http://informahealthcare.com/bij ISSN: 0269-9052 (print), 1362-301X (electronic) Brain Inj, Early Online: 1–4 ! 2015 Informa UK Ltd. DOI: 10.3109/02699052.2015.1033014 ORIGINAL ARTICLE Trends in incidence and severity of sports-related traumatic brain injury (TBI) in the emergency department, 2006–2011 R. Sterling Haring 1,2,3 , Joseph K. Canner 3 , Anthony O. Asemota 3,4 , Benjamin P. George 3,5 , Shalini Selvarajah 3 , Adil H. Haider 6 , & Eric B. Schneider 3 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA, 3 Center for Surgical Trials and Outcomes Research (CSTOR), 4 Department of Neurology and Neurosurgery, Johns Hopkins University, Baltimore, MD, USA, 5 University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA, and 6 Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA Abstract Objective: To characterize and identify trends in sports-related traumatic brain injury (TBI) emergency department (ED) visits from 2006–2011. Methods: This study reviewed data on sports-related TBI among individuals under age 65 from the Nationwide Emergency Department Sample from 2006–2011. Visits were stratified by age, sex, injury severity, payer status and other criteria. Variations in incidence and severity were examined both between groups and over time. Odds of inpatient admission were calculated using regression modelling. Results: Over the period examined, 489 572 sports-related TBI ED visits were reported. The majority (62.2%) of these visits occurred among males under the age of 18. The average head Abbreviated Injury Severity score among these individuals was 1.93 (95% CI ¼ 1.93–1.94) and tended to be lowest among those in middle school and high school age groups; these were also less likely to be admitted. The absolute annual number of visits grew 65.9% from 2006 until 2011, with the majority of this growth occurring among children under age 15. Hospitalization rates dropped 35.6% over the same period. Conclusion: Changes in year-over-year presentation rates vs. hospitalization rates among young athletes suggest that players, coaches and parents may be more aware of sports-related TBI and have developed lower thresholds for seeking medical attention. Keywords Emergency department, epidemiology, sport, TBI History Received 10 November 2014 Revised 30 January 2015 Accepted 19 March 2015 Published online 12 May 2015 Introduction Background The Centers for Disease Control and Prevention (CDC) [1] estimates that traumatic brain injury (TBI) affects over 2.5 million individuals annually. Sports have been recognized as playing a significant role in the incidence of TBI in recent years and, in response, 43 states and the District of Columbia have instituted so-called ‘Return-to-play’ laws establishing guidelines for the prevention and treatment of TBI among school-aged participants in multiple sports [2]. These legis- lative efforts, combined with campaigns by the CDC in conjunction with the National Football League (NFL), the National Collegiate Athletic Association (NCAA), the National Federation of State High School Associations (NFHS) and others, have been targeted primarily at young athletes, their coaches and families [3,4]. In addition to instituting policies regarding the signs, symptoms and evidence-based treatment of sports-related TBI, these campaigns have sought to raise awareness of concussion and TBI, along with possible short- and long-term changes associated with TBI. The NCAA has implemented and publicized football rules prescribing harsh consequences for helmet-to-helmet contact and establishing a mandatory one-down break for players who lose their helmets in play; indeed, the focus on TBI prevention has been nearly impossible to miss among those with even a passing interest in sports [5]. The impact TBI awareness campaigns, return-to-play laws and other regulations are having on the incidence and treatment of TBI among athletes has yet to be determined. Importance The purpose of the introduction of new rules and training campaigns is to increase knowledge of the potential severity and consequences of sustaining a TBI while participating in sports. Increased awareness may precipitate increased util- ization of safety measures and, at the same time, may lead to higher rates of injury reporting and follow-up. Research is needed to examine possible changes in sports-related TBI presentation and treatment in US emergency departments (ED) over time. Correspondence: R. Sterling Haring, MPH, 600 N. Wolfe St., Blalock 618, Baltimore, MD 21287, USA. Tel: 239-287-0142. Fax: 410-955- 8101. E-mail: sharing1@jhu.edu Brain Inj Downloaded from informahealthcare.com by 50.246.243.185 on 05/12/15 For personal use only.