title: Adding Injury to Insult: A National Analysis of Combat Sport-Related Facial Injury.
abstract: OBJECTIVE
  To estimate the incidence of patients presenting to emergency departments (EDs) for facial trauma sustained from participation in combat sports and evaluate injury patterns and patient demographics.
  
  
  METHODS
  The National Electronic Injury Surveillance System (NEISS) was evaluated for facial injuries from wrestling, boxing, and martial arts leading to ED visits from 2008 to 2013. Relevant entries were examined for injury mechanism, location, type, as well as other patient characteristics.
  
  
  RESULTS
  There were 1143 entries extrapolating to an estimated 42 395 ED visits from 2008 to 2013. Injury rates for boxing, marital arts, and wrestling were, respectively, 44, 56, and 120 injuries per 100 000 participants. Males comprised the majority (93.7%). A plurality of injuries involved lacerations (46.0%), followed by fractures (26.2%) and contusions/abrasions (19.3%). The proportion of fractures was highest among boxers (36.9%). Overall, the most common mechanisms of injury were punching, kicking, and head butting.
  
  
  CONCLUSIONS
  The significant number of ED visits resulted from combat sports facial trauma, reinforcing the importance of familiarity with injury patterns among practitioners managing facial trauma. As most injuries involve individuals younger than 19 despite guidelines suggesting children and adolescents avoid combat sports, these findings may be used for patient education and encouragement of the use of personal protective equipment. Furthermore, injury patterns reported in this analysis may serve as an adjunct for enhancing clinical history taking and physical examination.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA.
authors.forename: Houmehr
authors.initials: H
authors.lastname: Hojjat
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA psvider@gmail.com.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Svider
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA Section of Otolaryngology, Department of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan, USA.
authors.forename: Ho-Sheng
authors.initials: HS
authors.lastname: Lin
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Folbe
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA Section of Otolaryngology, Department of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan, USA Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA.
authors.forename: Mahdi A
authors.initials: MA
authors.lastname: Shkoukani
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey, USA.
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA Section of Otolaryngology, Department of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan, USA Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Zuliani
mesh_terms: D000293:Adolescent; D000328:Adult; D001914:Boxing / Q000293:injuries*; D003288:Contusions / Q000453:epidemiology*; D016208:Databases, Factual; D004636:Emergency Service, Hospital; D005147:Facial Bones / Q000293:injuries; D005151:Facial Injuries / Q000453:epidemiology*; D005260:Female; D006801:Humans; D022125:Lacerations / Q000453:epidemiology*; D008297:Male; D008337:Mandibular Fractures / Q000453:epidemiology; D016139:Martial Arts / Q000293:injuries*; D009295:Nasal Bone / Q000293:injuries; D009917:Orbital Fractures / Q000453:epidemiology; D017678:Sex Distribution; D012887:Skull Fractures / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014952:Wrestling / Q000293:injuries*; D055815:Young Adult
keywords: National Electronic Injury Surveillance System; boxing; combat sports; facial fracture; facial injury; facial trauma; martial arts; wrestling