Systematic Review of Traumatic Brain Injuries in Baseball and Softball: A Framework for Prevention

Abstract

BackgroundTraumatic brain injuries (TBIs) are an important public health challenge. The classification of baseball and softball as low contact sports and their association with extremity injuries cause individuals to overlook the risk of TBI in baseball and softball.PurposeTo summarize our knowledge of the epidemiology and risk factors of TBIs associated with baseball and softball with an aim to better design and implement preventive strategies.MethodsA search algorithm containing keywords that were synonymous to the terms “TBI,” “baseball” was applied to the following nine databases: MEDLINE, Scopus, PubMed, EMBASE, CINAHL, Healthstar, PsychINFO, AMED, Cochrane library. Cited reference lists of identified articles were also consulted yielding a total of eighty-eight articles for full review. The search was concluded on November 14, 2016. The level of evidence was evaluated according to the guidelines from Strengthening the Reporting of Observational Studies in Epidemiology statement.ResultsTwenty-nine articles published between 2000 and 2016 met the criteria for analysis. Collectively, they examined the years 1982–2015 and identified 242,731 baseball-and softball-related TBIs. The most explored outcome of TBI was concussion. The average injury rate per 1,000 athletic exposures was 0.13 (range 0.03–0.46). The most common mechanism of injury was being struck by bat for younger players and being struck by ball for older athletes (adolescent and beyond). Rates of TBI were on average 4.17 times greater in games compared to practices. Females were on average 2.04 times more likely to sustain a TBI than males. Severity of TBIs varied considerably from mild and returning to the field on the same day, to immediate death. Generally, there is poor compliance with helmet use and return-to-play post-concussion guidelines. An increase TBI rates was observed over time. Multifaceted preventive strategies must be implemented to reduce the frequency and burden of these injuries.ConclusionIt is difficult to compare the epidemiologic trends of TBI in baseball and softball due critical differences in the methods employed across the studies. Additional research is needed to provide a greater understanding of baseball- and softball-related TBI and to aid in the development of prevention and management modules.

Baseball-Related Craniofacial Injury Among the Youth: A National Electronic Injury Surveillance System Database Study

“…The majority of the current literature focuses on the importance of protective equipment to prevent concussions. [11][12][13] For example, 1 study stated that head protective gears have decreased sports-related head injuries, whereas their protective effects on concussions are less clear. 4 However, we found that traumatic facial injuries such as facial contusions, lacerations, and fractures, are more common than concussions amongst youth baseball players.…”

“…The aim of this investigation is to examine the type and frequency of baseball-related craniofacial injuries among the pediatric baseball athletes. The majority of the current literature focuses on the importance of protective equipment to prevent concussions 11–13 . For example, 1 study stated that head protective gears have decreased sports-related head injuries, whereas their protective effects on concussions are less clear 4 .…”

Effectiveness of 2ndSkull Products in Reducing Head Impact in Simulated Sports

“…Consequences of impact to the front of the head have also been greatly discussed as the most frequent area of impact in many sports (Crisco et al, 2010; Comstock et al, 2014). For example, there are a considerable number of reports on projectile impact via a bat or ball to the front of the head in baseball and softball catchers (Beyer et al, 2012; Cusimano et al, 2017). This 2 nd Skull study showed reduced impact at the front of the head for both baseball by 44% and softball by 51%, which exhibits the promising effect of the 2 nd Skull caps in confronting this issue.…”

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“…Other sports that can involve head impact and can be related to TBI's are: ball games -basketball (Covassin et al, 2017), volleyball (Baugh et al, 2017), baseball and softball (Cusimano, Zhu, 2017), floorball (Pasanen et al, 2017), lacrosse (Barber Foss et al, 2017), hurling (O'Sullivan et al, 2017); contact sports -judo (Čierna et al, 2017), wrestling (Kroshus et al, 2017); othersgymnastics , horse racing (O'Connor et al, 2017).…”