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Objectives: This paper provides an overview of the epidemiology of sport-related concussion and associated costs in New Zealand requiring medical treatment from 2001 to 2011 in seven sports codes., Design: A retrospective review of injury entitlement claims by seven sports from 2001 to 2011., Methods: Data were analyzed by sporting code, age, ethnicity, gender and year of competition for total and moderate-to-severe (MSC) Accident Compensation Corporation (ACC) claims and costs., Results: A total of 20,902 claims costing $NZD 16,546,026 were recorded over the study period of which 1330 (6.4%) were MSC claims. The mean yearly number and costs of MSC claims were 133 ± 36 and $1,303,942 ± 378,949. Rugby union had the highest number of MSC claims per year (38; 95% CI 36-41 per 1000 MSC claims). New Zealand Māori recorded the highest total ($6,000,759) and mean cost ($21,120) per MSC claim., Conclusions: Although MSC injury claims were only 6.4% of total claims, they accounted for 79.1% of total costs indicating that although the majority of sport-related concussions may be minor in severity, the related economic costs associated with more serious sport-related concussion can be high. The finding that rugby union recorded the most MSC claims in the current study was not unexpected. Of concern is that rugby league recorded a low number of MSC claims but the highest mean cost per claim. Due to the high mean cost per concussion, and the high total and mean cost for New Zealand Māori, further investigation is warranted., (Copyright © 2013 Sports Medicine Australia. 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: Hamstring strain injuries (HSIs) have remained the most prevalent injury in the Australian Football League (AFL) over the past 21 regular seasons. The effect of HSIs in sports is often expressed as regular season games missed due to injury. However, the financial cost of athletes missing games due to injury has not been investigated. The aim of this report is to estimate the financial cost of games missed due to HSIs in the AFL., Method: Data were collected using publicly available information from the AFL's injury report and the official AFL annual report for the past 10 competitive AFL seasons. Average athlete salary and injury epidemiology data were used to determine the average yearly financial cost of HSIs for AFL clubs and the average financial cost of a single HSI over this time period., Results: Across the observed period, average yearly financial cost of HSIs per club increased by 71% compared with a 43% increase in average yearly athlete salary. Over the same time period the average financial cost of a single HSI increased by 56% from $A25,603 in 2003 to $A40,021 in 2012, despite little change in the HSI rates during the period., Conclusions: The observed increased financial cost of HSIs was ultimately explained by the failure of teams to decrease HSI rates, but coupled with increases in athlete salaries over the past 10 season. The information presented in this report highlights the financial cost of HSIs and other sporting injuries, raising greater awareness and the need for further funding for research into injury prevention strategies to maximise economical return for investment in athletes.

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.

Introduction: Soccer is the world's most popular sport and one that is physically demanding and highly competitive. Consequently, the rate of injuries resulting from this sport is only increasing. It is estimated that 2-20% of all such injuries are fractures, one-third of which are located in the lower extremities. The aim of this epidemiological study was to investigate the incidence of lower-leg fractures (LLFs) in Belgian soccer players and determine the possible risk factors that lead to them., Methods: All injuries of players associated with the Royal Belgium Football Association (RBFA) were reported and collected in a nationwide registry. We retrospectively compared the incidence rate of and risk factors for LLFs in Belgian soccer players during two seasons, 1999-2000 and 2009-2010., Results: In total, 1600 fractures (3%) were located in the lower leg. After a decade, the number of LLFs remained unchanged. Ankle fractures were the most common (37%), followed by foot and tibia fractures (33% and 22%, respectively). The least common were fibula fractures, which accounted for just 9%. A higher incidence of every type of LLF was observed in older and amateur-level soccer players, when compared with their younger and professional counterparts. Male players experienced more tibia and foot fractures, whereas the incidences of ankle and fibula fractures were comparable with those in female soccer players. The vast majority of fractures occurred during soccer games., Conclusion: Ankle fractures and foot fractures represented two-thirds of all fractures noted in this analysis. Male gender, recreational level and adult age were important risk factors for LLFs. After 10 years, the incidence of LLFs did not decrease. Given the socioeconomic impact of these injuries, improved prevention techniques are required to reduce their incidence, particularly with regard to the frequently occurring ankle and foot fractures in this population., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: To compare the injury-related societal costs of an injury prevention program with usual warm up programs for amateur adult male soccer players., Design: Cost effectiveness analysis of a cluster-randomized controlled trial., Setting: Regional amateur male soccer competitions in the Netherlands during the 2009 season. Cost estimates in the Netherlands are made in 2009 Euros (&OV0556;1.00∼US$1.43 in late 2009)., Participants: Soccer teams from 2 first-class competitions (the second-highest Dutch amateur level) were approached. Male players aged between 18 and 40 years, who were part of the first team at the start of the season, were eligible for inclusion. Twenty-three teams including 479 players were randomized and 456 (95%) were included in the analysis., Intervention: The injury prevention program was The11, which includes 10 structured exercises developed by the FIFA Medical and Research Centre. The exercises, led by trained coaches, were designed to improve the stability, strength, co-ordination, and flexibility of the trunk, hip, and leg muscles and were performed 2 or 3 times per week as warm-up sessions. Compliance with the exercises was monitored randomly by the researchers. The control teams continued their usual warm-up routines. During the season, individual participants' exposure to training sessions or matches (in minutes) was reported weekly by the coaches. All participants completed questionnaires that included playing and injury history and current occupation and hours worked. Employment (vs studying) was nonsignificantly more common in the control group than the intervention group (68% vs 56%)., Main Cost and Outcome Measures: Costs included those of the intervention, direct healthcare costs of injury, and indirect costs such as hours of work lost, which were recorded on a recovery form. Injuries occurring during the competition season were recorded weekly by the paramedical staff of the team. An injury was defined as a physical complaint sustained by a participant that resulted from a soccer training session or soccer match, whether or not there was lost time from soccer or need for medical attention. Full recovery was defined as participation throughout a training or match session., Main Results: The players' injury rates were almost identical in the intervention and control groups (0.93 vs 0.94, representing 60.5% and 59.7% of players). The mean cost of The11, per player, was &OV0556;14 for the intervention group and &OV0556;0 for the control group. Direct healthcare costs per player were not significantly lower in the intervention group (difference, &OV0556;-44; 95% confidence interval [CI], -17 to 111). Indirect costs were lower in the intervention group (difference, &OV0556;-172; 95% CI, -352 to -28). The total cost per player was also lower in The11 group (difference, &OV0556;-201; 95% CI, -426 to -15). Direct health care costs per injured player were not significantly lower in the intervention group (difference, &OV0556;-76; 95% CI, -285 to 18). Indirect costs were lower in The11 group (difference, &OV0556;-288; 95% CI, -589 to -49). The total per injured player was, therefore, lower in The11 group (difference, &OV0556;-350; 95% CI, -733 to -51)., Conclusions: The injury prevention strategy, The11, did not lower the rate of injuries in adult male soccer players, but the costs per player and per injured player were lower in the intervention group.

Objective: To describe trends in hospitalisation for sport-related concussion., Design, Setting and Patients: Analysis of routinely collected hospital admissions data from all Victorian hospitals (public and private) over the 2002-03 to 2010-11 financial 2013s for patients aged ≥ 15 2013s with a diagnosis of concussion and an ICD-10-AM external cause activity code indicating sport., Main Outcome Measures: Number and cost of hospitalisations; rate of hospitalisation per 100 000 participants overall and for specific sports; and percentage change in frequency and hospitalisation rate per 100 000 participants over 9 2013s., Results: There were 4745 hospitalisations of people aged ≥ 15 2013s for sport-related concussion, with a total hospital treatment cost of $17 944 799. The frequency of hospitalisation increased by 60.5% (95% CI, 41.7%-77.3%) over the 9 2013s, but could only partially be explained by increases in sports participation, as the rate per 100 000 participants also increased significantly, by 38.9% (95% CI, 17.5%-61.7%). After adjustment for participation, rates were highest for motor sports, equestrian activities, Australian football, rugby and roller sports. The greatest significant increases in rates were seen in roller sports, rugby, soccer and cycling., Conclusions: The frequency and participation-adjusted rate of hospitalisation for sport-related concussion, both overall and across several sports, increased significantly over the 9 2013s. These findings, along with high levels of public concern, make prevention of head injury in sport a population health priority in Australia.

Introduction: Physical and military training is an essential component of training in the armed forces. Although there is considerable evidence for the health benefits of training, the negative impacts cannot be ignored. A study was conducted to determine the frequency of sport-related injuries and conditions in the French armed forces in 2011., Materials and Method: To cover the cost of treating injuries and conditions related to military service, medical officers report all accidents to the Caisse Nationale Militaire de Sécurité Sociale. Based on this evidence, the following information was collected: type of sport, age, sex, length of service, service branch and type of lesion., Results: 8,157 injuries and conditions were reported in the first six months of 2011, giving an incidence rate of 4.472 per 100,000 person-years. An army soldier was found to be 2.1 times more likely to suffer an injury than a member of the navy. The study also found that men were more likely to be injured, except during the first four months of service. Running was the most common cause of exercise-related injury (21.5%). Traumas accounted for 92% of all conditions, diseases for 3%, and overuse injuries for 3%. Lower limb injuries were the most common problem (63%), with a majority of ankle lesions, followed by knee lesions. The frequency of musculoskeletal lesions was 75%., Discussion: A new approach to exercise has been developed to reduce the frequency of sport-related injuries and conditions.

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.)

Despite the health benefits of sports activities, sports injury and fear of injury are important barriers to participation in sport. The incidence, prevalence and type of sports injuries vary among men and women as well as age groups. It is usually difficult to examine these different aspects of sports injuries due to insufficient data. This study argues that sport injuries can be considered as an important economic burden in terms of the direct and indirect costs it bears. As a result, strong and effective strategies are needed to prevent sports injuries. Sports medicine has also been attracted increasing attention in recent years, particularly. In this article, the importance of sports injuries and their economic costs as well as the role of sport medicine as a prevention method for sports injuries were discussed.

Horse-related injury can be severe and disabling. We investigated the causes, severity, and costs of equestrian injury with the goal of injury prevention. A retrospective review of horse-related injuries from 2001 to 2008 identified 231 patients with a mean age of 38 years and a mean Injury Severity Score of 11 (range, 1 to 45). Mean length of stay was 5.5 days. Fifty-nine patients (25%) required 84 surgeries. Helmet use was 20 per cent and of the 172 patients not wearing a helmet while mounted, 38 per cent received potentially preventable head injuries. There were three deaths of which two were the result of intracranial hemorrhage in riders not wearing a helmet. Mean hospital charge was $29,800 for a total of $6.9 million. Ninety-one patients completed a survey regarding causation and disability. Thirty-four per cent reported wearing a helmet at the time of injury. Forty per cent reported that poor environmental factors contributed, 30 per cent reported poor horse and rider pairing, and 9 per cent reported equipment failure. Fifty-nine per cent reported long-term disabilities. Compared with the general population, respondents had diminution in their ability to perform usual daily activities associated with physical problems, diminution in social function, and higher bodily pain. We conclude that equestrian injury is costly, disabling, and frequently preventable.

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.

The purpose of this report is to review the available literature to provide an epidemiological overview of skateboarding injuries, as well as to suggest possible areas for future research. A literature search was performed with the databases of PubMed, Sport Discus, Google and Google Scholar using the search terms 'skateboard', 'skateboarding', 'injury' and 'injuries', with all articles published in refereed journals in the English language being considered. An ancestry approach was also used. Articles from non-juried journals were also infrequently included to provide anecdotal information on the sport. Comparison of study results was compromised by the diversity of different study populations and variability of injury definitions across studies. The majority of injuries affect young males although conflicting arguments arise over the issues of age and experience in relation to injury severity. Most injuries are acutely suffered, and the most commonly affected body part was the wrist and forearm, with lower leg and ankle injuries also common. The incidence was relatively high but reports on severity differed. Clear conclusions could not be drawn on environmental location and risk factors. Most injuries tend to occur from a loss of balance leading to a fall, in more recent times due to a failed trick. Research on injury prevention is not conclusive although protective equipment and skatepark use are recommended. Further research using more rigorous study designs is required to gain a clearer picture of the incidence and determinants of injury, and to identify risk factors and viable injury countermeasures., (Copyright © 2012 S. Karger AG, Basel.)

Off-road motorsports are popular in rural and suburban areas, and allow for racing, recreation, and easy access to backcountry destinations. This chapter will review the incidence and types of injuries sustained in off-road motorsports. We completed a structured review of motocross and all-terrain vehicle (ATV) injuries, assessing for injury rates, risk factors, and mortality figures. Information for this study was obtained from a PubMed search under the terms 'motocross', 'motorcross', 'all-terrain vehicles', 'injury', 'motorcycle', 'ATV'. Abstracts and articles in the English language from 1980 onward were reviewed. Further statistics were obtained from the US Consumer Product Safety Commission publications. Operating vehicles off-road requires coordination, experience, and training. Motocross is an organized sport with national associations governing the competition of highly trained athletes. ATVs are used both recreationally and commercially, typically for farming and ranching. ATV use appears more dangerous that motocross, with a higher mortality rate, disproportionately for children. Both sports continue to have high rates of head, spinal cord, and extremity injury. Future prospective studies in off-road motorsports should evaluate the risk factors for injury and target specific areas for injury prevention. Improved training programs, use and improvement of safety helmets, and for ATV use, limiting access to minors, may improve the overall safety of off-road motorsports., (Copyright © 2012 S. Karger AG, Basel.)

The objective of this review was to summarize the epidemiological literature for surfboard riding (surfing), kite surfing and personal watercraft (PWC) riding injuries and describe the incidence and nature of these injuries, common risk factors, and strategies for prevention. The databases searched for relevant publications included Medline, ScienceDirect, ProQuest International, PubMed, Academic Search Premier as well as Google Scholar to identify additional, non-indexed studies. Overall, there was a lack of good quality descriptive studies for these three sports and many of the studies reviewed involved the use of administrative datasets or case-series designs. Among the few studies to provide incidence estimates, there were inconsistencies in how injury was defined, the inclusion criteria, and the reporting of incidence rates, making comparisons within and between the sports difficult. While the reported incidence rates were generally low, head and lower extremity injuries were common across all three sports. Only two studies reported evidence for postulated risk factors. Bigger waves and surfing over rock or reef sea floor increased the risk of injury among competitive surfers, while older age and having more experience increased the risk of significant injuries among recreational surfers. No evaluations of preventative measures were identified. This review demonstrates the need for well-designed epidemiological research, especially studies that focus on the accurate measurement and description of incidence, nature, severity and circumstances of injuries. Once this has occurred, interventions targeted at reducing the incidence of injuries among these sports can be designed, implemented and evaluated., (Copyright © 2012 S. Karger AG, Basel.)

The objective of this article is to provide an overview of the current knowledge related to the epidemiology of injury in selected adventure and extreme sports. PubMed and Google Scholar were searched using the terms 'epidemiology', 'injury,' 'adventure sports' and 'extreme sports'. Publications from the past 10 years were largely selected, but commonly referenced or highly regarded older publications were also included. References lists of articles identified in the search strategy were also searched and articles selected that were judged to be relevant. Important aspects of the epidemiology of injury related to adventure and extreme sports are discussed including occurrence of injury, who is affected by injury, where and when injury occurs, injury outcome, risk factors, inciting events, prevention and further research. Given the life-changing impact injury can have in sports (personal, social, financial, psychological, political, and medical), the current paucity of well-designed descriptive and particularly analytical epidemiological studies in some adventure and extreme sports is disturbing. The importance of denominator-based and longitudinal data collection in obtaining an accurate picture of injury risk and severity and as a basis for testing risk factors and evaluating preventive measures is emphasized., (Copyright © 2012 S. Karger AG, Basel.)

The epidemiology of injury associated with recreational scuba diving is reviewed. A search of electronic databases and reference lists identified pertinent research. Barotrauma, decompression sickness and drowning-related injuries were the most common morbidities associated with recreational scuba diving. The prevalence of incidents ranged from 7 to 35 injuries per 10,000 divers and from 5 to 152 injuries per 100,000 dives. Recreational scuba diving fatalities account for 0.013% of all-cause mortality aged ≥ 15 years. Drowning was the most common cause of death. Among treated injuries, recovery was complete in the majority of cases. Dive injuries were associated with diver-specific factors such as insufficient training and preexisting medical conditions. Environmental factors included air temperature and flying after diving. Dive-specific factors included loss of buoyancy control, rapid ascent and repetitive deep diving. The most common event to precede drowning was running out of gas (compressed air). Though diving injuries are relatively rare prospective, longitudinal studies are needed to quantify the effects of known risk factors and, indeed, asymptomatic injuries (e.g. brain lesions). Dive injury health economics data also remains wanting. Meanwhile, health promotion initiatives should continue to reinforce adherence to established safe diving practices such as observing depth/time limits, safety stops and conservative ascent rates. However, there is an obvious lack of evaluated diving safety interventions., (Copyright © 2012 S. Karger AG, Basel.)

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.

The Ladies Gaelic Football Association has a playing population of 150,000 of which 33% are adults. A number of studies have been published on rates of injury among male athletes but none on female athletes in Gaelic football. A retrospective review of insurance claims, submitted under the Gaelic Athletic Association Player Insurance Injury Scheme. 405 injuries were recorded, 248 [107 (70%) male, 141 (58%) female] to the lower limb, 91 [33 (21%) male, 58 (23%) female] to the upper limb. The majority of lower limb injuries [56 (52%) male, 56 (40%) female] were to muscle. Almost a third of upper limb injuries were fractures [10 (30.3%) male, 33 (57%) female]. injuries/1000 hours playing was 8.25 for men and 2.4 for women. The injury rate in ladies Gaelic football was found to be significantly lower than in men's Gaelic football. Lower limb injuries accounted for the majority of injuries in both sports.

Background: Injuries in children occur most often in physical activity-related activities. A lot of these injuries result in direct and indirect costs. A detailed overview of the economic burden of those injuries in children is lacking., Method: A prospective study was conducted with 996 children in Dutch primary schools to describe the economic burden of injuries that occur during organised sports, leisure time and physical education (PE) class activities. Injuries were continuously monitored by PE teachers during the school year 2006-2007. An injury was recorded if it occurred during PE class, leisure time or organised sports activity and caused the child to at least stop the current activity. If an injury was recorded, parents received a cost diary to report the direct and indirect costs of the child's injury. Costs were collected from a societal perspective., Results: During one school year, a total of 119 injuries were reported by 104 children. The mean total costs as a result of an injury were €188 ± 317. The mean direct costs as a result of an injury were much higher than the mean indirect costs (€131 ± 213 and €57 ± 159, respectively). The highest costs were found for upper extremity and leisure time injuries., Conclusion: Physical activity-related injuries are common in children and result in medical costs. Injuries that lead to the highest costs are those that occur during leisure time activities and upper extremity injuries. Intervention programmes for children to prevent upper extremity injuries and leisure time activity injuries may reduce direct (ie, healthcare) and indirect costs., Trial Registration: ISRCTN78846684.

King et al. reported that of 5 941 moderate to serious claims resulting in medical treatment for rugby league injuries, the knee, shoulder, and head and neck body sites and soft tissue and fracture-dislocation injuries were most frequent and costly in the New Zealand national no-fault injury compensation corporation database during 1999 to 2007. However, additional analyses of knee, shoulder and head and neck body sites by soft tissue and fracture-dislocation injury types was required to enable a greater understanding of the nature of injuries most likely to be seen by sports medical personnel dealing with rugby league players. From 1999 to 2007 the injury claims and costs for head and neck soft tissue, fracture-dislocations, shoulders soft tissue significantly increased. Knee soft tissue injury claims and costs significantly decreased from 1999 to 2007. There was no significant difference in knee fracture-dislocation injury claims but there was a significant increase in knee fracture-dislocation injury costs from 1999 to 2007. Changes in the nature of injuries may be related to changes in defensive techniques employed in rugby league during this time. Sports medical personnel dealing with rugby league players should focus their injury prevention strategies on reducing musculoskeletal injuries to the head and shoulder. There should be a focus on increasing awareness of correct tackling technique, head injury awareness and management of suspected cervical spine injuries., (© Georg Thieme Verlag KG Stuttgart · New York.)

Rugby league is a popular participation sport, but there have been concerns raised regarding the possible high number of severe neck, back and spine injuries. Therefore an epidemiological overview of rugby league neck, back and spine injuries and associated costs of these injuries was undertaken in one country over nine years. The New Zealand national Accident Compensation Corporation data for moderate to serious injury entitlement claims (MSC) over nine years were analysed for the number, type and cost of neck, back and spine rugby league injuries resulting in medical treatment. There were 206 (3%) neck, back and spine MSC claims totalling NZD$1,585,927 (4%) of the total injury entitlement costs for rugby league over the nine-year period. The rate of MSC neck, back and spine rugby league injuries was 26 per 1000 total rugby league claims. Although the rate of neck, back and spine injuries varied over the nine years from 22 to 40 per 1000 injury claims, there was a significant increase over the duration of the study in the number of neck, back and spine MSC claims (χ2=849, df=8, p<0.001), and the cost per MSC injury claim (χ2=19,054, df=8, p<0.001). The frequency, severity and first 12 months cost of neck, back and spine injuries in rugby league is an issue that needs to be addressed. Unfortunately the ACC data base does not provide information on how or why the injuries occurred. A prospective injury epidemiology study needs to be conducted that will allow collection of information surrounding the mechanisms of injury and possible causative risk factors such as tackling technique. In the meantime it is suggested that coaches should ensure tackling technique is correctly taught to all rugby league players to reduce the risk of neck, back and spine injury. Team medical personnel should be trained in dealing with neck and spine injuries as well as head related injuries, and emergency procedures in dealing with players with a suspected neck or back injury should be practiced at clubs., (Copyright © 2010 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Background: In Switzerland, the national accident insurance company registered a total of 42 262 soccer injuries, resulting in costs of approximately 145 million Swiss francs (~US$130 million) in 2003. Research on injury prevention has shown that exercise-based programs can reduce the incidence of soccer injuries., Purpose: This study was conducted to assess the implementation and effects of a countrywide campaign to reduce the incidence of soccer injuries in Swiss amateur players., Study Design: Cohort study; Level of evidence, 3., Methods: All coaches of the Schweizerischer Fussballverband (SFV) received information material and were instructed to implement the injury prevention program "The 11" in their training of amateur players. After the instruction, the coaches were asked to rate the quality and the feasibility of "The 11." Before the start of the intervention and 4 years later, a representative sample of about 1000 Swiss soccer coaches were interviewed about the frequency and characteristics of injuries in their teams. Teams that did or did not practice "The 11" were compared with respect to the incidence of soccer injuries., Results: A total of 5549 coaches for amateur players were instructed to perform "The 11" in the training with their teams. The ratings of the teaching session and the prevention program were overall very positive. In 2008, 80% of all SFV coaches knew the prevention campaign "The 11" and 57% performed the program or most parts of it. Teams performing "The 11" had an 11.5% lower incidence of match injuries and a 25.3% lower incidence of training injuries than other teams; noncontact injuries in particular were prevented by the program., Conclusion: "The 11" was successfully implemented in a countrywide campaign and proved effective in reducing soccer injuries in amateur players. An effect of the prevention program was also observed in the population-based insurance data and health-care costs.

Background: There has been growing interest in anatomical reconstruction of the anterior cruciate ligament (ACL), including the use of double-bundle (DB) reconstruction techniques., Hypothesis: The DB technique will not be cost-effective when compared with single-bundle (SB) reconstruction., Study Design: Economic and decision analysis; Level of evidence, 1., Methods: A decision-analysis model with input values derived from the literature was used to estimate the cost-effectiveness of DB ACL reconstruction compared with SB ACL reconstruction. Effectiveness was based on the revision rate and the postoperative International Knee Documentation Committee (IKDC) score., Results: Sixty-four percent of DB knees result in an IKDC score of A, compared with 54% of SB knees. The incremental cost-effectiveness ratio of a DB reconstruction compared with an SB reconstruction was $6416 per quality adjusted life year in the baseline scenario and $64 371 per quality adjusted life year in the alternate scenario. The model is very sensitive to the proportions of IKDC A outcomes. The model is also sensitive to the utility values assigned to IKDC A and B outcomes and is less sensitive to the marginal cost of a DB reconstruction., Conclusion: This preliminary analysis based on published clinical results to date shows DB ACL reconstruction may be cost-effective, despite increased upfront cost. More research is needed to confirm whether there is any difference in the distribution of IKDC outcomes between the 2 techniques. Perhaps more importantly, the lack of any other demonstrated clinical benefit from the DB technique questions the clinical relevance of this difference in IKDC scores., Clinical Relevance: Revision data and longer term outcomes after DB reconstruction and more reliable clinical utility data are needed to definitively compare the cost-effectiveness of DB and SB ACL reconstruction. Studies of ACL reconstruction and other sports medicine procedures should report the distribution of outcomes data to facilitate future analyses of clinical effectiveness.

Aim: There is scarce information on rugby league injuries in female players. This paper provides an overview of the epidemiology of women's rugby league injuries requiring medical treatment and associated costs in New Zealand., Method: New Zealand Accident Compensation Corporation injury data for the period 1999-2007 were searched for rugby league injury cases occurring in females. Data were analysed by demographics, body region, nature/severity of injury, and medical procedure and costs., Results: There were 320 moderate to serious injury claims recorded for females participating in rugby league activities over the study period. There was a mean (SD) of 37.9 (9.5) injury claims per year. The mean cost per year for the study period was $196 514 ($99,133) (£76,066 (£38,374)) with half of the injury claims occurring in New Zealand Maori. Concussion/brain injuries accounted for 3.8% of total female moderate to serious injury claims but accounted for 5.4% of female injury costs ($84,399 (£32,688)) with the highest mean cost per claim ($7033 (£2724)). The lower limb accounted for 65% of the total female injury claims and 58.7% of total injury costs ($922,296 (£356,968)). The mean cost per claim was higher for the lower limb ($4434 (£1714)) than the upper ($3331 (£1288)) limb. Clerks recorded 16.3% of the total injury claims, 20.3% of total injury costs ($319,474 (£123,211)) and had the highest mean cost per claim ($6144 (£2370)). The 25-29 age group recorded 31.9% of injury claims and 33.8% of injury costs. The 35-39 age group recorded the highest mean cost per claim ($6200 (£2392)) but only 10.9% of total claims and 13.8% of total costs., Discussion: When compared with other studies in rugby league injuries, it appears that females incur substantially fewer injuries (5.7%) than males (94.3%). Although no participation data by sex are available, it is likely that participation percentages are reflected in the injury percentages. The high frequency (65%) and cost proportion (58.7%) for lower limb injuries was higher in females than in male rugby league players (previously reported as 42.4% of the injury claims and 31.5% of the total injury claim costs for the lower limb)., Conclusions: Injury prevention programmes for women's rugby league should focus on the 25-29 age group and address ways to prevent concussion and lower limb injuries.

Objective: The aim of the study was to examine the interactions between alcohol, bicycle helmet use, experience level, riding environment, head and brain injury, insurance status, and hospital charges in a medium-sized city without an adult helmet law., Methods: A study of adult bicycle accident victims presenting to a regional trauma center over a 1-year period was undertaken. Data were collected at the bedside regarding helmet use, alcohol use, experience level, location and type of accident and prevailing vehicle speed (for road accidents), and presence and degree of head or brain injury., Results: Two hundred patients 18 years or older were enrolled from December 2006 through November 2007. Alcohol use showed a strong correlation with head injury (odds ratio, 3.23; 95% confidence interval, 1.57-6.63; P = .001). Impaired riders were less experienced, less likely to have medical insurance, rarely wore helmets, were more likely to ride at night and in slower speed zones such as city streets, and their hospital charges were double (all P values <.05)., Conclusions: Alcohol use leads to a host of unsafe bicycling practices, increased head and brain injuries, and costs to the cyclist and community. The interrelated characteristics of the riding patterns of the cyclists who use alcohol might help target interventions.

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.

Background: Motocross is a nationally organized sport that is growing in popularity. The distribution and severity of motocross injuries in the pediatric population is not known. We hypothesize a high rate of musculoskeletal injuries requiring hospitalization and/or surgical intervention., Methods: All patients 17 years of age or younger with injuries sustained while using off-road 2-wheeled motorcycles were identified through surgical, diagnostic, and trauma registries at a level 1 regional trauma center. Type, severity, and mechanism of injury were assessed, as well as charges billed for medical care. Both recreational and competitive motocross activities were included., Results: From 2000 to 2007, 299 cases were noted in 249 unique patients. In 141 instances, hospital admission was required, for a total of 412 inpatient days. Twenty patients required ICU admission. Surgery was performed in 91 cases (81 orthopaedic, 6 general, 1 urology, and 4 facial reconstructions). Orthopaedic surgical procedures included treatment of 29 femur fractures, 8 forearm, 6 ankle, 5 tibial shaft, 6 proximal tibia, 5 spine, 6 proximal humerus, 4 hand, 4 foot, 3 elbow fractures, and 5 other. Orthopaedic interventions also included 8 reductions under general anesthesia and 31 conscious sedations. Mean age at injury was 14.1 years (range: 5.4 to 17.9). Ninety-four percent of patients were male and 85% were White. The majority of patients were wearing helmets/safety equipment. One hundred and eighty-four injuries occurred on a track, with 150 during competition. The mean charge billed per injury was $14,947 (range: $105 to $217,780), with a total cost of $4.5 million., Conclusions: Nearly half of motocross patients treated at a regional level 1 trauma center required hospitalization, and nearly one-third required surgery. The vast majority of surgical procedures (89%) were orthopaedic. Despite a high usage rate of helmets and protective gear, severe injuries were still sustained, including femur fracture (29), hemiparesis/spinal cord injury (2), and head injury (43). The majority of injuries occurred during organized race or practice. Families should be counseled with regard to the use of safety equipment and the severity of injuries sustained during competitive motocross activity., Level of Evidence: Level IV, case series.

There has been an intensive research effort directed at determining the cause of non-contact anterior cruciate ligament (ACL) injury over the past decade, but few studies have reported data on the incidence of ACL and other knee ligament injury in the general population. New Zealand's no-fault injury compensation data provides a national injury resource of data on claims for knee ligament injury. The goal of this paper was to provide a descriptive epidemiology of knee ligament injury in this country. Data were obtained for knee ligament injuries between 1 July 2000 and 30 June 2005. Injuries were categorised as non-surgical (NS), ACL surgeries (ACLS) and other knee ligament surgeries (OKLS). Incidence rates per 100,000 person-years were computed using population estimates. Costs and number of treatment/rehabilitation visits were obtained as an indication of severity. The incidence rate per 100,000 person-years was 1147.1 for NS, 36.9 for ACLS and 9.1 for OKLS. Males had a higher incidence rate than females for NS, ACLS, and OKLS. The mean (and median) number of treatment visits were NS: 6.6 (4), ACLS: 27.1 (24), and OKLS: 31.3 (24). The mean (median) treatment costs of these injuries were NS $885 ($129), ACLS $11,157 ($8574), and OKLS $15,663 ($8054). Analysis of injury descriptions for ACLS injuries indicated that 58% involved a non-contact mechanism of injury. These data underscore the high level of short-term disability associated with knee ligament injuries, especially ACL injuries that require surgery.

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.

Aim: This paper provides an overview of the epidemiology of rugby league injuries and associated costs in New Zealand requiring medical treatment., Method: New Zealand national Accident Compensation Corporation injury data for the period 1999 to 2007 were searched for rugby league injury cases. Data were analysed by demographics, body region, nature/severity of injury, and medical procedure and costs., Results: A total of 5941 injury entitlement claims were recorded over the study period with a significant decrease observed in the injury rate between the 1999-2000 and 2002-2003 reporting years. The total cost of the injuries for the study period was $42,822,048 (equivalent to pound15,916,072). The mean (SD) number of injury entitlement claims per year was 743 (271) and yearly cost was $5,352,760 (pound1,989,880) ($2,485,535 (pound923,994)). The knee was the most commonly reported injury site (225 per 1000 entitlement claims; $8,750,147 (pound3,252,020)) and soft tissue injuries were the most common injury types (474 per 1000 entitlement claims; $17,324,214 (pound6,438,599)). Accounting for only 1.8% of total injury entitlement claims, concussion/brain injuries accounted for 6.3% of injury entitlement costs and had the highest mean cost per claim ($25 347 (pound9420)). The upper and lower arm recorded the highest mean injury site claim cost of $43,096 (pound16,016) per claim. The 25-29 age group recorded 27.7% of total injury entitlement claims and 29.6% of total injury entitlement costs, which was slightly more than the 20-24 age group (27.3% claims; 24.7% costs). Nearly 15% of total moderate to serious injury entitlement claims and 20% of total costs were recorded from participants 35 years or older., Discussion: This study identified that the knee was the most common injury site and soft tissue injuries were the most common injury type requiring medical treatment, which is consistent with other international studies on rugby league epidemiology. This study also highlights that the rate of injury and the average age of injured rugby league players increased over time. The high cost of concussion/brain injuries is a cause for concern as it reflects the severity of the injuries., Conclusion: Injury prevention programmes for rugby league should focus on reducing the risk of concussion/brain injury and knee and soft tissue injury, and should target participants in the 20-30 years old age range. More longitudinal epidemiological studies with specific details on injury mechanisms and participation data are warranted to further identify the injury circumstances surrounding participation in rugby league activities.

Although equestrian injury studies to date have provided useful information for injury prevention, these studies have not been detailed enough or inclusive enough, to identify and characterise all sub-populations that may be at risk. One study has reported injury rates for the population-at-risk. The present study was carried out to determine, more precisely, who is injured in horse-related activities in New Zealand, what sorts of injuries they sustain, the circumstances of injury and the cost of treatment. A novel search of linked hospital discharge and compensation claim data for 2002 and 2003 was carried out. Of 716 newly hospitalised cases, 29% were in the 5-19-year and 28% in the 35-49-year age groups. Incidence rates for regular riders peaked at 13-15 years (900/100000) and 50+ years (880/100000). Where the 'place of occurrence' was specified only 12% of cases sustained injury in a 'sports and athletics area'. This new study has highlighted injuries occurring in farm and other 'open' locations such as mountains and forest, injuries to older riders and injuries to bystanders/handlers during non-organised recreational activity. Attention was drawn to the high in-patient cost of hospitalised injuries in persons >40 years and the need for injury information relating to specific riding activities. Current equestrian injury prevention tends to target young females and organised riding; in focusing on these, other significant population groups and injury mechanisms may be overlooked and opportunities for injury prevention missed.

RugbySmart, a rugby union injury prevention programme, was launched in New Zealand in 2001. It was compulsory for all coaches and referees to complete RugbySmart requirements annually in order to continue coaching or refereeing. After 5 years of implementation the programme partners, Accident Compensation Corporation and New Zealand Rugby Union, evaluated RugbySmart to determine its effectiveness in reducing injuries. The purpose was to evaluate the effect of RugbySmart on reducing injury rates per 100,000 players and resulting injury prevention behaviours. The RugbySmart programme was associated with a decrease in injury claims per 100,000 players in most areas the programme targeted; the programme had negligible impact on non-targeted injury sites. The decrease in injury claims numbers was supported by results from the player behaviour surveys pre- and post-RugbySmart. There was an increase in safe behaviour in the contact situations of tackle, scrum and ruck technique.

Objective: To define target populations for sports injury prevention programs., Design: A computer-assisted telephone survey on sports injuries and sports participation during 2000-2005 using a 3-month recall period., Setting: Data obtained from a representative sample of Dutch citizens., Participants: Fifty-eight thousand four hundred five Dutch citizens aged older than 3 years., Assessment of Risk Factors: Age, gender, and type of sports were used to distinguish subgroups with a substantial contribution to sports injuries., Main Outcome Measures: The absolute number of sports injuries, the incidence of sports injuries per 10,000 hours, the severity, and costs of sports injuries., Results: Sports participation was associated with 1.5 million injuries per year and 10 injuries per 10,000 hours; of these, 50% had to be treated medically. Two-thirds of all medically treated sports injuries were associated with 9 sports (representing 18 subpopulations, all younger than 55 years): outdoor soccer (males 4-54 years and females 4-17 years), indoor soccer (males 18-34 years), tennis (males/females 35-54 years), volleyball (females 18-54 years), field hockey (males 18-34 years and females 4-17 years), running/jogging (males/females 35-54 years), gymnastics (males/females 4-17 years), skiing/snowboarding (males 4-17 years and females 18-34 years), and equestrian sports (females 18-34 years). These groups showed more than average injury rates and covered two-thirds of all direct and indirect costs (euro 400 million)., Conclusions: The survey identified the most important (sports-, age-, and gender-specific) target populations for injury prevention programs in the Netherlands. Sports participants aged older than 55 years were excluded from these target groups because of their limited contribution to the total sports injury problem.

Health benefits of physical activity in children are well known. However, a drawback is the risk of physical activity-related injuries. Children are at particular risk for these injuries, because of a high level of exposure. Because of the high prevalence of physical activity injuries and the negative short- and long-term consequences, prevention of these injuries in children is important. This article describes how we systematically developed a school-based physical activity injury prevention programme using the intervention mapping (IM) protocol. IM describes a process for developing theory- and evidence-based health promotion programmes. The development can be described in six steps: (i) perform a needs assessment; (ii) identify programme and performance objectives; (iii) select methods and strategies; (iv) develop programme; (v) adopt and implement; and (vi) evaluate. First, the results of the needs assessment showed the injury problem in children and the different risk factors for physical activity injuries. Based on the results of the needs assessment the main focus of the injury prevention programme was described. Second, the overall programme objective of the injury prevention programme was defined as reducing the incidence of lower extremity physical activity injuries. Third, theoretical methods and practical strategies were selected to accomplish a decrease in injury incidence. The theoretical methods used were active learning, providing cues and scenario-based risk information, and active processing of information. The practical strategy of the injury prevention programme was an 8-month course about injury prevention to be used in physical education classes in primary schools. Fourth, programme materials that were used in the injury prevention programme were developed, including newsletters for children and parents, posters, exercises to improve motor fitness, and an information website. Fifth, an implementation plan was designed in order to ensure that the prevention programme would be implemented, adopted and sustained over time. Finally, an evaluation plan was designed. The injury prevention programme is being evaluated in a cluster randomized controlled trial with more than 2200 children from 40 primary schools throughout the Netherlands. The IM process is a useful process for developing an injury prevention programme. Based on the steps of the IM we developed an 8-month injury prevention programme to be used in physical education classes of primary schools.

Objective: This study determines the injury rate (%) and the associated direct medical and indirect costs of sports injuries in Flanders., Setting: Epidemiological cohort designs and a human capital method were set up to measure respectively the medical direct and indirect cost of sports injuries., Participants: 72 out of 82 Flemish sports federations participated., Intervention: Insurance statistics from 2003 were used to determine the overall rate of injury and injury localisations. Using these data, the medical direct cost and the impact sports injuries have on indirect costs were estimated. The indirect costs were determined by multiplying the days of absence from work with the daily cost resulting from a loss of production, being 200 euros., Main Outcome: The total direct medical cost extrapolated for the Flemish sports participants was 15,027,423 euros, which amounted to 0.07% to 0.08% of the total budget spent on healthcare. The indirect cost extrapolated for the Flemish sports participants was 111,420,813 euros, which is about 3.4% of the costs arising from absenteeism from work., Results: Of the 14 in-depth analysed sports, the rate of injury was highest in European team handball (8.96%; 95% confidence interval (CI) 8.95-8.96) and lowest in swimming (0.62%; 95% CI 0.62-0.62). The highest direct medical cost was found for anterior cruciate ligament (ACL) injuries (1358 euros per injury) and the lowest for foot injuries (52 euros per injury)., Conclusion: The costs calculated in this study could become critical statistics in medical care debates. Data obtained here will enable a cost-benefit analysis of the impact of preventive measures to be made.

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 determine the direct and indirect cost of injuries in professional jockeys as a result of race riding., Design: Cohort study., Setting: Professional horse racing., Participants: Professional jockeys in the UK registered with the Jockey Club., Main Outcome Measures: Payouts under the Professional Riders Insurance Scheme (PRIS) for injuries sustained by professional jockeys, which were recorded by the Jockey Club injury database between 1996 and 2006 inclusive., Results: In the 11-year period of the study, there were 1328 injuries that resulted in jockeys missing a total of 71,509 days of racing, and as a result PRIS paid out 4,496,019 pounds sterling in compensation. Most injuries were minor, with a third of injured jockeys returning to race riding within 2 weeks and 45% of the claims receiving a payout of < 1000 pounds sterling. Almost half the claims were due to fractures, with the clavicle being the most common site of injury. Joint dislocations accounted for the highest insurance payout and the longest time off racing., Conclusions: Horse racing is a sport known to have a high risk of injury. This study has found that almost 4.5 million pounds sterling was spent on the injuries that were reported to PRIS during the 11-year time period 1996-2006. This study sheds light on the overall injury cost in professional horse racing and will form the basis for more formal health economic analysis.

Objectives: To describe patient and hospital characteristics associated with hospitalisation for a diagnosis of non-fatal sport-related concussion, and to determine factors associated with these hospitalisations., Methods: Children aged 5-18 years with a primary diagnosis of a sport-related concussion in the Nationwide Inpatient Sample (2000-2004) were identified. Length of stay and hospital charges for sport-related concussions were documented. Logistic regression was used to assess the association of patient or hospital characteristics with hospitalisations for sport-related concussion., Results: Between 2000 and 2004, a total of 755 non-fatal paediatric sport-related hospitalisations for concussion were identified. Nationwide, this represents 3712 hospitalisations and over US$29 million total hospital charges, with nearly US$6 million in total hospital charges per year. Over half (52.3%) of patients with concussion experienced loss of consciousness. Over 80% of the patients hospitalised for concussion received no procedures during their average 1.1 day (median 0.8 day) of hospital stay. Older age, but not gender, was associated with increased odds of sport-related hospitalisations for concussion. Non-teaching hospitals or hospitals in rural areas had significantly greater odds of admitting sport-related concussions versus other sport-related traumatic brain injuries compared with teaching or urban hospitals., Conclusions: Management of paediatric sport-related concussions varied, depending on the patient and the hospital. Better guidelines are needed for the identification and management of sport-related concussions. Standardised procedures for hospitals treating concussive injuries may also be warranted.

Introduction: Clinical examination of suspected scaphoid fractures is sensitive, but not specific, and initial plain radiographs lack sensitivity. A variety of second-line imaging techniques have been proposed to improve immediate diagnosis and reduce overtreatment. Different sample populations and methods of reporting test performance have made side-by-side comparison difficult. The aim of this study is to describe the epidemiology of clinically suspected scaphoid fracture and determine the prevalence of true fracture. These data are used to compare second-line imaging techniques in our population., Patients and Methods: 200 consecutive patients attending a trauma service with clinically suspected scaphoid fracture were followed through diagnosis to discharge., Results: The prevalence of true fracture was 16% and was associated with male sex and injury playing sport. Magnetic resonance imaging has the best diagnostic performance, with the added benefit of soft tissue evaluation, but was the most expensive option. Ultrasound examination was least effective in detecting true fractures., Conclusions: Future studies should further evaluate the clinical and economic sequelae of overtreatment of suspected fractures. Clinicians should examine alternatives to "empirical" treatment without definite diagnosis based on their local facilities and patient demographics.

An increase in the physical activity of individuals has many health benefits, but a drawback of an increase in physical activity is the risk of related injuries. To reduce the short- and long-term effects in terms of social and economic consequences, prevention of physical activity injuries is an important challenge. A sequence of prevention model has been proposed that aims to prevent physical activity injuries in different steps. The model includes (i) identification of the problem in terms of incidence and severity of physical activity injuries, (ii) identification of the risk factors and injury mechanisms that play a role in the occurrence of physical activity injuries, (iii) introduction of measures that are likely to reduce the future risk and (or) severity of physical activity injuries, and (iv) evaluation of the effectiveness of the measures by conducting a randomized controlled trial (RCT). This review describes what is currently known about all of the various aspects of the sequence of prevention in children (steps i-iv).

Background: It has been previously shown that professional jump and flat racing jockeys suffer a high incidence of injury as a consequence of their profession. This paper specifically examines career-ending injuries to professional jockeys in Great Britain., Aims: To investigate career-ending injuries in professional jockeys., Method: Analysis of prospectively collected injury database on professional jockeys., Results: The majority of injuries in this study occurred to the head, shoulder or torso. Fractures were the most common type of injury that led to a decision to end a career, followed by neurological injury to the head and/or spine., Conclusion: Injuries to the head are the most common career-ending injuries, and consideration of injury counter measures could be an important strategy in equestrian sports.

In New Zealand (NZ), the Accident Compensation Corporation (ACC) has developed a pre and post-implementation cost-outcome formulae for sport injury prevention to provide information regarding the success of a prevention programme. The ACC provides for the cost of all personal injuries in NZ and invests in prevention programmes to offset 1.6 million annual claims that cost $NZD 1.9 billion. The ACC invests in nine national community sport injury prevention programmes that represent 40% of sport claims and costs. Pre-implementation is used to determine the decision whether to invest in implementation and to determine the level of such investment for the injury prevention programme. Post-implementation is calculated two ways: unadjusted, assuming ceteris paribus; and adjusted assuming no prevention programme was in place. Post-implementation formulae provide a return on investment (ROI) for each dollar invested in the programme and cost-savings. The cost-outcome formulae approach allows ACC to manage expectations of the prevention programme as well as when it will provide a ROI, allowing it to take a long-term view for investment in sport injury prevention. Originally developed for its sport injury prevention programmes, the cost-outcome formulae have now been applied to the other prevention programmes ACC invests in such as home, road and workplace injury prevention.

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.