Overuse injuries in college and high school populations: occurrence and methodological issues in surveillance

Roos, Karen

Overuse injuries in college and high school populations: occurrence and methodological issues in surveillance

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March 19, 2019

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Roos, Karen
- Affiliation: Gillings School of Global Public Health, Department of Epidemiology

Abstract

Overuse injuries are difficult to define, can have long term effects and are underrepresented in the literature. This dissertation aimed to 1) compare the incidence of overuse injuries between college and high school athletes, 2) compare how overuse injuries are captured in injury surveillance to medical records, and 3) describe variation between clinicians in the assessment of the role of overuse and the assignment of an overuse mechanism of injury to hypothetical injury scenarios. Overuse injury rates and rate ratios calculated from data from the National Collegiate Athletic Association's (NCAA) Injury Surveillance System (ISS) and the High School RIO (Reporting Information Online) indicate that overuse injuries occurred three times more often in college than high school athletes (IRR: 3.28, 95% CI: 3.12, 3.44) and more often in female than male athletes (IRR: 1.55 95% CI: 1.43, 1.68) (Aim 1). A capture-recapture analysis of ISS and medical records for college mens and womens soccer injuries demonstrated that the ISS captured 63.7% (95% CI: 52.8%, 74.5%) of total overuse injuries (Aim 2). A survey which presented hypothetical injury scenarios was conducted among athletic trainers (ATs), the data collectors for injury surveillance (Aim 3). All but one scenario generated some degree of discordance among respondents regarding the role of overuse in the scenario and the probability of reporting an overuse mechanism of injury to surveillance. ATs also reported that nearly 50% of total treated injuries were overuse, and of those, only 62% were reported to surveillance. In summary, the findings demonstrate that overuse injuries comprise a significant proportion of injuries, specifically to college and female athletes (Aim 1). However, overuse injuries can be difficult to assess, which likely contributes to underreporting (Aim 2) and variability (Aim 3) in the reporting of these injuries. Based on these results, it is recommended a consensus definition for overuse injuries be created and adopted, with the goal of improving the capture of overuse injuries in surveillance systems. Improved capture will result in a more complete understanding of the incidence of overuse injuries and may lead to effective and targeted interventions to prevent these debilitating injuries.

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