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Catastrophic Sports and Recreation Injuries in Ontario1986-1995

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Objectives• After this presentation, participants will:

– Understand the process of obtaining “comprehensive”* data on catastrophic injuries in sports

– Discuss the top 10 most injurious sports, from a neurotrauma perspective

– Know the major risk factors associated with neurotrauma in sports

– Be introduced to best practices in the prevention of neurotrauma in sports

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Understanding Injury Through Epidemiology

1. What?

2. How?

3. Where?

4. How often?

5. To whom?

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Method

• Data was gathered through prospective surveys sent to selected physicians and surgeons, or data coordinators at 11-13 regional Trauma Centres; Coroner’s System; media reports

• This study uses data from four study years: 1986, 1989, 1992, and 1995.

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Number of Individuals Sustaining Fatal or Non-Fatal Catastrophic Injuries

(1985-1989-1992-1995)

1986 1989 1992 1995 TOTAL %n n n n n

Survivors 443 286 342 452 1523 70.7%

Fatalities 87 210 226 108 631 29.3%

TOTAL 530 496 568 560 2154 100%

The annual rate of catastrophic injuries was 2154/4, or The annual rate of catastrophic injuries was 2154/4, or 539 per year539 per year

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1. What ?What do we mean by catastrophic*?

–Death –Lifelong disability

*includes all brain and spinal injuries (2154 cases or 539 per year of study)

Drowning (Fishing, swimming, boating)

Brain Injuries (bicycling, snowmobiling, ATVs)

Spinal Injuries (diving, snowmobiling, hockey)

Sudden Death (basketball, squash, badminton)

Chest Injuries (snowmobiling, bicycling)

Eye Injuries (hockey, baseball, racquet sports)

Facial Injuries (snow-mobiles, hockey,bicycling)

Limb Injuries (uncommon)

Types of Injuries

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2. How? Activities in which the injuries occurred

Incidence of Injury in Groups of Sports(1986, 1989.1992,1995)

525

426

350

289

12991 88

70 63 53 4325

0

100

200

300

400

500

600

Water Motor Winter Bicycling

MiscBaseball

Field Racquet

Play Floor

EquestrianHunting

Sports

# of Injuries

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Alcohol and Catastrophic Injury

0

10

20

30

40

50

60

% alcohol related

SnowmobileDivingFishingATV

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3. Where? Location of injury sites.

0

50

100

150

200

250

300

350

400

450

500

Location

Lakes/riversRoads/streetsOpen terrainPlaying fieldArenaPool

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Snowmobiling and Diving Locations

0102030405060708090

100

Snowmobiling Diving

Lake/riverOpen terrainstreets/roadsPools

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4. How Often? The frequency of the main types of injuries during the four study years

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Activity Injuries % Fatalities %

Water 525 24.4 334 52.9

Motor 426 19.8 146 23.1

Winter 350 16.3 13 2.1

Bicycling 289 13.4 67 10.6

Misc 129 6.0 33 5.2

Baseball 91 4.2 0 0

Field 88 4.1 3 0.5

Racquet 70 3.3 0 0

Play 63 2.9 8 1.3

Floor 53 2.5 2 0.3

Equestrian 43 2.0 10 1.6

Hunting 25 1.1 15 2.4

TOTAL 2152 100.0 631 100.0

Injuries and Fatalities by Group(1986, 1989, 1992, 1995)

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Water Sports Injuries and Fatalities

Activity Injuries % (all groups)

Fatalities %( all groups)

Water Sports

Canoe 27 1.3 27 4.3

Sail 8 0.4 7 1.1

Other boating

112 5.2 72 11.4

Diving 105 4.9 5 0.8

Fishing 126 5.9 117 18.5

Scuba diving

10 0.5 10 1.6

Swimming 100 4.6 86 13.6

Waterskiing 9 0.4 2 0.3

Other 28 1.3 8 1.3

TOTAL 525 24.4 334 52.2

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Motor Sports Injuries and Fatalities

Activity Injuries % (all groups)

Fatalities % (all groups)

Motor Sports

ATV 83 3.9 16 2.5

Snowmobile 290 13.5 120 19

Other 53 2.5 10 1.6

TOTAL 426 19.8 146 23.1

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Winter Sports Injuries and Fatalities

Activity Injuries % Fatalities %

Winter Sports

Hockey 190 8.8 2 0.3

Alpine skiing 65 3.0 5 0.8

Tobogganing 62 2.9 4 0.6

Other 33 1.5 2 0.3

TOTAL 350 16.3 13 2.1

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Catastrophic Injury RatesRisk to participants

RankRank ActivityActivity Catastrophic Catastrophic injury Rate*injury Rate*

No. of Catastrophic No. of Catastrophic Injuries Per 100,000 Injuries Per 100,000 Participants Per YearParticipants Per Year

1. Diving 0.570 570.0

2. Snowmobiling 0.088 88.2

3. Parachuting 0.060 62.9

4. Tobogganing 0.038 37.7

5. Hang Gliding 0.029 29.4

6. Water Polo 0.024 24.5

7. Equestrian 0.012 11.6

8. Scuba 0.012 12.2*Total Annual Catastrophic Injury Rate = Percentage of Participants *Total Annual Catastrophic Injury Rate = Percentage of Participants

Sustaining Catastrophic Injuries Per YearSustaining Catastrophic Injuries Per Year

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Catastrophic Injury RatesRisk to participants

RankRank ActivityActivity Catastrophic Catastrophic injury Rate*injury Rate*

No. of Catastrophic No. of Catastrophic Injuries Per 100,000 Injuries Per 100,000 Participants Per YearParticipants Per Year

9. Hunting 0.012 12.2

10. Fishing 0.011 11.0

11. Archery, Shooting

0.010 11.1

12. Rugby 0.008 7.8

13. Skateboarding 0.007 7.3

14. Football 0.007 7.1

15. Hockey-Ice 0.006 6.3

*Total Annual Catastrophic Injury Rate = Percentage of Participants *Total Annual Catastrophic Injury Rate = Percentage of Participants Sustaining Catastrophic Injuries Per YearSustaining Catastrophic Injuries Per Year

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Catastrophic Injury RatesRisk to participants

RankRank ActivityActivity Catastrophic Catastrophic injury Rate*injury Rate*

No. of Catastrophic No. of Catastrophic Injuries Per 100,000 Injuries Per 100,000 Participants Per YearParticipants Per Year

16. Wrestling 0.006 6.1

17. Boxing 0.006 5.7

18. Mountain Climbing

0.005 5.5

19. Racquetball 0.005 5.3

20. Snowboarding 0.005 4.9

21. Sailing 0.005 4.9

22. Kayaking, Canoeing

0.004 3.9

*Total Annual Catastrophic Injury Rate =Percentage of Participants *Total Annual Catastrophic Injury Rate =Percentage of Participants Sustaining Catastrophic Injuries Per YearSustaining Catastrophic Injuries Per Year

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Catastrophic Injury RatesRisk to participants

RankRank ActivityActivity Catastrophic Catastrophic injury Rate*injury Rate*

No. of Catastrophic No. of Catastrophic Injuries Per 100,000 Injuries Per 100,000 Participants Per YearParticipants Per Year

23. Skiing-Alpine 0.003 3.2

24. Squash 0.003 3.0

25. Badminton 0.003 3.0

26. Ball Hockey 0.002 2.4

27. Bicycling 0.002 2.4

*Total Annual Catastrophic Injury Rate =Percentage of Participants *Total Annual Catastrophic Injury Rate =Percentage of Participants Sustaining Catastrophic Injuries Per YearSustaining Catastrophic Injuries Per Year

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Head and Spine Injuries – Survivors and Fatalities 1985, 1989, 1992, and 1995

SPORTSPORT HeadHead SpineSpineAir Sports 2 4

ATV 36 18

Badminton 0 0

Ball Hockey 3 1

Baseball 23 2

Basketball 5 0

Bicycling 186 50

Boat-canoe 3 0

Boat-sail 0 0

Boat-other 15 15

Camp/Hike 5 1

Dirt Bike 10 7

Diving 8 96

Field Sports 3 0

SPORTSPORT HeadHead SpineSpineFishing 2 1

Floor Hockey 0 0

Floor Sports 3 1

Flying 2 0

Football 6 9

Golf 11 1

Hunting 6 1

In-line Skate 8 1

Jogging 3 1

Martial Arts 1 1

Miscellaneous 4 1

Missile 1 0

Motor Biking 8 7

Motor Sports 7 4

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Head and Spine Injuries – Survivors and Fatalities1985, 1989, 1992, and 1995

SPORTSPORT HeadHead SpineSpineMountain Climb 4 2

Parachuting 0 2

Pellet Guns 0 0

Playground/Play 27 9

Racquet Sports 0 0

Racquetball 0 1

Rugby 4 7

Scuba Diving 1 0

Seadoo/Jet Ski 3 1

Skateboarding 7 1

Skating 13 2

Skiing-Alpine 25 18

Skiing-Cross 0 2

Sledding 31 14

SPORTSPORT HeadHead SpineSpineSnowboarding 3 2

Snowmobile 97 74

Soccer 6 0

Squash 2 0

Swimming 2 7

Tennis 0 1

War Games 0 0

Water-Play 7 4

Waterskiing 2 2

Winter-other 1 0

Wrestling 1 3

TOTALTOTAL 640640 433433

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Brain and Spine Injury and Prevention

ATV Research under way

Bicycling “Wear it Right”, Give-a-kid-a-helmet, Helmet fitting clinics, lobbying

Diving “DiveSmart/Sudden Impact (Plongez Prudement/Impact Soudain)”

Alpine skiing “A little Respect/Observe, Relaxe, Respecte”

Sledding In talks with municipalities; Action Group for Injury Prevention - recommendations.

Snowmobiling Research under way

ACTIVITY ThinkFirst Initiatives

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5. Who? Age by Decade and Gender of Individuals Sustaining Fatal or Non-Fatal Catastrophic Injuries 1986-1989-1992-1995

Agen % n % n %

< 11 88 23.9% 188 10.7% 276 13.0%11-20 121 32.9% 552 31.4% 674 31.7%21-30 68 18.5% 431 24.5% 502 23.6%31-40 44 12.0% 264 15.0% 309 14.5%41-50 29 7.9% 166 9.5% 195 9.2%51-60 10 2.7% 80 4.6% 90 4.2%61-70 7 1.9% 49 2.8% 56 2.6%71-80 1 0.3% 20 1.1% 21 1.0%>80 0.0% 6 0.3% 6 0.3%

TOTALS 368 100.0% 1756 100.0% 2129 100.0%mean 22.1 years mean 26.8 yearsmedian 17.0 years median 23.0 yearsMissing info: 30

The annual rate of catastrophic injuries in females was 368/4=92 The annual rate of catastrophic injuries in males was 1756/4=439

Female Male Total

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83% 17%

5. Who?

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Gender differences in Injury

ATV n/a 8.2 : 1Bicycling No difference 3.6 : 1Diving 3: 1 7.75 : 1Alpine skiing No difference 3.1 : 1

Sledding No difference 2 : 1

Snowmobiling 2 : 1 6.25 : 1Fishing 4 : 1 29 : 1

ACTIVITY PARTICIPATION

MALE : FEMALE

INJURY RATE

MALE : FEMALE

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Best Practices…

…in sports injury prevention

• Prevention is the only cure!• Technological innovations, legislative interventions are most proven

• Context is key – sports are relatively autonomous fields

• Risk factors point to prevention approaches– What

– Where

– How often

– To whom

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ThinkFirst IP Programs

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Summary• Epidemiology answers many important questions

– what?, how?, where?, how often?, to whom?– Effective interventions are possible

• Missing info: Socio-cultural context of sports– What can be done? What should be done? How

can/should things be done?

• Interdisciplinarity is key- IP in sports involves changes in complex social and meaning systems

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thanks!