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Background The National Athletic Treatment, Injury and Outcomes Network Surveillance Program (NATION-SP) was established in 2011 to provide a comprehensive appraisal of injuries sustained by high school student-athletes who received services from athletic trainers (ATs). The purpose of this article is to update the surveillance methods of the NATION-SP for data reported during the 2014–2015 through 2018–2019 academic years. Surveillance System Structure The NATION-SP used a rolling recruitment model to identify a convenience sample of US high schools with access to ATs. The ATs at participating institutions volunteered to contribute data via electronic medical records systems; common data elements were then pushed to and maintained by the Datalys Center for Sports Injury Research and Prevention. The ATs completed detailed reports on each injury, including the condition and circumstances. The treatments component was used to comprehensively assess the services provided to athletes by ATs. The outcomes companion component was developed to monitor patient-reported outcomes after athletic injury. Summary The NATION-SP continues to serve a critical purpose in informing injury-prevention and treatment efforts among high school athletes.

BACKGROUND: We compared injury incidence and mechanisms among youth, high school (HS), and National Collegiate Athletic Association (NCAA) boys’ and men’s lacrosse athletes for the 2014–2015 to 2016–2017 lacrosse seasons. METHODS: Multiple injury surveillance systems were used to capture 21 youth boys’, 22 HS boys’, and 20 NCAA men’s lacrosse team-seasons of data during the 2014–2015 to 2016–2017 seasons. Athletic trainers reported game and practice injuries and athlete exposures (AEs). Injuries included those occurring during a game and/or practice and requiring evaluation from an athletic trainer and/or physician. Injury counts, rates per 1000 AEs, and injury rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated. RESULTS: The injury rate in youth was higher than those reported in HS (10.3 vs 5.3 per 1000 AEs; IRR = 2.0; 95% CI: 1.6–2.4) and the NCAA (10.3 vs 4.7 per 1000 AEs; IRR = 2.2; 95% CI: 1.9–2.5). When considering time loss injuries only (restricted participation of ≥24 hours), the injury rate in youth was lower than those reported in HS (2.0 vs 2.9 per 1000 AEs; IRR = 0.7; 95% CI: 0.5–0.95) and the NCAA (2.0 vs 3.3 per 1000 AEs; IRR = 0.6; 95% CI: 0.4–0.8). The concussion rate in youth was higher than those in HS (0.7 vs 0.3 per 1000 AEs; IRR = 2.4, 95% CI: 1.1–5.2) and the NCAA (0.7 vs 0.3 per 1000 AEs; IRR = 2.1, 95% CI: 1.2–3.7). Injuries at the youth, HS, and NCAA levels were most commonly associated with stick contact, inflammatory conditions (including bursitis, tendonitis, and other unspecified inflammation), and noncontact mechanisms, respectively. CONCLUSIONS: Although the time loss injury rate was lowest in youth boys’ lacrosse, the concussion rate was the highest. Injury prevention approaches should be specific to the mechanisms associated with each level of play (eg, equipment skill development in youth).

ObjectiveThe purpose of this study is to examine symptomology, symptom resolution time, and return to play (RTP) time between concussions sustained in the same academic year.BackgroundPrevious research shows that among those with a history of previous concussions, outcomes for a recurrent concussion are worse, especially when concussions occur within two weeks of each other. Despite this research, there has been little investigation into concussions that occur in the same academic year.Design/MethodsConcussion data was collected from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) during the 2009/10-2017/18 academic years. Concussions were reported by athletic trainers (ATs) and were included if the student-athlete sustained two concussions in the same academic year. Proportions and means of symptoms, symptom resolution time, and RTP time were calculated, and, as appropriate, McNemar’s tests and Wilcoxon sign-rank tests were used to compare these between the first and second concussions.ResultsOverall, 138 student-athletes sustained 276 concussions across 15 different sports a mean of 43 days apart (SD: 37.3). Fewer symptoms were reported in the second concussion compared to the first (4.3 vs. 5.2, respectively; p = 0.01). RTP time was, on average, five days longer for the second concussion (p = 0.01), and a larger proportion of second concussions resulted in participation restriction of ≥30 days (first: 7.3%, second: 26.8%; p < 0.01). Symptom resolution time did not differ between the first and second concussions.ConclusionsAlthough the RTP time was greater in second concussions compared to first, symptom resolution time did not differ. This suggests that there may be a difference in AT management of second concussions, with a more conservative, extended RTP progression. Further research is needed to examine the association between time between concussions and differences in concussion presentation.