title: Tackling causes and costs of ED presentation for American football injuries: a population-level study.
abstract: BACKGROUND
  American tackle football is the most popular high-energy impact sport in the United States, with approximately 9 million participants competing annually. Previous epidemiologic studies of football-related injuries have generally focused on specific geographic areas or pediatric age groups. Our study sought to examine patient characteristics and outcomes, including hospital charges, among athletes presenting for emergency department (ED) treatment of football-related injury across all age groups in a large nationally representative data set.
  
  
  METHODS
  Patients presenting for ED treatment of injuries sustained playing American tackle football (identified using International Classification of Diseases, Ninth Revision, Clinical Modification code E007.0) from 2010 to 2011 were studied in the Nationwide Emergency Department Sample. Patient-specific injuries were identified using the primary International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code and categorized by type and anatomical region. Standard descriptive methods examined patient demographics, diagnosis categories, and ED and inpatient outcomes and charges.
  
  
  RESULTS
  During the study period 397363 football players presented for ED treatment, 95.8% of whom were male. Sprains/strains (25.6%), limb fractures (20.7%), and head injuries (including traumatic brain injury; 17.5%) represented the most presenting injuries. Overall, 97.9% of patients underwent routine ED discharge with 1.1% admitted directly and fewer than 11 patients in the 2-year study period dying prior to discharge. The proportion of admitted patients who required surgical interventions was 15.7%, of which 89.9% were orthopedic, 4.7% neurologic, and 2.6% abdominal. Among individuals admitted to inpatient care, mean hospital length of stay was 2.4days (95% confidence interval, 2.2-2.6) and 95.6% underwent routine discharge home. The mean total charge for all patients was $1941 (95% confidence interval, $1890-$1992) with substantial injury type-specific variability. Overall, at the US population, estimated total charges of $771299862 were incurred over the 2-year period.
  
  
  CONCLUSIONS
  In this nationally representative sample, most ED-treated injuries associated with football were not acutely life threatening and very few required major therapeutic intervention. This study provides a cross-sectional overview of ED presentation for acute football-related injury across age groups at the population level in recent years. Longitudinal studies may be warranted to examine associations between the patterns of injury observed in this study and long-term outcomes among American tackle football players.
authors.affiliation: Rush University Medical College, Chicago, IL; Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Blair J
authors.initials: BJ
authors.lastname: Smart
authors.affiliation: Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: R Sterling
authors.initials: RS
authors.lastname: Haring
authors.affiliation: Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Anthony O
authors.initials: AO
authors.lastname: Asemota
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: John W
authors.initials: JW
authors.lastname: Scott
authors.affiliation: Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Canner
authors.affiliation: Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Besma J
authors.initials: BJ
authors.lastname: Nejim
authors.affiliation: Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD; Department of Neurology, University of Rochester, Rochester, NY.
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: George
authors.affiliation: Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Hatim
authors.initials: H
authors.lastname: Alsulaim
authors.affiliation: Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Kirsch
authors.affiliation: Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: eschneider3@partners.org.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D002648:Child; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D005538:Football / Q000293:injuries*; D017722:Hospital Charges; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D014481:United States; D055815:Young Adult