Preventative Measures for Football-Related Injuries for U.S. Children

The aim of this study was to examine the incidence of football-related injuries in children between 6 and 17 years years of age. There is an association among the type (sprain, fractures, dislocations etc), body region (upper extremities/lower extremities) and location (school, home or recreation facilities) of injury with the age and sex of injured children. Younger players (6 to 11 years) had more injuries on the upper extremities and older players (12 to 17 years) had more injuries on the lower extremities. The annual rate of injury was 6.2 injuries per 1,000 children.

Football is a very popular game among the youth in the United States, in spite of it being an injury-prone game. Previous studies have examined the injuries resulting from organized football matches and the type of injuries. However, only college-level or high school students were evaluated; there is no data available on younger children. Competitive football games are played by children as young as 5 to 6 years old; thus injuries caused by the game at this growing stage can cause serious physiological development problems. Hence it is essential to evaluate these injuries and take preventive methods to reduce the risk of injuries.

* This study evaluated football injuries in children between 6 and 17 years, who were treated in the emergency departments for a period of 18 years from 1990 to 2007.
* Data on age, gender, race, diagnosis of injury, and location of injury were collected for 144, 033 injuries from the National Electronic Injury Surveillance System database of the United States Consumer Product Safety Commission.
* Data was sorted into the 6 to 11 and 12 to 17 years age groups. Injuries were grouped on the basis of the location, namely lower extremities (leg, knee, ankle, foot and toe), upper extremities (shoulder, arm, hand, wrist and finger), and trunk (hip, pubic area and trunk).
* “The diagnoses were: concussions, fractures and dislocations, lacerations, soft tissue injuries, sprains and others (such as closed head injuries, dental injuries, hematomas and nerve damage).” Subjects were classified as released (who did not require hospitalization) and as hospitalized (who were admitted).

Results/Key findings
* Upper extremity fracture was the most common injury (21.8 percent in boys and 24.8 percent in girls).
* The 12- to 17-year age group accounted for 77.8 percent of the injuries. Lacerations were more common in 6 to 11 years old children while concussions were common in the 12- to 17-year-old group.
* Girls suffered from sprain or strains as compared to the boys who experienced more of concussions and lacerations. 31.3 percent of the injuries were sprains and strains, 28.4 percent were fractures and dislocations, and 23.7 percent were soft-tissue injuries. 49.1 percent of injuries were in the upper extremities, 26.2 percent in lower extremities, and 16.0 percent in the head, neck and face.
* Of all the injuries, 33.6 percent took place at sports centers, while 30.4 percent took place at schools. Girls and children 6- to 11 years old were more likely to get injured at home. Injuries did not require hospitalization 97.9 percent of the time. Among the injuries that required hospitalization, 63.3 percent consisted of fracture or dislocation.

Next steps/Shortcomings
The total number of injuries cannot be considered accurate as the database consists of only the injuries treated in emergency departments. Injuries treated in medical centers and by physiotherapists and family doctors have not been assessed. There was no data on whether the injuries occurred in organized or unorganized matches. Future studies need to identify risk factors in children and adolescents and assess the incidence of injury in unorganized versus organized matches.

The number of injuries resulting from football has increased significantly by 25.6 percent in the 18-year period of the study. In schools where certified physical trainers were present, only the most severe injuries encountered were treated in the emergency room. Only 42 percent of the schools had certified trainers. Thus there is a need for having certified trainers in all schools. There are a number of rules in place for player protection, such as the use of protective equipment while playing, including plastic helmets with facemasks and shoulder pads. More preventive efforts are needed to minimize the risk of injuries in young children and to make the game safer.

For More Information:
Football-Related Injuries among 6- to 17-Year-Olds Treated in U.S. Emergency Departments, 1990-2007
Publication Journal: Clinical Pediatrics, December 2010
By Adam D. Nation; Nicolas G. Nelson; Research Institute at Nationwide Children’s Hospital, Columbus, Ohio

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