An Epidemiologic Comparison of High School Sports Injuries Sustained in Practice and Competition

CONTEXT: More than 7 million US high school students play sports. OBJECTIVE: To compare practice and competition injury rates and patterns in 5 boys' sports (football, soccer, basketball, wrestling, and baseball) and 4 girls' sports (soccer, volleyball, basketball, and softball) during the 2005-2006 school year. DESIGN: Prospective injury surveillance study. SETTING: Injury data were collected from 100 nationally representative United States high schools via High School RIO (Reporting Information Online). PATIENTS OR OTHER PARTICIPANTS: Athletes from participating high schools injured while participating in a school-sanctioned practice or competition in one of the above sports. MAIN OUTCOME MEASURE(S): Practice and competition injury rates, body site, diagnosis, and severity. RESULTS: High school athletes participating in these 9 sports at participating schools sustained 4350 injuries during the 2005-2006 school year, which corresponds to an estimated 1 442 533 injuries nationally. The rate of injury per 1000 athlete-exposures was higher in competition (4.63) than in practice (1.69) (rate ratio RR = 2.73, 95% confidence interval CI = 2.58, 2.90). Of all sports, football had the highest competition (12.09) and practice (2.54) injury rates per 1000 athlete-exposures. Compared with injuries sustained during practice, higher proportions of competition injuries were head/face/neck injuries (proportion ratio PR = 1.61, 95% CI = 1.34, 1.94), particularly in boys' soccer (PR = 7.74, 95% CI = 2.53, 23.65) and girls' basketball (PR = 6.03, 95% CI = 2.39, 15.22). Competition injuries were more likely to be concussions (PR = 2.02, 95% CI = 1.56, 2.62), especially in boys' soccer (PR = 6.94, 95% CI = 2.01, 23.95) and girls' basketball (PR = 5.83, 95% CI = 2.06, 16.49). Higher proportions of competition injuries caused the athlete to miss more than 3 weeks of play (PR = 1.28, 95% CI = 1.08, 1.52), particularly in baseball (PR = 3.47, 95% CI = 1.48, 8.11) and volleyball (PR = 2.88, 95% CI = 1.01, 8.24). CONCLUSIONS: Rates and patterns of high school sport injuries differed between practice and competition. Providing athletic trainers with this information is a crucial step in developing the targeted, evidence-based interventions required to effectively reduce injury rates among the millions of high school student-athletes.