What is the clinical evidence from this study?

Study design: Observational. Population: Football-related injuries (n=40249). Intervention: College-aged athletes vs. High school-aged athletes. Primary outcome: Incidence of football-related ED visits per 100 at-risk participants (IRR 1.78, 95% CI 1.77-1.78).

What does this research mean for the field?

College-aged football athletes experience a significantly higher incidence of emergency department-evaluated injuries across nearly all injury types and anatomical locations compared to high school-aged athletes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To compare the incidence and characteristics of football-related injuries between high school and college athletes in the US.

May 23, 2026Open Access

Comparison of Football-Related Injuries at US Emergency Departments Between High School and Collegiate Athletes: A 10-Year NEISS Analysis, 2015-2024

Key Result

College-aged male football athletes had a significantly higher incidence of football-related ED visits compared to high school-aged athletes (21.34 vs 12.02 per 100 at-risk persons; IRR 1.78).

Key Points

To compare the incidence and characteristics of football-related injuries between high school and college athletes in the US.
Analyzed football-related injuries from the National Electronic Injury Surveillance System (NEISS) from 2015 to 2024.
Specifically focused on male athletes aged 14-23 years, assessing injury types, locations, and ED dispositions.
Calculated incidence rates and incidence rate ratios (IRRs) with 95% confidence intervals to compare injuries between athlete groups.
1,377,935 weighted national estimate of ED visits for football-related injuries between ages 14-23.
College-aged athletes had a significantly higher incidence of injuries at 21.34 per 100 at-risk persons compared to 12.02 for high school athletes (IRR, 1.78 [95% CI, 1.77-1.78]).
Higher rates of specific injuries including laceration (IRR, 4.35), dislocation (IRR, 3.44), and mouth injuries (IRR, 5.34) among college athletes.

Study Design

Type

Observational (n=40,249)

Multicenter

Yes

Structured PICO

Does the incidence and pattern of football-related ED visits differ between college-aged and high school-aged male athletes?

Population

Male high school-aged (14-18 years) and college-aged (19-23 years) athletes with football-related injuries evaluated in US emergency departments from 2015 to 2024 (n=40,249 unweighted cases, weighted national estimate 1,377,935).

Intervention

College-aged (19-23 years) level of play

Comparator

High school-aged (14-18 years) level of play

Outcome

Incidence of football-related ED visits per 100 at-risk participants

College-aged football players have a significantly higher incidence of ED visits for football-related injuries compared to high school-aged players, particularly for head and upper-extremity injuries.

Main Result

Effect estimate: IRR 1.78 (95% CI 1.77-1.78)

Absolute Event Rate: 21.34% vs 12.02%

Abstract

Background: Contemporary, sport-specific comparisons of injury patterns and epidemiological trends between high school- and college-aged football athletes are limited and dated, particularly from a single, nationally representative data set. Purpose: To provide an updated, comparative assessment of the epidemiology of football-related injuries among male high school- and college-aged athletes and to characterize the burden of these injuries on emergency departments (EDs) across the United States (US). Study Design: Descriptive epidemiology study. Methods: The National Electronic Injury Surveillance System (NEISS) was queried for football-related injuries among high school-aged (14-18 years) and college-aged (19-23 years) male athletes from 2015 to 2024. Injury characteristics, anatomic location, diagnosis, and ED disposition were analyzed. Annual National Federation of State High School Associations and National Collegiate Athletic Association participation counts defined at-risk populations. The incidence was calculated as ED visits per 100 at-risk participants, and incidence rate ratios (IRRs) with 95% CIs were used to compare levels of play. Results: Among 40,249 unweighted NEISS cases, the weighted national estimate was 1,377,935 football-related ED visits among male athletes aged 14 to 23 years during 2015 and 2024. College-aged athletes were significantly more likely than high school-aged athletes to be evaluated with football-related injuries (21.34 vs 12.02 per 100 at-risk persons; IRR, 1.78 95% CI, 1.77-1.78). The head, shoulders, knees, and fingers were most frequently involved. College-aged athletes had higher rates across most diagnosis categories—including laceration (IRR, 4.35 95% CI, 4.26-4.45), dislocation (IRR, 3.44; 95% CI, 3.38-3.50), and nerve damage (IRR, 2.23 95% CI, 1.97-2.53). Injuries to the mouth (IRR, 5.34 95% CI, 5.11-5.57) and face (IRR, 4.55 95% CI, 4.45-4.66) were disproportionately higher in college-aged athletes. Most visits resulted in treatment and discharge, but admissions and observations were more frequent among college-aged athletes. Conclusion: Among football-related injuries evaluated in US EDs from 2015 to 2024, the incidence was higher in college-aged than high school-aged athletes, with a concentration in head and upper-extremity presentations. Collegiate players sustained higher rates across nearly all injury types and locations, emphasizing the need for targeted prevention and clinical vigilance at advanced levels of play.