Sports and Recreation Brain Injuries in Children: 283,000 Emergency Visits a Year

Traumatic brain injuries (TBIs), including concussions, top public worries about children's sports injuries. Caused by a blow to the head or body, a TBI can have emotional, physiologic and cognitive effects, and a child's developing nervous system and thinner skull bones may raise the risk. An earlier study found that 70% of emergency visits for sports- and recreation-related TBIs were among children.

The data

CDC analyzed the National Electronic Injury Surveillance System–All Injury Program, run by the U.S. Consumer Product Safety Commission and drawn from 66 of 100 sampled hospitals with 24-hour emergency departments — about 500,000 injury visits a year. It counted TBIs (head injuries diagnosed as concussion or internal organ injury) among children under 18 during organized or informal sports and recreation, excluding violence-related injuries and deaths, for 2010–2016.

Findings

• About 283,000 children a year — an estimated 2 million over seven years — went to an ED for a sports- or recreation-related TBI.
• Overall, the rate held roughly steady: 354.7 per 100,000 children in 2010 and 371.0 in 2016, after a sharp rise from 2006 to 2012 in an earlier report.
• Boys had about twice the rate of girls. Boys' rates rose from 486.6 (2010) to 559.1 (2012), then fell to 482.7 (2016); girls' rates rose from 216.5 to 254.3.
• Ages 10–14 and 15–17 had the highest rates every year — likely reflecting more contact sports among boys and older children.
• Contact sports caused about 45% of visits — nearly twice as many as noncontact sports and four times as many as recreation.

Among girls, contact (27,180) and limited-contact sports (27,343) caused similar numbers. For the youngest children, playgrounds led: 38.2% of visits for boys under 5, 19.6% for boys 5–9, and 42.3% for girls under 5.

Why boys' rates fell after 2012 is unclear — safer rule changes in contact sports, fewer players, or changes in seeking care.

Prevention and care

• Limit player-to-player contact and change rules to reduce collisions in contact and limited-contact sports; research on strict officiating, state policies and athletic trainers could help.
• Use preparticipation exams to spot athletes at risk of TBI or slow recovery — older children and teens, and those with previous TBI, learning difficulties, neurologic or psychiatric disorders, lower socioeconomic status, or family and social stress — and to discuss sport-specific prevention.
• Follow CDC's 2018 Pediatric Mild TBI Guideline:
• 1. don't routinely image children to diagnose mild TBI;
  2. use validated, age-appropriate symptom scales;
  3. check for risk factors for prolonged recovery;
  4. give return-to-activity instructions tailored to symptoms;
  5. advise a gradual return to nonsports activities after no more than 2–3 days of rest.
• Develop and test prevention tailored to noncontact sports and recreation too.

Limitations

Injury rates by activity couldn't be calculated without participation data; many children with TBI never go to an ED; TBIs recorded as secondary diagnoses (such as with skull fractures) may be missed; records lack detail on circumstances and protective equipment; and the data can't show whether changes reflect true incidence or care-seeking.

Sources

Based on "Emergency Department Visits for Sports- and Recreation-Related Traumatic Brain Injuries Among Children — United States, 2010–2016," by Kelly Sarmiento, Karen E. Thomas, Jill Daugherty and colleagues, Morbidity and Mortality Weekly Report 68(10), Centers for Disease Control and Prevention; a work of the United States government in the public domain.