Predictors for severe sports injury aid in stratification, resource allocation

Several predictors for severe sports injuries, including older age, injuries to the head and neck, fractures, and dislocations, among others, may improve risk stratification and resource allocation, according to a Singapore study.

“This study further alerts emergency department (ED) physicians to children and teenagers at risk of severe sports injuries,” the researchers said.

A paediatric trauma surveillance registry was retrospectively reviewed from February 2012 to October 2017, including patient demographics, type of sports, circumstances, type of injuries, and clinical management in the hospital. Patients aged 5–17 years with a sports-related injury were included.

The researchers conducted logistic regression to identify the predictors of severe sports injuries (defined by Injury Severity Score of ≥9), injuries requiring hospitalization, trauma team activation, resuscitation, or those that resulted in death.

A total of 10,951 patients were analysed. Fractures (n=4,819; 44.0 percent) were the most common injuries sustained, followed by sprains and contusions (n-3,334; 30.4 percent). The median length of hospitalization for those with severe injuries was 2 days (interquartile range [IQR], 1–3 days), and time away from sports was 162 days (IQR, 104–182 days). [Ann Acad Med Singap 2020;49:955-962]

Severe injuries were predicted by the following: transportation by emergency medical service (adjusted odds ratio [aOR], 6.346, 95 percent confidence interval [CI], 5.147–7.823), involvement in rugby (aOR, 2.067, 95 percent CI, 1.446–2.957), neurological injuries (aOR, 4.585, 95 percent CI, 2.393–4.365), dislocations (aOR, 2.779, 95 percent CI, 1.744–4.427), fractures (aOR, 1.438, 95 percent CI, 1.039–1.990), injuries to the head and neck (aoR, 2.274, 95 percent CI, 1.184–4.365), and injuries to the abdomen and pelvis (aOR, 5.273, 95 percent CI, 3.225–8.623).

“We report similar injury characteristics from other published literature,” said the researchers, noting that fractures accounted for most ED presentations in both the younger and older age groups. [Acad Emerg Med 2000;7:1376-1382; Injury 2007;38:931-936]

This was consistent with a study by Taylor and Attia, which reported fractures as the most frequently evaluated paediatric injuries in the ED. [Acad Emerg Med 2000;7:1376-1382]

The top three sports resulting in injuries were soccer, basketball, and rugby, a finding consistent from that of a study by Darrow and colleagues, which found that soccer posed the highest rate of sports-related, as well as severe, injuries in the paediatric population. [Am J Sports Med 2009;37:1798-1805; J Burn Care Res 1986;7:363-364; Am J Sports Med 1980;8:318-324]

Soccer is popular among Singapore teens, and the long duration of contact during game play was associated with the risk of injury. [https://www.sportsingapore. gov.sg/about-us/sports-particpation-in-singapore; https://data.gov.sg/dataset/sport-participation-level?view_ id=f822c2c2-8375-46ef-8fb6-32014867fd71&resource_id=dd403f43- 61ae-4d78-b63b-019b0bffa94f]

“We identified several risk factors that will alert physicians of potential severe injuries when children and teenagers present to them with sports injuries,” the researchers said. “For such risk factors, there should be a lower threshold to involve a multidisciplinary team including orthopaedic, neurosurgical, and trauma surgeons for timely investigation and resuscitation as required.”