Emergency Department Visits for Sports- and Recreation-Related Traumatic Brain Injuries Among Children — United States, 2010–2016

Kelly Sarmiento, MPH; Karen E. Thomas, MPH; Jill Daugherty, PhD; Dana Waltzman, PhD; Juliet K. Haarbauer-Krupa, PhD; Alexis B. Peterson, PhD; Tadesse Haileyesus, MS; Matthew J. Breiding, PhD


Morbidity and Mortality Weekly Report. 2019;68(10):237-242. 

In This Article

Abstract and Introduction


Traumatic brain injuries (TBIs), including concussions, are at the forefront of public concern about athletic injuries sustained by children. Caused by an impact to the head or body, a TBI can lead to emotional, physiologic, and cognitive sequelae in children.[1] Physiologic factors (such as a child's developing nervous system and thinner cranial bones) might place children at increased risk for TBI.[2,3] A previous study demonstrated that 70% of emergency department (ED) visits for sports- and recreation-related TBIs (SRR-TBIs) were among children.[4] Because surveillance data can help develop prevention efforts, CDC analyzed data from the National Electronic Injury Surveillance System–All Injury Program (NEISS-AIP)* by examining SRR-TBI ED visits during 2010–2016. An average of 283,000 children aged <18 years sought care in EDs each year for SRR-TBIs, with overall rates leveling off in recent years. The highest rates were among males and children aged 10–14 and 15–17 years. TBIs sustained in contact sports accounted for approximately 45% of all SRR-TBI ED visits. Activities associated with the highest number of ED visits were football, bicycling, basketball, playground activities, and soccer. Limiting player-to-player contact and rule changes that reduce risk for collisions are critical to preventing TBI in contact and limited-contact sports. If a TBI does occur, effective diagnosis and management can promote positive health outcomes among children.

NEISS-AIP is operated by the U.S. Consumer Product Safety Commission and contains data on initial visits for all injuries in patients treated in U.S. hospital EDs. NEISS-AIP data are drawn from a nationally representative subsample of 66 of 100 NEISS hospitals that were selected as a stratified probability sample of hospitals in the United States and its territories; each hospital has a minimum of six beds and a 24-hour ED.[5] NEISS-AIP provides data on approximately 500,000 injury-related visits each year.

For this analysis, SRR-TBIs included those TBIs among children aged <18 years that occurred during organized and unorganized SRR activities. Each case was classified into mutually exclusive SRR categories based on an algorithm that uses the consumer products involved and the description of the incident from the medical record. Persons with injuries were classified as having a TBI if the primary body part injured was the head and the principal diagnosis was concussion or internal organ injury. Type of activity (i.e., contact sport, limited-contact sport, noncontact sport, or recreation) was determined based on classifications from previous studies. SRR-TBI cases were excluded if the injury was violence-related or if the person was dead on arrival or died in the ED. Methodology for coding and classifying data matched that of a previously published report.[6] The Joinpoint Regression Program (version 4.2.0; National Cancer Institute) was used to test time trends.

The overall rate of SRR-TBI ED visits did not change significantly from 2010 (354.7 visits per 100,000 children) to 2016 (371.0); however, there were differences by sex (Table 1). Throughout the study period, the number and rate of SRR-TBI ED visits by males were higher than were those among females. The rate of SRR-TBI ED visits in males significantly increased from 2010 (486.6) to 2012 (559.1) and significantly decreased from 2012 to 2016 (482.7). However, the rate in females significantly increased from 216.5 per 100,000 children in 2010 to 254.3 in 2016. During all 7 years, children aged 10–14 and 15–17 years had higher rates of ED visits than did children in all younger age groups.

From 2010 to 2016, contact sports were associated with a higher number of TBI-related ED visits by males (99,784) than were limited contact sports (29,080), noncontact sports (44,848), and recreational activities (20,628) (Table 2). Among females, contact sports (27,180) and limited contact sports (27,343) contributed to a similar number of SRR-TBI-related ED visits. Football contributed to more ED visits (52,088) among males than did any other sport. Soccer (11,670) and playground activities (11,255) contributed to more TBI-related ED visits among females than did all other activities.

SRR-activities associated with the highest percentage of ED visits varied by age group and sex (Table 3). Football was associated with 26.8% of all SRR-TBI ED visits for males aged 0–17 years. Among males aged <5 years and 5–9 years, playground activities accounted for the most ED visits (38.2% and 19.6%, respectively). Among all females aged 0–17 years, soccer, playground activities, and basketball were the most common causes of SRR-TBI ED visits, contributing to 13.1%, 12.6%, and 11.9% of all SRR-TBI-related ED visits, respectively. Playground activities led to 42.3% of SRR-TBIs visits among females aged <5 years.