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Trends in Sports- and Recreation-Related Traumatic Brain Injuries Treated in US Emergency Departments

The National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) 2001-2012

Coronado, Victor G. MD, MPH; Haileyesus, Tadesse MS; Cheng, Tabitha A. MD; Bell, Jeneita M. MD, MPH; Haarbauer-Krupa, Juliet PhD; Lionbarger, Michael R. MPH; Flores-Herrera, Javier MD, MPH; McGuire, Lisa C. PhD; Gilchrist, Julie MD

Section Editor(s): Bell, Jeneita M. MD, MPH; Taylor, Christopher A. PhD; Breiding, Matthew J. PhD

The Journal of Head Trauma Rehabilitation: May/June 2015 - Volume 30 - Issue 3 - p 185–197
doi: 10.1097/HTR.0000000000000156
Original Articles

Importance: Sports- and recreation-related traumatic brain injuries (SRR-TBIs) are a growing public health problem affecting persons of all ages in the United States.

Objective: To describe the trends of SRR-TBIs treated in US emergency departments (EDs) from 2001 to 2012 and to identify which sports and recreational activities and demographic groups are at higher risk for these injuries.

Design: Data on initial ED visits for an SRR-TBI from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) for 2001-2012 were analyzed.

Setting: NEISS-AIP data are drawn from a nationally representative sample of hospital-based EDs.

Participants: Cases of TBI were identified from approximately 500 000 annual initial visits for all causes and types of injuries treated in EDs captured by NEISS-AIP.

Main Outcome Measure(s): Numbers and rates by age group, sex, and year were estimated. Aggregated numbers and percentages by discharge disposition were produced.

Results: Approximately 3.42 million ED visits for an SRR-TBI occurred during 2001-2012. During this period, the rates of SRR-TBIs treated in US EDs significantly increased in both males and females regardless of age (all Ps < .001). For males, significant increases ranged from a low of 45.8% (ages 5-9) to a high of 139.8 % (ages 10-14), and for females, from 25.1% (ages 0-4) to 211.5% (ages 15-19) (all Ps < .001). Every year males had about twice the rates of SRR-TBIs than females. Approximately 70% of all SRR-TBIs were reported among persons aged 0 to 19 years. The largest number of SRR-TBIs among males occurred during bicycling, football, and basketball. Among females, the largest number of SRR-TBIs occurred during bicycling, playground activities, and horseback riding. Approximately 89% of males and 91% of females with an SRR-TBI were treated and released from EDs.

Conclusion and Relevance: The rates of ED-treated SRR-TBIs increased during 2001-2012, affecting mainly persons aged 0 to 19 years and males in all age groups. Increases began to appear in 2004 for females and 2006 for males. Activities associated with the largest number of TBIs varied by sex and age. Reasons for the reported increases in ED visits are unknown but may be associated with increased awareness of TBI through increased media exposure and from campaigns, such as the Centers for Disease Control and Prevention's Heads Up. Prevention efforts should be targeted by sports and recreational activity, age, and sex.

Division of Unintentional Injury Prevention (Drs Coronado, Cheng, Bell, Haarbauer-Krupa, and Gilchrist and Mr Lionbarger), Division of Analysis, Research Practice Integration (Mr Haileyesus), National Center for Injury Prevention and Control, and The CDC Experience Applied Epidemiology Fellowship, Division of Scientific Education and Professional Development (Dr Cheng), and Division of Nutrition Physical Activity, National Center for Chronic Disease Prevention and Health Promotion (Dr McGuire), Centers for Disease Control and Prevention, Atlanta, Georgia; and Medical Emergency Service of Madrid, SUMMA 112, Spanish Field Epidemiology Training Program, Epidemiology National Center, Madrid, Spain (Dr Flores-Herrera).

Corresponding Author: Victor G. Coronado, MD, MPH, Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4170 Buford Hwy NE, MS-F62, Atlanta, GA 30341 (

The Centers for Disease Control and Prevention (CDC) Experience is a 1-year fellowship in applied epidemiology at the CDC) made possible by a public/private partnership supported by a grant to the CDC Foundation from External Medical Affairs, Pfizer Inc.

The authors thank Tom Schroeder, Director, Division of Hazard and Injury Data Systems, and other staff of the US Consumer Product Safety Commission for providing high-quality National Electronic Injury Surveillance System-All Injury Program data for this study.

The findings and conclusion of this research are those of the authors and do not necessarily represent the official views of the US Department of Health and Human Services (DHHS) and the Centers for Disease Control and Prevention (CDC). The inclusion of individuals, programs, or organizations in this article does not constitute endorsement by the US federal government, DHHS, or CDC.

The authors declare no conflicts of interest.

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