous studies have examined the legal application of the liability principles from a law perspective, but few kinds of research attempted to analyze the progress of liability determination from the perspective of "law economics". To fill this research gap, we introduce the evolutionary game model, as an important theoretical tool of "law economics", to investigate how various factors influence the strategy selection of the parties, as well as examine what liability principle can effectively treat school sports injury accidents. The results indicate that the strategic selection of the subject of liability is significantly related to the accident compensation cost and the prevention cost of both parties. Moreover, we also find that both strict and proportional liability rules can play key roles in dealing with the issue of liability determination of school sports injury accidents, but the two liability rules have different effects on the strategic selection of parties. More specifically, compared to the strict liability principle, the proportional liability principle can motivate both the school and the students to adopt the active strategy of "appropriate caution" to prevent occurring sports injury accidents in schools.

Background: BASE (building, antenna, span, earth) jumping involves jumping from fixed objects with specialized parachutes. BASE jumping is associated with less aerodynamic control and flight stability than skydiving because of the lower altitude of jumps. Injuries and fatalities are often attributed to bad landings and object collision., Methods: We performed a retrospective analysis of the 2010-2014 National Emergency Department Sample database, a nationally representative sample of all visits to US emergency departments (EDs). BASE jumping-associated injuries were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes [E004.0]. Outcomes evaluated included morbidity, mortality, inpatient admission, and costs. Adjusted analyses accounting for survey methodology were performed., Results: After weighting, 1790 BASE-associated ED presentations were identified with 358±28 injuries annually. A total of 1313 patients (73%) were aged 18 to 44 y, and 1277 (71%) were male. Nine hundred seventy-six (55%) multiple body system injuries and 677 (38%) isolated extremity injuries were reported. There were 1588 (89%) patients discharged home from the ED; only 144 (7%) were admitted as inpatients. On multivariate logistic regression, only anatomic site of injury was associated with inpatient admission (odds ratio=0.6, P<0.001, 95% CI 0.5-0.8). Including ED and inpatient costs, BASE injuries cost the US healthcare system approximately $1.7 million annually. No deaths were identified within the limitations of the survey design., Conclusions: Although deemed one of the most dangerous extreme sports, many patients with BASE injuries surviving to arrival at definitive medical care do not require inpatient admission., (Copyright © 2019 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)

Introduction: Rock climbing and mountaineering are popular outdoor recreational activities. More recently, indoor climbing has become popular, which has increased the number of persons at risk for climbing-related injuries. The purpose of this study was to assess the morbidity, mortality, and healthcare cost due to climbing-related injury among persons presenting to US emergency departments (ED)., Methods: We performed a retrospective analysis of the 2010 to 2014 National Emergency Department Sample database, a nationally representative sample of all visits to US EDs. Rock climbing, mountain climbing, and wall climbing injuries were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes (E004.0). Outcomes evaluated included morbidity, mortality, inpatient admission, and costs. Adjusted analyses accounting for survey methodology were performed., Results: A weighted-estimate 15,116 adult ED visits were associated with climbing-related injury. Patient age was 32.8±14.7 (mean±SD) (95% CI: 32.1-33.5) y, and 62% of patients were male. The majority of the injuries occurred in the Western census region (9593; 63%). Less than 1% of all climbing-related visits resulted in death. Only of injury severity score >15 was associated with death (P = 0.005). A total of 1610 (11%) of patients were admitted as inpatients. Accounting for ED and inpatient costs, climbing-related injuries cost the US healthcare system approximately $102 (95% CI: $75-130) million USD for the 5-y period, averaging $20±9.5 million USD per y., Conclusions: Most persons with climbing-related injuries presenting to EDs do not require inpatient admission. Although death is rare among patients with climbing-related injuries, the costs of injuries in survivors remain high., (Copyright © 2018 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)

Introduction: Since hoverboards became available in 2015, 2.5 million have been sold in the US. An increasing number of injuries related to their use have been reported, with limited data on associated injury patterns. We describe a case series of emergency department (ED) visits for hoverboard-related injuries., Methods: We performed a retrospective chart review on patients presenting to 10 EDs in southeastern Virginia from December 24, 2015, through June 30, 2016. We used a free-text search feature of the electronic medical record to identify patients documented to have the word "hoverboard" in the record. We reported descriptive statistics for patient demographics, types of injuries, body injury location, documented helmet use, injury severity score (ISS), length of stay in the ED, and ED charges., Results: We identified 83 patients in our study. The average age was 26 years old (18 months to 78 years). Of these patients, 53% were adults; the majority were female (61.4%) and African American (56.6%). The primary cause of injury was falls (91%), with an average ISS of 5.4 (0-10). The majority of injuries were contusions (37.3%) and fractures (36.1%). Pediatric patients tended to have more fractures than adults (46.2% vs 27.3%). Though 20% of patients had head injuries, only one patient reported using a helmet. The mean and median ED charges were $2,292.00 (SD $1,363.64) and $1,808.00, respectively. Head injuries resulted in a significantly higher cost when compared to other injuries; median cost was $2,846.00., Conclusion: While the overall ISS was low, more pediatric patients suffered fractures compared to adults. Documented helmet use was low, yet 20% of our population had head injuries. Further investigation into proper protective gear and training is warranted., Competing Interests: Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Background: The risk of falls and injuries in horseracing varies with sex and experience of the jockey., Aims: To determine whether the incidence and costs of insurance claims also differ by such factors., Methods: A retrospective analysis of compensation claims by flat racing and jumps jockeys injured in a race-day fall in Australia between 2002 and 2009. Claim incidence, costs, absentee days and location, cause and type of injury sustained were described, stratified by jockey sex, age and experience., Results: The incidence of claims by flat and jumps racing was 0.6 and 6.5 per 1000 rides, respectively. The mean cost of a claim was 43374 Australian dollars (AUD) (SD 249612) in flat racing and AUD 52589 (SD 157808) in jumps racing. The incidence of claims was greater for experienced flat racing jockeys than apprentices but mean costs were higher for apprentices. After adjustment for experience, there were no sex differences in the average cost or incidence of flat racing jockeys' claims. In general, the fall incidence declined, but the claim incidence and median cost of a claim increased, with age. On average, jockeys were absent from work for 9 weeks following a substantive injury. Limb fractures (33%), muscular or soft tissue injuries (28%) and contusions (17%) were the most commonly reported injuries., Conclusions: The economic costs of jockey injuries sustained in race-day falls are considerable. Identification of differences in incidence and costs of insurance claims between jockey characteristics will assist decision makers in the development and assessment of targeted safety strategies., (© The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Context: Gaelic games (Gaelic football and hurling) are indigenous Irish sports with increasing global participation in recent years. Limited information is available on longitudinal injury trends. Reviews of insurance claims can reveal the economic burden of injury and guide cost-effective injury-prevention programs., Objective: To review Gaelic games injury claims from 2007-2014 for male players to identify the costs and frequencies of claims. Particular attention was devoted to lower limb injuries due to findings from previous epidemiologic investigations of Gaelic games., Design: Descriptive epidemiology study., Setting: Open-access Gaelic Athletic Association Annual Reports from 2007-2014 were reviewed to obtain annual injury-claim data., Patients or Other Participants: Gaelic Athletic Association players., Main Outcome Measure(s): Player age (youth or adult) and relationships between lower limb injury-claim rates and claim values, Gaelic football claims, hurling claims, youth claims, and adult claims., Results: Between 2007 and 2014, €64 733 597.00 was allocated to 58 038 claims. Registered teams had annual claim frequencies of 0.36 with average claim values of €1158.4 ± 192.81. Between 2007 and 2014, average adult claims were always greater than youth claims (6217.88 versus 1036.88), while Gaelic football claims were always greater than hurling claims (5395.38 versus 1859.38). Lower limb injuries represented 60% of all claims. The number of lower limb injury claims was significantly correlated with annual injury-claim expenses (r = 0.85, P = .01) and adult claims (r = 0.96, P = .01) but not with youth claims (r = 0.69, P = .06)., Conclusions: Reducing lower limb injuries will likely reduce injury-claim expenses. Effective injury interventions have been validated in soccer, but whether such changes can be replicated in Gaelic games remains to be investigated. Injury-claim data should be integrated into current elite injury-surveillance databases to monitor the cost effectiveness of current programs.

Objectives: Previous sports injury is a known risk factor for subsequent osteoarthritis (OA), but population-based rates of sports injury are unknown. The aims of this study were to: (1) describe the trends in the population incidence and burden of all hospital-treated sports injury in Victoria, Australia in adults aged 15+ years; (2) determine the incidence of lower limb and knee injuries; and (3) quantify their population health burden as average direct hospital costs per injury and lengths of stay., Methods: Health sector data relating to adults aged 15+ years, for 2004-2010 inclusive, was extracted from the Victorian Admitted Episodes Dataset (VAED) and Victorian Emergency Minimum Dataset (VEMD). Data relating to sports injuries were identified using activity codes in each dataset Trends in injury frequency and rates were determined, and economic burden was calculated., Results: The overall annual rate of hospital treated sports injuries increased by 24% (P = 0.001), and lower limb injuries by 26% (P = 0.001) over the 7 years. The associated accumulated economic burden was $265 million for all sports injuries and $110 million for lower limb injuries over the 7-years., Conclusions: The findings of this study show a significant increase in sports injuries in the state of Victoria, Australia over a 7-year period. As previous sports injury is a risk factor for the development of OA, the future incidence of OA will escalate, placing an even greater burden on health care systems. Population-wide preventative strategies that reduce the risk of sports injury are urgently required in order to reduce the future burden of OA., (Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.)

Context: Basketball is a popular US high school sport with more than 1 million participants annually., Objective: To compare patterns of athletes with basketball-related injuries presenting to US emergency departments from 2005 through 2010 and the high school athletic training setting from the 2005-2011 seasons., Design: Descriptive epidemiology study., Setting: Data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission and the High School Reporting Information Online database., Main Outcome Measure(s): Complex sample weights were used to calculate national estimates of basketball-related injuries for comparison., Patients or Other Participants: Adolescents from 13 to 19 years of age treated in US emergency departments for basketball-related injuries and athletes from 13 to 19 years of age from schools participating in High School Reporting Information Online who were injured while playing basketball., Results: Nationally, an estimated 1,514,957 (95% confidence interval = 1,337,441, 1,692,474) athletes with basketball-related injuries reported to the emergency department and 1,064,551 (95% confidence interval = 1,055,482, 1,073,620) presented to the athletic training setting. Overall, the most frequent injuries seen in the emergency department were lacerations and fractures (injury proportion ratios [IPRs] = 3.45 and 1.72, respectively), whereas those seen in the athletic training setting were more commonly concussions and strains/sprains (IPRs = 2.23 and 1.19, respectively; all P values < .0001). Comparisons of body site and diagnosis combinations revealed additional differences. For example, athletes with lower leg fractures more often presented to the emergency department (IPR = 6.53), whereas those with hand fractures more frequently presented to the athletic training setting (IPR = 1.18; all P values < .0001)., Conclusions: Patterns of injury differed among high school basketball players presenting for treatment in the emergency department and the athletic training setting. Understanding differences specific to clinical settings is crucial to grasping the full epidemiologic and clinical picture of sport-related injuries. Certified athletic trainers play an important role in identifying, assessing, and treating athletes with sport-related injuries who might otherwise present to clinical settings with higher costs, such as the emergency department.

Background: Ankle sprains continue to pose a significant burden to the individual athlete, as well as to society as a whole. However, despite ankle sprains being the single most common sports injury and despite an active approach by various Dutch organisations in implementing preventive measures, large-scale community uptake of these preventive measures, and thus actual prevention of ankle sprains, is lagging well behind. In an attempt to bridge this implementation gap, the Dutch Consumer Safety Institute VeiligheidNL developed a freely available interactive App ('Strenghten your ankle' translated in Dutch as: 'Versterk je enkel; available for iOS and Android) that contains - next to general advice on bracing and taping - a proven cost-effective neuromuscular program. The 'Strengthen your ankle' App has not been evaluated against the 'regular' prevention approach in which the neuromuscular program is advocated through written material. The aim of the current project is to evaluate the implementation value of the 'Strengthen your ankle' App as compared to the usual practice of providing injured athletes with written materials. In addition, as a secondary outcome measure, the cost-effectiveness will be assessed against usual practice., Methods/design: The proposed study will be a randomised controlled trial. After stratification for medical caregiver, athletes will be randomised to two study groups. One group will receive a standardized eight-week proprioceptive training program that has proven to be cost-effective to prevent recurrent ankle injuries, consisting of a balance board (machU/ MSG Europe BVBA), and a traditional instructional booklet. The other group will receive the same exercise program and balance board. However, for this group the instructional booklet is exchanged by the interactive 'Strengthen your ankle' App., Discussion: This trial is the first randomized controlled trial to study the implementation effectiveness of an App for proprioceptive balance board training program in comparison to a traditional printed instruction booklet, with the recurrence of ankle sprains among athletes as study outcome. Results of this study could possibly lead to changes in practical guidelines on the treatment of ankle sprains and in the use of mobile applications for injury prevention. Results will become available in 2014., Trial Registration: The Netherlands National Trial Register NTR4027. The NTR is part of the WHO Primary Registries.

Question: Is an injury prevention program consisting of 10 exercises designed to improve stability, muscle strength, co-ordination, and flexibility of the trunk, hip and leg muscles (known as The11) cost effective in adult male amateur soccer players?, Design: Cost-effectiveness analysis of a cluster-randomised controlled trial., Participants: 479 adult male amateur soccer players aged 18-40 years., Intervention: The intervention group was instructed to perform the exercises at each training session (2 to 3 sessions per week) during one soccer season. The exercises focus on core stability, eccentric training of thigh muscles, proprioceptive training, dynamic stabilisation, and plyometrics with straight leg alignment. The control group continued their usual warm-up., Outcome Measures: All injuries and costs associated with these injuries were compared between groups after bootstrapping (5000 replications)., Results: No significant differences in the proportion of injured players and injury rate were found between the two groups. Mean overall costs in the intervention group were €161 (SD 447) per athlete and €256 (SD 555) per injured athlete. Mean overall costs in the control group were €361 (SD 1529) per athlete and €606 (SD 1944) per injured athlete. Statistically significant cost differences in favour of the intervention group were found per player (mean difference €201, 95% CI 15 to 426) and per injured player (mean difference €350, 95% CI 51 to 733)., Conclusions: The exercises failed to significantly reduce the number of injuries in male amateur soccer players within one season, but did significantly reduce injury-related costs. The cost savings might be the result of a preventive effect on knee injuries, which often have substantial costs due to lengthy rehabilitation and lost productivity., Trial Registration: NTR2416., (Copyright © 2013 Australian Physiotherapy Association. Published by .. All rights reserved.)

Concussion, also referred to as mild traumatic brain injury (TBI), is defined as a "complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces." Various symptoms may be observed in patients with concussions. All of these might not be evident at the time of the injury and be intermittent in their nature. It is estimated that 300,000 of the yearly TBIs in the United States are sports-related, the second leading cause for TBIs after motor vehicle accidents among people aged 15 to 24 years old. Due to some recently reported high profile injuries and deaths of sports personalities, sports-related concussion has seen increasing media and public interest in the last decade. We review the role of football in youth concussions and analyze the Nationwide Inpatient Sample from 2007 to 2009 to elucidate the outcome and costs associated with sports-related concussions of the youth in the United States. We also review the latest state legislative efforts to decrease the incidence of dangerous sports-related concussions in youth--the Louisiana Youth Concussion Act.

Object: Skiing and snowboarding injuries have increased with the popularity of these sports. Spinal cord injuries (SCIs) are a rare but serious event, and a major cause of morbidity and mortality for skiers and snowboarders. The purpose of this study is to characterize the patterns of SCI in skiers and snowboarders., Methods: The authors queried the Nationwide Inpatient Sample for the years 2000-2008 for all patients admitted with skiing or snowboarding as the mechanism of injury, yielding a total of 8634 patients. The injury patterns were characterized by the ICD-9 diagnostic and procedure codes. The codes were searched for those pertaining to vertebral and skull fracture; spinal cord, chest, abdominal, pelvic, and vessel injuries; and fractures and dislocations of the upper and lower extremity. Statistical analysis was performed with ANOVA and Student t-test., Results: Patients were predominantly male (71%) skiers (61%), with the average age of the skiers being older than that of snowboarders (39.5 vs 23.5 years). The average length of stay for patients suffering from spine trauma was 3.8 days and was increased to 8.9 days in those with SCI. Among hospitalized patients, SCI was seen in 0.98% of individuals and was equally likely to occur in snowboarders and skiers (1.07% vs 0.93%, p < 0.509). Cervical spine trauma was associated with the highest likelihood of SCI (19.6% vs. 10.9% of thoracic and 6% of lumbar injuries, p < 0.0001). Patients who were injured skiing were more likely to sustain a cervical spine injury, whereas those injured snowboarding had higher frequencies of injury to the lumbar spine. The most common injury seen in tandem with spine injury was closed head injury, and it was seen in 13.4% of patients. Conversely, a spine injury was seen in 12.9% of patients with a head injury. Isolated spine fractures were seen in 4.6% of patients., Conclusions: Skiers and snowboarders evaluated at the hospital are equally likely to sustain spine injuries. Additionally, participants in both sports have an increased incidence of SCI with cervical spine trauma.

Objective: The purposes of this study were (a) to evaluate the distribution by primary payer (public vs. private) of U.S. pediatric patients aged 5-18 years who were hospitalized with a sports-related lower extremity fracture and (b) to discern the adjusted mean hospital length of stay and mean charge per day by payer type., Methods: Children who were aged 5 to 18 years and had diagnoses of lower extremity fracture and sports-related injury in the 2006 Healthcare Cost and Utilization Project Kids' Inpatient Database were included. Lower extremity fractures are defined as International Classification of Diseases, 9th Revision, Clinical Modification codes 820-829 under Section "Injury and Poisoning (800-999)," while sports-related external cause of injury codes (E-codes) are E886.0, E917.0, and E917.5. Differences in hospital length of stay and cost per day by payer type were assessed via adjusted least square mean analysis., Results: The adjusted mean hospital length of stay was 20% higher for patients with a public payer (2.50 days) versus a private payer (2.08 days). The adjusted mean charge per day differed about 10% by payer type (public, US$7,900; private, US$8,794)., Conclusions: Further research is required to identify factors that are associated with different length of stay and mean charge per day by payer type, and explore whether observed differences in hospital length of stay are the result of private payers enhancing patient care, thereby discharging patients in a more efficient manner.

Objective: To identify search and rescue (SAR) trends in US National Park Service (NPS) units., Methods: A retrospective review of the US National Park Service Annual Search and Rescue Reports from 1992 to 2007 and the SAR statistics for all NPS units in 2005., Results: From 1992 to 2007 there were 78,488 individuals involved in 65,439 SAR incidents. These incidents ended with 2659 fatalities, 24,288 ill or injured individuals, and 13,212 saves. On average there were 11.2 SAR incidents each day at an average cost of $895 per operation. Total SAR costs from 1992 to 2007 were $58,572 164. In 2005, 50% of the 2430 SAR operations occurred in just 5 NPS units. Grand Canyon National Park (307) and Gateway National Recreation Area (293) reported the most SAR operations. Yosemite National Park accounted for 25% of the total NPS SAR costs ($1.2 million); Wrangell-St. Elias National Park and Preserve ($29,310) and Denali National Park and Preserve ($18,345) had the highest average SAR costs. Hiking (48%) and boating (21%) were the most common activities requiring SAR assistance. Hiking (22.8%), suicides (12.1%), swimming (10.1%), and boating (10.1%) activities were the most common activities resulting in fatalities., Conclusions: Without the presence of NPS personnel responding to SAR incidents, 1 in 5 (20%) of those requesting SAR assistance would be a fatality. Future research and the development of any prevention efforts should focus on the 5 NPS units where 50% of all SAR incidents are occurring.

Objective: To identify the emergency medical service (EMS) workload and trends associated with search and rescue (SAR) operations in Utah's National Park Service (NPS) units., Methods: Data for this study were collected from the Annual Emergency Medical Services Report and the Annual Search and Rescue Report for National Park Service units in Utah from 2001-2005., Results: There were 4762 EMS incidents reported between 2001 and 2005, including 79 fatalities (50 traumatic; 29 nontraumatic). The most common EMS transportation method was ground (1505) and helicopter (553) transport. The heaviest trauma, medical, and cardiac workload was at Glen Canyon National Recreation Area (GLCA) and the heaviest first aid workload was at Zion National Park (ZION). There were 1190 SAR operations between 2001 and 2005 involving 67 fatalities, 623 ill or injured visitors, 1813 non-ill or non-injured visitors, and 92 saves. GLCA and ZION accounted for 47% and 21% of all SAR operations. The total cost of SAR operations was $1 363 920. SAR operations most commonly occurred on weekends, involved male visitors (59%), visitors aged 20-29 years (23%), and 40-49 years (20%), and visitors participating in day hiking (221), motorized boating (196), and canyoneering (98) activities. Most SAR operations were in lake (226), desert (147), and canyon (140) environments and were resolved within 24 hours., Conclusions: GLCA and ZION experienced heavy use of EMS resources that should be noted by EMS administrators and planners. GLCA and ZION also reported the most SAR operations. The development of techniques to prevent the need for SAR at GLCA and ZION would likely have the most potential to reduce the financial impact of SAR incidents and morbidity and mortality to visitors.

Objective: To estimate the economic cost of injuries in a population of US high school varsity athletes., Design and Setting: The North Carolina High School Athletic Injury Study, conducted from 1996 to 1999, was a prospective cohort study of injury incidence and severity. A two-stage cluster sampling technique was used to select athletic teams from 100 high schools in North Carolina. An injury cost model was used to estimate the economic cost of injury., Participants: Varsity athletes from 12 sports: football, girls' and boy's soccer, girls' and boys' track, girls' and boy's basketball, baseball, softball, wrestling, volleyball, and cheerleading., Main Outcome Measures: Descriptive data were collected at the time of injury. Three types of costs were estimated: medical, human capital (medical costs plus loss of future earnings), and comprehensive (human capital costs plus lost quality of life)., Results: The annual statewide estimates were $9.9 million in medical costs, $44.7 million in human capital costs, and $144.6 million in comprehensive costs. The mean medical cost was $709 per injury (95% CI $542 to $927), $2223 per injury (95% CI $1709 to $2893) in human capital costs, and $10,432 per injury (95% CI $8062 to $13,449) in comprehensive costs. Sport and competition division were significant predictors of injury costs., Conclusions: Injuries among high school athletes represent a significant economic cost to society. Further research should estimate costs in additional populations to begin to develop cost-effective sports injury prevention programs.

The primary aims of this study were to establish a client injury baseline for the New Zealand adventure tourism and adventure sport sector, and to examine patterns and trends in claims for injury during participation in adventure activities. Content analysis of narrative text data for compensated injuries occurring in a place for recreation and sport over a 12-month period produced over 15,000 cases involving adventure tourism and adventure sport. As found in previous studies in New Zealand, highest claim counts were observed for activities that are often undertaken independently, rather than commercially. Horse riding, tramping, surfing and mountain biking were found to have highest claim counts, while hang gliding/paragliding/parasailing and jet boating injuries had highest claim costs, suggesting greatest injury severity. Highest claim incidence was observed for horse riding, with female claimants over-represented for this activity. Younger male claimants comprised the largest proportion of adventure injuries, and falls were the most common injury mechanism.

Aims: The aim of this study was to examine the involvement of adventure tourism and adventure sports activity in injury claims made to the Accident Compensation Corporation (ACC)., Methods: Epidemiological analysis of ACC claims for the period, July 2004 to June 2005, where adventure activities were involved in the injury., Results: 18,697 adventure tourism and adventure sports injury claims were identified from the data, representing 28 activity sectors. Injuries were most common during the summer months, and were most frequently located in the major population centres. The majority of injuries were incurred by claimants in the 20-50 years age groups, although claimants over 50 years of age had highest claims costs. Males incurred 60% of all claims. Four activities (horse riding, mountain biking, tramping/hiking, and surfing) were responsible for approximately 60% of all adventure tourism and adventure sports-related injuries. Slips, trips, and falls were the most common injury initiating events, and injuries were most often to the back/spine, shoulder, and knee., Conclusions: These findings suggest the need to investigate whether regulatory intervention in the form of codes of practice for high injury count activities such as horse riding and mountain biking may be necessary. Health promotion messages and education programs should focus on these and other high-injury risk areas. Improved risk management practices are required for commercial adventure tourism and adventure sports operators in New Zealand if safety is to be improved across this sector.

A comparison is made between abbreviated formal neuropsychologic testing programs and computerized neuropsychologic programs such as ImPACT, Headminders, CogSport, and others. Issues of time, cost, need for supervision, liability, and validation are discussed. Specific time and monetary costs per athlete are calculated for each program. The estimated cost is between $22 and $27 per athlete for abbreviated formal testing and between $669 and $677 per athlete for computerized testing. Because of the significant time and monetary costs of neuro-psychologic testing, its lack of validation in deter-mining recovery, limited validation and utility in diagnosing concussion, and its numerous logistic concerns, its widespread use is probably not justified until appropriate data are published and costs contained. Recommendations for alternative evaluation techniques are suggested.

Objectives: To evaluate the cost effectiveness of a proprioceptive balance board training programme for the prevention of ankle sprains in volleyball., Methods: A total of 116 volleyball teams participated in this study which was carried out during the 2001-2002 volleyball season. Teams were randomly allotted to an intervention group (66 teams, 628 players) or a control group (52 teams, 494 players). Intervention teams followed a prescribed balance board training programme as part of their warm up. Control teams followed their normal training routine. An ankle sprain was recorded if it occurred as a result of volleyball and caused the subject to stop volleyball activity. The injured player completed a cost diary for the duration of the ankle sprain. Analyses were performed according to the intention to treat principle. Mean direct, indirect, and total costs were calculated and were compared between the two groups., Results: The total costs per player (including the intervention material) were significantly higher in the intervention group (36.99 (93.87)) than in the control group (18.94 (147.09)). The cost of preventing one ankle sprain was approximately 444.03. Sensitivity analysis showed that a proprioceptive balance board training programme aimed only at players with previous ankle sprains could be cost effective over a longer period of time., Conclusions: Positive effects of the balance board programme could only be achieved at certain costs. However, if broadly implemented, costs associated with the balance board programme would probably be lower.

Objectives: To determine whether integrating primary care sports medicine into academic emergency medicine (EM) can enhance both revenue and the academic program., Methods: A retrospective descriptive review of all patients seen in a primary care sports medicine practice at a university hospital sports medicine clinic was done over a 24-month period. All patients seen initially in the ED for a sports injury either by the author or by another EM faculty member with follow-up by the author in the sports medicine clinic were included in the study group. The study group was analyzed for diagnoses, payor mix, and revenue generated by the ED follow-up sports medicine clinic visits., Results: There were 199 patients who met the inclusion criteria. This resulted in 483 ED follow-up sports medicine clinic visits. The author practiced 13 hours/week in the ED and 16 hours/week in the primary care sports medicine practice, which resulted in 1,536 sports medicine clinic hours. The study group accounted for 20% of the total patient volume in the author's primary care sports medicine practice. There were 111 lower-extremity injuries (knee 52%, foot/ankle 40%, hip/pelvis 8%), 81 upper-extremity injuries (hand/wrist 48%, shoulder 43%, elbow 9%), and seven spine injuries. Payor mix was 47% traditional indemnity, 45% HMO, 4% self-pay, and 4% Medicare/Medicaid. Total charges for the ED follow-up sports medicine clinic visits were $44,767 ($92.68/visit) and net receipts were $30,276 ($62.68/visit). This represented 20% of the total charges and 16% of the net receipts in the author's sports medicine practice during this period. Revenue generated by the ED follow-up sports medicine clinic visits could have supported 12% of the equivalent cost of the base pay for a full-time EM faculty position., Conclusion: The integration of primary care sports medicine into an academic EM faculty practice can enhance revenue through the establishment of an ED follow-up sports medicine clinic while also providing an opportunity to expand resident learning experiences.

A cross-sectional multicenter study was conducted to estimate the direct costs for each cause of spinal cord injury in the United States. Random samples of 227 new injuries and 508 persons 2-16 years postinjury were selected. Prospective data were collected during one year on all charges for emergency medical services, hospitalizations, attendant care, equipment, supplies, medications, environmental modifications, physician and outpatient services, nursing homes, household assistance, vocational rehabilitation, and miscellaneous items. In 1995 dollars, first year charges averaged $233,947 for vehicle crashes, $217,868 for violence, $295,643 for sports, $185,019 for falls and $208,762 for other causes. Recurring annual charges for each cause averaged $33,439, $17,275, $27,488, $26,238 and $23,510, respectively. Using average age at time of injury for each cause, a 2% real discount rate, and the most recent survival data from the National Spinal Cord Injury Statistical Center, average lifetime charges for each cause were $969,659, $613,345, $950,973, $630,453 and $673,749, respectively. Given an estimated 10,000 new cases of spinal cord injury occurring each year of which 35.9% are caused by vehicle crashes, 29.5% are caused by violence, 20.3% are caused by falls, 7.3% are caused by sports, and 7% result from other causes, annual aggregate direct costs of traumatic spinal cord injury in the United States are $3.48 billion for vehicle crashes, $1.81 billion for violence, $1.28 billion for falls, $694 million for sports and $472 million for other causes. Total direct costs for all causes of SCI in the United States are $7.736 billion.

All skiing injuries presenting to a fracture clinic during the period December 1992 to April 1993 were studied. Fifty five patients with 59 injuries were treated during this period. Thirty (54.5%) were male and 25 (45.5%) female. The mean age was 34 years (range 9-61). The anatomical distribution of injuries seen corresponded very closely with those seen in much larger studies abroad. There were 35 upper limb injuries (59.3%), 22 lower limb injuries (37.3%), with only two spine and trunk injuries (3.4%). While only two patients underwent surgery abroad, a further 12 needed surgical intervention on return, requiring a total stay of 61 'inpatient days'. The bulk of the workload was, however, on an outpatient basis, with a total of 172 appointments. Many advances have been made towards improving the safety of skiing. However with skiing becoming increasingly popular we can expect an increasing workload and cost associated with such injuries.

A postal survey was conducted of the attitudes and advice of Welsh governing bodies of amateur sports and their Cardiff-based clubs towards personal sports insurance. Information on 36 of the 39 sports surveyed (92%) was sufficient for analysis. Twenty-two of these 36 sports (61%) organized insurance at a national level, one at club level (3%) and 13 (36%) provided no insurance advice. Only 12 sports (33%) insisted on mandatory insurance cover. Many sportsmen and women are left to search for an appropriate insurance cover themselves or remain uninsured. Owing the lack of advice in 36% of cases it was decided to survey Cardiff-based insurance brokers to establish what type of policy they would recommend. Only 41% of the brokers were able to offer a suitable policy. Club policies recommended by the Central Council for Physical Recreation provide individuals with the same sports cover (but at a lower premium) as is available from a personal accident policy. However, cover is somewhat inadequate and may provide a false sense of security. Sports with mandatory sports insurance are not necessarily those with the highest risk of disabling injury.

About 30% of all sports injuries to the eye seen at Wellington Hospital are due to indoor cricket. An analysis of 29 eye injuries, January 1987 to June 1989 was carried out. Traumatic iritis, mydriasis and commotio retinae were the common injuries. There were eight blow out fractures of the orbit. Only two patients had permanent loss of vision due to choroidal tears with best vision in the damaged eye reduced to 6/9. A total of 88 eye clinic visits and 24 inpatient days were involved. The incidence of these injuries could be reduced by wearing eye and/or facial protection.

Maxillofacial and dental ice hockey injuries in Finland were studied during 1979 to 1985. A total of 6,885 accidents occurred to registered players between 1979 and 1982, and 791 (11.5%) of them affected the maxillofacial and dental regions. There were 1,401 separate injuries during the same period, 1,184 of which (84.5%) affected the teeth. The most common cause of accidents (in 54.1% of cases) was a blow received from a stick. Maxillofacial and dental injuries accounted for 38.0% of the total cost of all ice hockey injuries. The mean cost of maxillofacial and dental injuries was over 3 times as high as that for ice hockey injuries as a whole. The use of a mandatory full-cage face mask greatly reduced the number of maxillofacial and dental injuries and hence the cost of treatment.

The present investigation analyses all the acute soccer injuries recorded in Finland during one year (1980). The mean follow-up time was 18 months. The calculated yearly injury incidence was 5.8%. No significant difference in the injury incidences between the two sexes could be detected. A major part, 64% of the injuries were located in the lower extremities. Fractures and dislocations accounted for 11% of all injuries. One quarter of the injuries were classified as mild, causing a playing disability shorter than a week. Most injuries occurred through physical contact with another player (p less than 0.001). The calculated median time of absence from practice after injury was 4 weeks.