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6 CATASTROPHIC SPORTS

INJURIES

Barry P Boden, MD

INTRODUCTION

• In the United States approximately 10% of all brain
  injuries and 7% of all new cases of paraplegia and
  quadriplegia are related to athletic activities (Mueller,
  1996).


• Information on catastrophic injuries in athletes is col-
  lected by the National Center for Catastrophic Sports
  Injury Research (NCCSIR), the US Consumer
  Product Safety Commission (CPSC), and the profes-
  sional league data registries.


• The NCCSIR defines catastrophic sports injury as
  “any severe spinal, spinal cord, or cerebral injury
  incurred during participation in a school- or college-
  sponsored sport.” Concussions are not considered to
  be catastrophic injuries.


• The NCCSIR classifies injuries as direct, resulting
  from participating in the skills of a sport (i.e., trauma
  from a collision), or indirect, resulting from systemic
  failure owing to exertion while participating in a
  sport.


• The NCCSIR subdivides catastrophic injuries into
  three categories: fatal, nonfatal, and serious. A nonfa-
  tal injury is any injury where the athlete suffered a
  permanent, severe, functional disability. A serious
  injury is a severe injury with no permanent functional
  disability, e.g., a fractured cervical vertebra without
  paralysis (Mueller, 1996).


• The CPSC operates a statistically valid injury and
  review system known as the national electronic injury
  surveillance system (NEISS) (www.cpsc.gov). The
  NEISS estimates are calculated using data from a
  sample of hospitals that are representative of emergency

departments in the United States. The CPSC does not

provide data on injury specifics nor does it include

information on injuries that initially presented to physi-

cian offices.

• The National Collegiate Athletic Association (NCAA)
  and the National Federation of State High School
  Associations (NFSH) review injury epidemiology
  annually and publish a rules book for each sport with
  the intent of promoting safe play (www.ncaa.org;
  http://www.nfhs.org)..)

EPIDEMIOLOGY

•For all sports followed by the NCCSIR, the total

direct and indirect incidence of catastrophic injuries is

1 per 100,000 high school athletes and 4 per 100,000

college athletes (Mueller and Cantu, 2000).

• The combined fatality rate for direct and indirect
  injuries in high school is 0.40 for every 100,000 high
  school athletes and 1.42 for every 100,000 college
  participants (Mueller and Cantu, 2000).
  •Football is associated with the greatest number of cat-
  astrophic injuries for all major team sports.


• Pole vault, gymnastics, ice hockey, and football have
  the highest incidence of injury per 100,000 male par-
  ticipants (Mueller and Cantu, 2000).


• Cheerleading is associated with the highest number of
  direct catastrophic injuries for all female sports
  (Mueller and Cantu, 2000).

INDIRECT INJURIES

• Indirect or nontraumatic deaths in athletes have been
  identified to be predominantly caused by cardiovascu-
  lar conditions such as hypertrophic cardiomyopathy
  (HCM), cardiac artery anomalies, myocarditis, aortic
  stenosis, and dysrhythmias. The most common etiol-
  ogy of sudden cardiac death is HCM for those under
  age 35, and coronary artery disease for those over
  age 35. Noncardiac conditions that cause fatalities are
  heat illness and miscellaneous diagnoses such as
  rhabdomyolysis, status asthmaticus, and electrocution
  caused by lightning.

CARDIAC CONDITIONS

• Most young athletes who die suddenly have HCM.
  These athletes typically have prodromal symptoms
  such as presyncope or syncope with or without exer-
  cise prior to the fatal event. A systolic murmur is often

24 SECTION 1 • GENERAL CONSIDERATIONS IN SPORTS MEDICINE