Epidemiology of Contact Injuries in High School Athletes in the United States

OBJECTIVES: Lacrosse and ice hockey are fast growing youth sports in the United States. Football remains the most popular and is the leading cause of sports-related injuries among high school students. Injuries remain a concern given the physical nature of these three contact sports. The objective of this study was to compare the rates and patterns of injury in boys’ football, ice hockey, and lacrosse. METHODS: We conducted a secondary analysis of High School RIO (Reporting Information Online) data including exposure and injury data collected from a large sample of high schools in the United States from 2005/2006-2015/2016. In High School RIO, athletic trainers submitted exposure and injury information weekly. In this study data was analyzed to calculate rates, assess patterns, and evaluate potential risk factors for player-player contact injuries. RESULTS: A total of 34,532 injuries in boys’ football, ice hockey, and lacrosse occurred during 9,078,902 exposures for a rate of 3.80 injuries per 1,000 AE in the three contact sports of interest. The rate of injury was found to be higher in competition compared to practice for all three sports, with the largest difference in ice hockey (RR = 8.28; 95% CI = 7.74-8.86). In football, 46.6% of injuries were due to tackling or being tackled, 41.1% of injuries in ice hockey and 15.3% of injuries in lacrosse were due to checking or being checked. In football and lacrosse, a greater percentage of injuries were due to being tackled or checked, respectively. Similarly, in ice hockey, a greater percentage of injuries occurred due to being checked compared to checking, but surprisingly the proportion was much higher (81.6% vs 18.4%). In addition, a smaller proportion of hockey athletes injured while being checked were able to return to play in less than a week compared with both being tackled in football (IPR = 0.41) and being checked in lacrosse (IPR = 0.47). A significantly greater proportion of concussions sustained in football were the result of tackling compared to being tackled (28.3% vs 24.8%; IPR = 1.17; 95% CI = 1.11-1.24). Conversely, in ice hockey, a greater proportion of concussions were sustained while being checked compared to checking (33.8% vs. 20.5%; IPR = 1.65; 95% CI = 1.04-2.61). There was a significantly higher concussion rate in competition compared to practice for all three sports with no concussions sustained in ice hockey practice due to checking. CONCLUSION: While all three sports studied were similar in regards to a higher injury rate associated with being on the receiving end of intentional contact (being tackled or checked), the proportion was much higher in ice hockey and the injured ice hockey players were less likely to return to play in less than one week. Also of note, concussions were sustained equally while tackling and being tackled, however in ice hockey, no concussions were sustained while checking opposing players during practice. Future studies are needed to further investigate these patterns in high school contact athletes, with particular emphasis placed on understanding the lack of concussions during ice hockey practice in an attempt to translate similar practices to other contact sports.