title: Epidemiology of Exertional Heat Illnesses in Youth, High School, and College Football.
abstract: Data on exertional heat illness (EHI) in youth football are limited and have not been compared across competition levels.
  
  
  
  This study describes the epidemiology of EHI events in youth, high school (HS), and college football in the 2012-2014 seasons.
  
  
  
  One hundred and eighteen youth teams (players age 5-14 yr), 96 HS programs (~14-18 yr), and 34 college programs (~18-23 yr) participated. During games and practices, athletic trainers recorded EHI events and athlete exposures (AE), defined as one athlete participating in one game/practice. We calculated the number of reported EHI by time in season, game/practice, and need for emergency transportation. EHI rates, risk, included rate ratios (IRR), and risk ratios (RR) with 95% confidence intervals (CI) were calculated in 2015.
  
  
  
  EHI rates for youth, HS, and college football were 1.82, 0.57, and 1.67/10,000 AE, respectively. Rates were highest during the preseason (youth: 2.76; HS: 1.47; college: 3.66/10,000 AE). Game rates were higher than practice rates in youth (4.04 vs 1.22/10,000 AE; IRR = 3.31; 95% CI, 1.75-6.26) and college (4.42 vs 1.38/10,000 AE; IRR = 3.21; 95% CI, 2.00-5.16); the practice rate was higher than the game rate in HS (0.63 vs 0.27/10,000 AE; IRR = 2.33; 95% CI, 1.01-5.38). The EHI risk was higher in college (0.9%) than in youth (0.6%; RR = 1.59; 95% CI, 1.06-2.37) and HS (0.5%; RR = 2.01; 95% CI, 1.43-2.81). Common EHI events included heat cramps (youth: 15.8%; HS: 28.6%; college: 45.6%), heat exhaustion (youth: 42.1%; HS: 32.9%; college: 20.0%), and dehydration (youth: 31.6%; HS: 28.6%; college: 28.9%).
  
  
  
  EHI risk was low. Higher preseason football EHI rates across levels emphasize developing and continually modifying preseason heat acclimatization policies. Lower EHI rates in HS games and youth practices may be attributable to night events, suggesting the importance of modifying/canceling events based on environmental conditions.
authors.affiliation: 1Department of Exercise Science, University of South Carolina, Columbia, SC; 2Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN; 3Department of Kinesiology, University of Connecticut, Storrs, CT; and 4National Collegiate Athletic Association Sport Science Institute, Indianapolis, IN.
authors.forename: Susan W
authors.initials: SW
authors.lastname: Yeargin
authors.forename: Zachary Y
authors.initials: ZY
authors.lastname: Kerr
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Casa
authors.forename: Aristarque
authors.initials: A
authors.lastname: Djoko
authors.forename: Ross
authors.initials: R
authors.lastname: Hayden
authors.forename: John T
authors.initials: JT
authors.lastname: Parsons
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Dompier
mesh_terms: D000293:Adolescent; D056352:Athletes; D001265:Athletic Injuries; D002648:Child; D002675:Child, Preschool; D003681:Dehydration / Q000453:epidemiology*; D005538:Football; D018882:Heat Stress Disorders / Q000453:epidemiology*; D006358:Hot Temperature; D006801:Humans; D012574:Schools; D014481:United States; D014495:Universities; D055815:Young Adult; D000067009:Youth Sports