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Epidemiology of Chest, Rib, Thoracic Spine, and Abdomen Injuries Among United States High School Athletes, 2005/06 to 2013/14

Johnson, Bernadette K. MD*,†; Comstock, R. Dawn PhD‡,§

Clinical Journal of Sport Medicine: July 2017 - Volume 27 - Issue 4 - p 388–393
doi: 10.1097/JSM.0000000000000351
Original Research

Objective: Describe chest and abdominal injury epidemiology among US high school athletes.

Design: Retrospective analysis of longitudinal surveillance data.

Setting: Injury data from 2005/06 to 2013/14 academic years were collected using an internet-based surveillance system.

Participants: A large sample of US high schools.

Assessment of Risk Factors: Injuries sustained as a function of sport.

Main Outcome Measures: Chest, rib, thoracic spine, and abdominal injuries sustained during high school athletic events.

Results: Overall 1487 chest, rib, thoracic spine, and abdominal injuries occurred during 30 415 179 athletic exposures (AEs); an injury rate of 4.9 injuries per 100 000 AEs. Over half (56.8%) of injured athletes were evaluated by another medical provider in addition to the athletic trainer, and 34 injuries (2.3%) required surgery. Diagnostic techniques, including x-ray, magnetic resonance imaging or computed tomography were used in 729 (49.0%) injuries. The injury rate was higher in boys' (6.8) than girls' (2.0) sports [rate ratio (RR), 3.43; 95% CI, 3.04-4.10]. Football (47.7%) accounted for the highest proportion of injuries followed by wrestling (18.5%), boys' soccer (4.6%), and girls' soccer (3.7%). The rate of injury was higher in competition than practice, (RR, 2.86; 95% CI, 2.59-3.23). Only 57.7% of injured athletes were able to return to play within 1 week.

Conclusions: Chest and abdominal injuries in high school sports although relatively rare, can result in loss of playing time and frequently prompt medical evaluation. Thus, they present a physical and economic burden. To optimize prevention, further studies can focus on subgroup risk factor identification to drive development of targeted prevention strategies.

*Children's Hospital Colorado, Aurora, Colorado;

Section of Emergency Medicine, Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado;

Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado; and

§Pediatric Injury Prevention, Education, and Research (PIPER) Program, Aurora, Colorado.

Corresponding Author: Bernadette Johnson, MD, 13123 E 16th Ave, Box B251, Aurora, CO 80045 (

The content of this report provided by the High School RIO surveillance System was funded in part by the Centers for Disease Control and Prevention (grant No. R49/CE000674-01 and R49/CE001172-01).

Presented at the Pediatric Academic Societies Annual Meeting; May 5, 2014; BC, Vancouver.

The authors report no conflicts of interest.

D. Comstock collected the data for this study. D. Comstock and B. Johnson designed the methodology, analyzed the data and wrote the article. D. Comstock had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control and Prevention. The author responsible for High School RIO, RDC, also acknowledges the generous research funding contributions of the NFHS, NOCSAE, DonJoy Orthotics, and EyeBlack. An additional acknowledgment goes to the hundreds of certified athletic trainers who have reported data to High School RIO—without their dedication this data set would not exist.

Received July 07, 2015

Accepted March 11, 2016

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.