Context Bone stress injury (BSI) is common in collegiate athletics. Injury rate and healthcare utilization is not well documented in running athletes. Objective The purpose of this study was to describe the rate, classification, and healthcare utilization in collegiate cross-country runners with BSI. Design Descriptive Epidemiology Study Setting Sports medicine facilities participating in the PAC-12 Health Analytics Program. Patients or Other Participants Collegiate cross-country athletes. Main Outcome Measures Counts of injury and healthcare resources utilized for each injury. Injury rates were calculated based on athlete seasons. Results A total of 168 BSIs were reported over four seasons from 80 team season (M: 34, F: 46) and 1,220 athlete seasons, resulting in 1,764 AT services and 117 physician encounters. BSIs represented 20% of all injuries reported by cross-country athletes. The average bone stress injury rate was 0.14 per athlete season. Injury rates were higher in female athletes (0.16) compared to males (0.10) and rates were higher in the 2019–2020 season (0.20) compared to the 2020–21(0.14), 2018–2019 (0.12) and 2021–2022 (0.10) seasons. A majority of BSI's occurred in the lower leg (23.8%) and the foot (23.8%). Most injuries were classified as overuse and time-loss (73%) and accounted for the majority of AT services (75%) and physician encounters (73%). On average, there were 10.89 AT services per overuse-TL injury and 12.20 AT service per overuse-NTL injury. Mean occurrence was lower for physician encounters (0.70), prescription medications (0.04), tests (0.75), procedures (0.01), and surgery (0.02) compared to AT services. Conclusions BSIs are common in collegiate cross- country runners and require considerable athletic training resources. Athletic trainers should be appropriately staffed for this population and suspected BSIs should b e confirmed with medical diagnosis. Future investigations should track treatment codes associated with BSI to determine best-practice patterns.
Context: Health care utilization and the occurrence of non-time-loss (NTL) lateral ankle sprains is not well documented in collegiate athletes but could provide better estimates of injury burden and inform clinician workload. Design: Descriptive epidemiologic study. Methods: Lateral ankle sprain injury occurrence for Division I collegiate student-athletes in a conference with 32 sports representing 732 team seasons was collected during the 2018–2019 through 2020–2021 academic years. Injuries were designated as acute or overuse, and time-loss (TL) or NTL. Associated health care utilization, including athletic training services (AT services), and physician encounters were reported along with anatomical structures involved and season of occurrence. Results: A total of 1242 lateral ankle sprains were reported over the 3 years from 732 team seasons and 17,431 player seasons, resulting in 12,728 AT services and 370 physician encounters. Most lateral ankle sprains were acute-TL (59.7%), which were associated with the majority of AT services (74.1%) and physician encounters (70.0%). Acute-NTL sprains represented 37.8% of lateral ankle sprains and were associated with 22.3% of AT services and 27.0% of physician encounters. On average, there were 12.7 (5.8) AT services per acute-TL sprain and 6.0 (3.6) per acute-NTL sprain. Most sprains involved “ankle lateral ligaments” (45.6%), and very few were attributed to overuse mechanisms (2.4%). Conclusions: Lateral ligament sprains are a common injury across many sports and result in substantial health care utilization from ATs and physicians, including NTL lateral ankle sprains. Although TL injuries were the majority of sprains, a substantial proportion of sprains were NTL and accounted for a considerable proportion of health care utilization.
Bone stress injuries (BSI) occur frequently in runners and females. However, their occurrence in other sports, time-lost (TL) status, and associated healthcare utilization is unclear. PURPOSE: To describe bone stress injuries and associated healthcare utilization in a population of collegiate student athletes. METHODS: A descriptive epidemiology design utilizing de-identified electronic medical records from all sponsoring institutions in one NCAA conference was used. Injury occurrences were collected from August 2017 -March 2020, representing 810 team-seasons (351 men's and 459 women's). Injuries were identified by onset (acute or overuse) and stratified as TL or non-timeloss (NTL). Lower extremity injury location and injury type were identified. Associated healthcare utilization, including athletic training services (ATS) provided, and injuries resulting in one or more physician encounters (PE), prescribed medication, diagnostic test, procedure, or surgery were determined. Mean BSI per team per season were calculated. RESULTS: A total of 501 BSI were captured, representing 2.5% of all injuries/illnesses in the time period (n=20080). The majority (n=341, 68.1%) were in women's teams. Overuse-NTL BSI comprised 13.8% of the sample (n=69). The foot was the most frequent location (n=164, 68.3%). Women's track and field (n=106, 21.2%, 2.9) and women's cross country (n=86, 17.2%, 2.4) reported the highest occurrence of BSI by sport and highest occurrence per team per season. BSI necessitated 13907 ATS, and 462 BSI required PE, resulting in medications prescribed in 54, tests in 458, procedures in 8, and surgeries in 74 cases. Of ATS, 65% (n=9056) were for overuse injuries, with women utilizing 77.7% (n=7037) of them. CONCLUSIONS: Women experienced the majority of BSI, concentrated in running sports. Most BSI in men and women were designated as overuse and resulted in TL, but almost 14% were managed as overuse-NTL. BSI required substantial AT and physician services, and prevention may be possible with data-driven programs. This project was supported by the Pac-12 Conference's Student-Athlete Health and Well-Being Initiative.
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