PEDIATRICS Vol. 121 No. 6 June 2008, pp. 1181-1187 (doi:10.1542/peds.2007-2572)
ARTICLE |
Epidemiological Features of High School Baseball Injuries in the United States, 2005–2007
a Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
b Department of Pediatrics, College of Medicine
c Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio
 |
ABSTRACT |
|---|
 TOP ABSTRACT METHODSRESULTSDISCUSSIONREFERENCES |
|---|
OBJECTIVES. The goals were to calculate injury rates among high school baseball players and to characterize the general epidemiological features of high school baseball injuries and, more specifically, injuries attributed to being hit by a batted ball.
METHODS. We analyzed baseball exposure and injury data collected over the 2005–2006 and 2006–2007 school years from a nationally representative sample of 100 US high schools by using an injury surveillance system, Reporting Information Online.
RESULTS. Nationally, an estimated 131555 high school baseball-related injuries occurred during the 2005–2006 and 2006–2007 academic years, for an injury rate of 1.26 injuries per 1000 athletic exposures. The most commonly injured body sites were the shoulder (17.6%), ankle (13.6%), head/face (12.3%), hand/finger (8.5%), and thigh/upper leg (8.2%). The most common injury diagnoses were ligament sprains (incomplete tears) (21.0%), muscle strains (incomplete tears) (20.1%), contusions (16.1%), and fractures (14.2%). Although the majority of injuries resulted in a time loss of <7 days, 9.7% resulted in medical disqualification for the season, and 9.4% required surgery. Of the 431 reported baseball injuries, 50 (11.6%) were attributed to being hit by a batted ball. Greater proportions of injuries attributed to being hit by a batted ball were to the head/face (48.0%) and mouth/teeth (16.0%), compared with injuries not attributed to being hit by a batted ball (8.2% and 1.3%, respectively). A greater proportion of injuries attributed to being hit by a batted ball required surgery (18.0%), compared with other baseball-related injuries (6.8%).
CONCLUSIONS. Although high school baseball is relatively safe, targeted, evidence-based interventions could reduce the rate of high school baseball-related injuries. On the basis of our findings, we strongly recommend that helmets with face shields or at least mouth guards and eye protection be used by pitchers, infielders, and batters at the high school level.
Key Words: baseball • injury • high school • sports
Abbreviations: RIO—Reporting Information Online • ATC—certified athletic trainer • RR—rate ratio • IPR—injury proportion ratio • CI—confidence interval
More than one half of all high school students in the United States participated in athletics during the 2005–2006 academic year.1 Baseball, one of the most popular US high school sports among male students, had >470600 participants during 2005–2006, an increase of nearly 11000 players from the previous year.1 Being active in sports is one way for adolescents to maintain a physically fit, healthy lifestyle. However, sports participation also places athletes at an inherent risk of injury. As participation in high school baseball continues to increase, so will the incidence of baseball-related injuries.
Multiple studies have examined pediatric baseball-related injuries; however, many of those studies focused on injuries to specific body sites,2–6 diagnoses,7–9 or player positions.3,5 Several other studies examined injuries to youth or youth players10–14 and catastrophic injuries sustained in various sports, including baseball.15–17 The largest, most comprehensive study of high school baseball-related injuries was conducted 10 years ago.18 That study found that baseball had a relatively low rate of injury, compared with other high school sports, but also had the largest proportion of fractures and the second largest proportion of injuries that resulted in a time loss of >7 days.18
There has been controversy about the performance standards of baseball bats used by high school athletes, specifically the comparative batted-ball speeds (ie, the speed at which a baseball comes off the bat) of metal and wooden bats.19–21 Some research on injuries resulting from being hit by a batted ball, including catastrophic injuries, has been conducted with youth and collegiate athletes.11,12,22–25 However, no previous research has investigated the epidemiological features of injuries resulting from being hit by a batted ball among high school baseball players.26
The objective of this study was to describe the epidemiological features of high school baseball-related injuries. The specific aims were (1) to calculate rates of injury among high school baseball players during the 2005–2006 and 2006–2007 academic years, (2) to characterize the general epidemiological features of high school baseball injuries, and, (3) more specifically, to characterize the epidemiological features of high school baseball injuries that were attributed to being hit by a batted ball.
|
METHODS |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
|---|
Reporting Information Online (RIO), an Internet-based surveillance system, was used to capture injuries sustained by US high school baseball players during the 2005–2006 and 2006–2007 academic years. The RIO system is closely modeled after the National Collegiate Athletic Association Injury Surveillance System, which has successfully collected quality data on injuries, athletic exposures, and risk factors since 1982 and has been used to develop preventive interventions that have had proven success in reducing injuries among collegiate athletes.27 The RIO, Internet-based, injury surveillance system has been used successfully in several other projects, including studies of US high school rugby-related injuries, other types of US high school sports-related injuries, and illnesses and injuries among campers and staff members at US summer camps.6,28–31
All US high schools with a Board of Certification-certified and National Athletic Trainers' Association-affiliated certified athletic trainer (ATC) with a valid email address (n = 4120 in 2005–2006 and n = 3378 in 2006–2007) were invited to participate in the National High School Sports-Related Injury Surveillance Study. Schools interested in participating (n = 425 in 2005–2006 and n = 316 in 2006–2007) were placed in 1 of 8 sampling strata according to the US Census geographic location of the high school (Northeast, Midwest, South, or West)32 and enrollment size (<1000 or 
1000 students). Schools were randomly selected from each stratum, to obtain a nationally representative study sample of 100 high schools each year. If a school dropped out of the study, then another school from the same stratum was randomly selected for replacement, to maintain the representativeness of the study sample. For calculation of national estimates of the number of injuries, each reported injury was assigned a sample weight based on the inverse of the probability of the school's selection for the study (based on the total number of US high schools in each of the 8 sampling strata).
ATCs at participating high schools reported baseball-related athletic exposures and injury and injury event information weekly throughout the 2005–2006 and 2006–2007 academic years. An athletic exposure was defined as one athlete participating in one practice or competition. A reportable injury was defined as 1 that (1) occurred as a result of an organized high school athletic practice or competition, (2) required medical attention from a team athletic trainer or a physician, and (3) resulted in restriction of the athlete's participation for 1 day beyond the day of injury. For each injury, the ATC completed a detailed report that described characteristics of the injured baseball player (eg, age, weight, and year in school), the injury itself (eg, body site, diagnosis, and severity), and the circumstances leading to the injury (eg, general mechanism, specific activity, and specific mechanism, including an answer option for being hit by a batted ball). Throughout the study, ATCs were able to view all of the data they had submitted and to update reports as needed (eg, need for surgery and number of days until to return to play).
Data were analyzed by using SPSS 14.0 (SPSS, Chicago, IL) and Epi Info 6.0 (Centers for Disease Control and Prevention, Atlanta, GA) software. All rate calculations and analyses for injuries attributed to being hit by a batted ball used unweighted case counts (ie, the absolute numbers of reported injuries and injuries attributed to being hit by a batted ball). Additional high school baseball-related injury analyses used national estimates, with SEs adjusted for the high school RIO sampling plan by using the SPSS complex samples module. Rate ratios (RRs) and injury proportion ratios (IPRs) were calculated as measures of the magnitude of associations. Statistical significance was assessed by using 95% confidence intervals (CIs), and P < .05 was considered significant. The following is an example of the RR calculation comparing the rate of competition baseball-related injuries to the rate of practice baseball-related injuries: RR = [(no. of unweighted competition baseball-related injuries/no. of competition athletic exposures) x 1000]/[(no. of unweighted practice baseball-related injuries/no. of practice athletic exposures) x 1000]. The following is an example of the IPR calculation comparing the proportion of head/face injuries among batters and infielders: IPR = (national estimated no. of head/face injuries sustained by batters/national estimated no. of total injuries sustained by batters)/(national estimated no. of head/face injuries sustained by infielders/national estimated no. of total injuries sustained by infielders). This study was approved by the institutional review board at Nationwide Children's Hospital.
|
RESULTS |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
|---|
General Characteristics of High School Baseball Injuries
During the 2005–2006 and 2006–2007 school years, high school baseball players sustained 431 injuries during 341883 athletic exposures, for an injury rate of 1.26 injuries per 1000 athletic exposures. The rate of injury was higher in competition (1.89 injuries per 1000 athlete-competitions) than in practice (0.85 injuries per 1000 athlete-practices; RR: 2.22; 95% CI: 1.83–2.70; P < .001). The reported 431 injuries reflect an estimate of 131555 baseball-related injuries that occurred nationally during the 2005–2006 and 2006–2007 seasons.
Among all baseball injuries, the most commonly injured body sites were the shoulder (17.6%), ankle (13.6%), head/face (12.3%), hand/finger (8.5%), and thigh/upper leg (8.2%) (Table 1). In addition, 3.3% of all injuries were to the mouth/teeth. The most common injury diagnoses were ligament sprains (incomplete tears) (21.0%), muscle strains (incomplete tears) (20.1%), contusions (16.1%), and fractures (14.2%) (Table 1). Although 3.5% of all injuries were concussions, the most common diagnoses among head/face injuries (n = 16161 nationally) were concussions (28.7%), fractures (28.7%), and contusions (20.0%). The body sites most commonly fractured were the hand/finger (30.5%), head/face (26.0%), and ankle (14.4%). The majority (89.4%) of injuries were new injuries, rather than recurrences.
|
The most common mechanisms of baseball-related injuries were contact with playing apparatus (eg, ball, bat, or base; 31.8%), no contact (eg, pulled muscle or overuse; 30.4%), and contact with the playing surface (16.2%). More specifically, the most common activities that resulted in injury were fielding (21.6%), running bases (14.4%), and pitching (13.2%). Although the majority (50.3%) of injuries resulted in a time loss of <7 days, 6.7% of all baseball-related injuries resulted in a time loss of >21 days, and an additional 9.7% resulted in medical disqualification for the season (Table 1). In addition, 9.4% of all baseball-related injuries required surgery. The most common diagnoses for injuries that resulted in medical disqualification for the season were fractures (47.6%) and ligament sprains (complete tears) (16.8%). Similarly, the most common diagnoses for injuries that required surgery were fractures (38.9%) and ligament sprains (complete tears) (16.4%).
Of the players injured, 30.2% were infielders (first base, second base, third base, or shortstop), 22.2% were outfielders (left, center, or right field), 20.0% were pitchers, 10.5% were catchers, 8.8% were base runners, 5.7% were batters, and 0.4% were players not on the field (eg, on deck or in the dugout); the player position was other/unknown in 2.2% of injuries. The shoulder was the most commonly injured body part among pitchers, catchers, and outfielders (Table 2). There were no statistically significant differences in the proportions of head/face injuries sustained by batters, outfielders, infielders, pitchers, and catchers. Base runners sustained a greater proportion of ankle injuries (29.3%) than did catchers (8.7%; IPR: 3.51; 95% CI: 1.02–12.09; P = .03) and pitchers (7.5%; IPR: 3.91; 95% CI: 1.55–9.87; P = .002).
|
The most common diagnoses for each player position were muscle strains (incomplete tears), ligament sprains (incomplete tears), and/or contusions (Table 2). There were similar proportions of concussions sustained by various player positions, as well as similar proportions of fractures sustained by pitchers, batters, infielders, base runners, and outfielders. Infielders (17.7%; IPR: 6.28; 95% CI: 1.74–22.71; P < .001), batters (16.2%; IPR: 5.75; 95% CI: 1.29–25.71; P = .01), outfielders (14.9%; IPR: 5.29; 95% CI: 1.42–19.66; P = .004), and pitchers (11.3%; IPR: 4.03; 95% CI: 1.05–15.49; P = .026) sustained greater proportions of fractures than did catchers (2.8%). Outfielders, pitchers, and base runners sustained the greatest proportions of injuries that resulted in a time loss of >21 days or medical disqualification for the season (Table 2). With regard to mechanism, 60.8% of injuries to batters were related to contact with a playing apparatus (eg, ball or bat), and 60.3% of injuries to pitchers were related to no contact (eg, overuse or chronic injury) (Table 2).
High School Baseball Injuries Attributed to Being Hit by a Batted Ball
Fifty (11.6%) of the 431 baseball injuries were attributed to being hit by a batted ball. The body parts most commonly injured when hit by a batted ball were the head/face (48.0%), mouth/teeth (16.0%), and hand/finger (12.0%) (Fig 1). A greater proportion of injuries to the head/face were attributed to being hit by a batted ball (48.0%), compared with those not attributed to being hit by a batted ball (8.2%; IPR: 5.90; 95% CI: 3.78–9.20; P < .001). Similarly, a greater proportion of injuries to the mouth/teeth were attributed to being hit by a batted ball (16.0%), compared with those not attributed to being hit by a batted ball (1.3%; IPR: 12.19; 95% CI: 4.15–35.82; P < .001). Conversely, greater proportions of shoulder (17.3%) and ankle (16.0%) injuries were not attributed to being hit by a batted ball, compared with those attributed to being hit by a batted ball (0.0% and 0.0%, respectively; P < .01 for both). The most common diagnoses for injuries attributed to being hit by a batted ball were contusions (44.0%), fractures (22.0%), lacerations (10.0%), and concussions (8.0%) (Fig 2). A greater proportion of injuries attributed to being hit by a batted ball were contusions (44.0%), compared with injuries not related to being hit by a batted ball (14.4%; IPR: 3.05; 95% CI: 2.05–4.53; P < .001). In addition, although the finding was not statistically significant, a greater proportion of injuries attributed to being hit by a batted ball were fractures (22.0%), compared with other baseball-related injuries (13.6%; P = .08). A greater proportion of injuries attributed to being hit by a batted ball were concussions (8.0%), compared with injuries not attributed to being hit by a batted ball (2.9%), although again this difference was not statistically significant (P = .17).
|
|
Although the majority (62.0%) of injuries attributed to being hit by a batted ball resulted in a time loss of <1 week, 4.0% resulted in a time loss of >21 days and 12.0% (all of which were fractures) resulted in medical disqualification for the season. Injuries attributed to being hit by a batted ball and other baseball-related injuries were similar with respect to time loss. However, a greater proportion of baseball-related injuries attributed to being hit by a batted ball required surgery (18.0%), compared with injuries not attributed to being hit by a batted ball (6.8%; IPR: 2.64; 95% CI: 1.31–5.30; P = .012). Of the 9 injuries related to being hit by a batted ball that required surgery, 5 were dental injuries, 3 were facial fractures, and 1 was an eye laceration. The use of protective equipment was reported for only 2 of the injuries attributed to being hit by a batted ball and included only a batting helmet and a protective cup. The type of bat used (eg, metal or wood) was reported for only 28.0% of injuries that were attributed to being hit by a batted ball, and all of those involved metal bats.
With regard to playing position, 23.2% of all injuries that occurred during pitching and 26.6% of all injuries that occurred during fielding were attributed to being hit by a batted ball. Overall, 50.0% of injuries attributed to being hit by a batted ball were sustained during fielding, 26.0% during pitching, 16.0% during batting, and 6.0% during catching (by the catcher); 2.0% were sustained while players were not on the field (eg, on deck or in the dugout). The greatest proportions of such injuries that occurred during fielding, batting, and pitching were to the head/face (56.0%, 50.0%, and 38.5%, respectively).
|
DISCUSSION |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
|---|
Compared with other high school sports, high school baseball is relatively safe.29,30,33 However, efforts to make the sport even safer to play for the nearly 500000 US athletes who participate in high school baseball could reduce injury rates significantly. Previous studies showed that youth baseball, among all youth sports in the United States, results in the most sports-related facial injuries requiring medical attention, severe eye injuries,34–37 and dental injuries.34,38,39 With monitoring of patterns of injury and identification of specific risk factors, the rates of baseball-related injuries could be reduced through targeted, evidence-based interventions.
This study seems to be the most comprehensive study of high school baseball-related injuries in the past 10 years and the first to examine all injuries attributed to being hit by a batted ball at the high school level. We found an overall baseball injury rate of 1.26 injuries per 1000 athletic exposures. Although it is often difficult to compare injury rates across studies because of differences in injury definitions and exposure units, previous studies of high school baseball-related injuries reported injury rates of 1.5 injuries per 1000 athletes to 2.8 injuries per 1000 athletic exposures.18,33,40,41 Consistent with the largest, most recent study of baseball injuries, conducted by Powell and Barber-Foss,18 we found that the most commonly injured body sites were the shoulder, ankle, hand/finger, and thigh/upper leg. However, we found a greater proportion of injuries to the head/face (12.3%), compared with that (1.9%) in the study by Powell and Barber-Foss.18 In addition, we found greater proportions of fractures (14.2%) and injuries that required surgery (9.4%), compared with values (8.8% and 3.5%, respectively) in the study by Powell and Barber-Foss.18 Although the overall rate of high school baseball-related injuries seems to have decreased in the past 10 years, it seems that the severity of injuries has increased. Potential explanations may include increased intensity of competition and increased size and strength of players, allowing them to throw faster, to hit harder, and to create greater forces during player-to-player contact. Alternatively, ATCs may be able to identify and to treat less-severe injuries more quickly, before time loss actually occurs, with head/face injuries, fractures, and injuries that require surgery accounting for greater proportions of overall injuries now than 10 years ago. In addition, overuse injuries may be more common because a growing number of high school baseball players participate in baseball throughout the year. Future research is needed for more complete understanding of the observed differences.
Previous research found that 20% of all youth injuries were related to being hit by a batted ball,12 which is higher than the 11.6% of all high school baseball-related injuries we identified as being attributable to being hit by a batted ball. Although batted balls might have increased velocity at the high school level because of increased batter strength or size, which would increase risk, players at the high school level also might have better reaction times, coordination, and/or playing skills, which should decrease risk. Youth baseball is played on a smaller field than high school baseball, which might result in increased risk of being hit by a batted ball because of the closer proximity of the pitcher, infielders, and base runners to the batter. The only research performed at the collegiate level regarding injuries that resulted from being hit by a batted ball found that 3% of all reported competition-related injuries were injuries to pitchers who were hit by a batted ball.25 Similarly, in our study, 4.0% of all injuries that occurred during a competition were injuries to pitchers who were hit by a batted ball. More research is needed to investigate differences in injuries attributed to being hit by a batted ball at various levels of baseball, including the type and properties of the bat being used.
We also found that the pitcher is not the only position at risk for being injured when hit by a batted ball. More than one fourth of all high school baseball injuries that occurred during fielding were attributed to being hit by a batted ball, which is consistent with findings at the youth level.12 In addition, more than one half of the injuries attributed to being hit by a batted ball during fielding and batting were to the head/face. Previous research found that face guards could reduce the risk of facial and dental injuries in youth baseball, particularly during batting.14,42 Although both eye protection and face protection have been available for more than a decade, they are commonly not worn in baseball, especially at the high school level.43 However, the use of face guards among batters is becoming more accepted in lower levels of youth baseball.8,14 Unfortunately, despite the availability and apparent success in the prevention of head/face and dental injuries, this protective equipment does not seem to be widely accepted at the high school level.
Like all studies, this study had limitations. Although schools were selected to be nationally representative with respect to geographic location and school size, only schools with a National Athletic Trainers' Association-affiliated ATC were eligible to participate. Therefore, our results may not be generalizable to all schools in the United States. However, we think that this potential limitation was outweighed by the quality of data provided by these medically trained professionals. Only injuries that came to the attention of the ATC and resulted in 1 day of time loss were included in the study; therefore, it is possible that we actually underestimated the rate of baseball-related injuries. However, this was necessary to reduce the time burden placed on the participating ATCs. In addition, there is a relative lack of clinical importance of non–time loss injuries. Another potential limitation was the definition of an athletic exposure as 1 athlete's participation in a practice or competition. Although there is a current movement to use a more-quantitative, time-based unit of athletic exposure, such as minutes or hours,44 it was not feasible for the reporters, that is, high school ATCs, to be present at all athletic practices and competitions to collect such detailed exposure data. Furthermore, we argue that all athletes are at risk for injury during every practice and competition in which they participate. Finally, although we used a weighting factor to estimate national numbers of all baseball-related injuries, we did not apply the weighting factor to injuries that were attributed to being hit by a batted ball, because of the issue of stability of estimates derived by applying weighting factors to small actual counts.
On the basis of our findings that players in all positions are at risk of head/face and dental injuries when hit by a batted ball, the proportion of injuries attributable to being hit by a batted ball that require surgery, and previous research on the effectiveness of eye protection, face shields, and mouth guards,14,42 we recommend strongly that helmets with face shields or at least mouth guards and eye protection be used by pitchers, infielders, and batters at the high school level. Additional research is needed (1) to investigate why face shields and/or mouth guards currently are not being commonly used at the high school level, (2) to use the findings of such research to develop effective education programs for players, parents, and coaches, to promote the use of these pieces of protective equipment, and (3) to evaluate the effectiveness of such educational interventions.
|
ACKNOWLEDGMENTS |
|---|
This research was funded in part by the Centers for Disease Control and Prevention (grant R49/CEOOO674-01). The content of this report is solely the responsibility of the authors and does not necessarily represent the official view of the CDC.
|
FOOTNOTES |
|---|
Accepted Oct 11, 2007.
Address correspondence to Christy L. Collins, MA, Center for Injury Research and Policy, Research Institute at Nationwide Children's Hospital, Columbus, OH 43205. E-mail: christy.collins{at}nationwidechildrens.org
The contents of this report are solely the responsibility of the authors and do not necessarily represent the official view of the Centers for Disease Control and Prevention.
The authors have indicated they have no financial relationships relevant to this article to disclose.
| What's Known on This Subject Although some research has been performed at the youth and collegiate levels, no previous research investigated the epidemiological features of injuries resulting from being hit by a batted ball among high school baseball players.
|
| What This Study Adds This study seems to be the most comprehensive study of high school baseball-related injuries in the past 10 years and the first to examine all injuries attributed to being hit by a batted ball at the high school level.
|
|
REFERENCES |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
|---|
1. National Federation of State High School Associations. 2005–06 high school athletics participation summary. Available at: www.nfhs.org/core/contentmanager/uploads/2005_06NFHSparticipationsurvey.pdf. Accessed August 15, 2007
2. Lyman S, Fleisig GS, Waterbor JW, et al. Longitudinal study of elbow and shoulder pain in youth baseball pitchers. Med Sci Sports Exerc. 2001;33 (11):1803 –1810[CrossRef][Web of Science][Medline]
3. Lyman S, Fleisig GS, Andrews JR, Osinski ED. Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers.
Am J Sports Med. 2002;30
(4):463
–468
4. Hale CJ. Little Leaguer's shoulder: a report of 23 cases.
Am J Sports Med. 1999;27
(2):269
5. Olsen SJ, Fleisig GS, Dun S, Loftice J, Andrews JR. Risk factors for shoulder and elbow injuries in adolescent baseball pitchers.
Am J Sports Med. 2006;34
(6):905
–912
6. Fernandez WG, Yard EE, Comstock RD. Epidemiology of lower extremity injuries among US high school athletes. Acad Emerg Med. 2007;14 (7):641 –645[CrossRef][Web of Science][Medline]
7. Hennigan SP, Bush-Joseph CA, Kuo KN, Back BR Jr. Throwing-induced humeral shaft fracture in skeletally immature adolescents. Orthopedics. 1999;22 (6):621 –622[Medline]
8. Powell JW, Barber-Foss KD. Traumatic brain injury in high school athletes.
JAMA. 1999;282
(10):958
–963
9. Nassab PF, Schickendantz MS. Evaluation and treatment of medial ulnar collateral ligament injuries in the throwing athlete. Sports Med Arthrosc. 2006;14 (4):221 –231[CrossRef][Medline]
10. Hale CJ. Injuries among 771810 Little League baseball players. J Sports Med Phys Fitness. 1961;1 :80 –83
11. Pasternack JS, Veenema KR, Callahan CM. Baseball injuries: a Little League survey.
Pediatrics. 2001;107
(4):782
–784
12. Mueller FO, Marshall SW, Kirby DP. Injuries in Little League baseball from 1987 through 1996. Phys Sportsmed. 2001;29 (7):41 –48[Web of Science]
13. Radelet MA, Lephart SM, Rubinstein EN, Myers JB. Survey of the injury rate for children in community sports. Pediatrics. 2002;110 (3). Available at: www.pediatrics.org/cgi/content/full/110/3/e28
14. Marshall SW, Mueller FO, Kirby DP, Yang J. Evaluation of safety balls and faceguards for prevention of injuries in youth baseball.
JAMA. 2003;289
(5):568
–574
15. Mueller FO. Catastrophic head injuries in high school and collegiate sports. J Athl Train. 2001;36 (3):312 –315[Web of Science][Medline]
16. Luckstead EF, Patel DR. Catastrophic pediatric sports injuries. Pediatr Clin North Am. 2002;49 (3):581 –591[CrossRef][Web of Science][Medline]
17. Boden BP, Tacchetti R, Mueller FO. Catastrophic injuries in high school and college baseball players.
Am J Sports Med. 2004;32
(5):1189
–1196
18. Powell JW, Barber-Foss KD. Sex-related injury patterns among selected high school sports.
Am J Sports Med. 2000;28
(3):385
–391
19. Greenwald RM, Penna LH, Crisco JJ. Differences in batted-ball speed with wood and aluminum baseball bats: a batting cage study. J Appl Biomech. 2001;17 (3):241 –252[Web of Science]
20. Nicholls RL, Elliott BC, Miller K. Bat design and ball exit velocity in baseball: implications for player safety. In: Ackland T, Goodman C, eds. 2001: A Sports Medicine Odyssey: Challenges, Controversies and Change: Australian Conference of Science and Medicine in Sport. Canberra, Australia: Sports Medicine Australia; 2001
21. Crisco JJ, Greenwald RM, Blume JD, Penna LH. Batting performance of wood and metal baseball bats. Med Sci Sports Exerc. 2002;34 (10):1675 –1684[Web of Science][Medline]
22. Viano DC, Andrzejak DV, King AI. Fatal chest injury by baseball impact in children: a brief review. Clin J Sports Med. 1992;2 :161 –165
23. Adler P, Monticone RC Jr. Injuries and deaths related to baseball (children ages 5 to 14). In: Kyle S, ed. Youth Baseball Protective Equipment: Final Report. Washington, DC: US Consumer Product Safety Commission; 1996:1 –43
24. van Amerongen R, Rosen M, Winnik G, Horwitz J. Ventricular fibrillation following blunt chest trauma from a baseball. Pediatr Emerg Care. 1997;13 (2):107 –110[CrossRef][Web of Science][Medline]
25. Dick RW. A discussion of the baseball bat issue related to injury from a batted ball. NCAA News. 1999;12 :4
26. Nicholls RL, Elliott BC, Miller K. Impact injuries in baseball: prevalence, aetiology, and the role of equipment performance. Sports Med. 2004;34 (1):17 –25[CrossRef][Web of Science][Medline]
27. National Collegiate Athletic Association. National Collegiate Athletic Association Injury Surveillance System. Available at: www.ncaa.org/iss.html. Accessed August 21, 2007
28. Collins CL, Micheli LJ, Yard EE, Comstock RD. Injuries sustained by high school rugby players in the United States, 2005–2006.
Arch Pediatr Adolesc Med. 2008;162
(1):49
–54
29. Centers for Disease Control and Prevention. Sports-related injuries among high school athletes: United States, 2005–06 school year. MMWR Morb Mortal Wkly Rep. 2006;55 (38):1037 –1040[Medline]
30. Shankar PR, Fields SK, Collins CL, Dick RW, Comstock RD. Epidemiology of high school and collegiate football injuries in the United States, 2005–2006.
Am J Sports Med. 2007;35
(8):1295
–1303
31. Yard EE, Scanlin MM, Ebner Erceg L, et al. Illness and injury among children attending summer camp in the United States, 2005. Pediatrics. 2006;118 (5). Available at: www.pediatrics.org/cgi/content/full/118/5/e1342
32. US Census Bureau. Census regions of the United States. Available at: www.census.gov/const/regionmap.pdf. Accessed August 20, 2007
33. Powell JW, Barber-Foss KD. Injury patterns in selected high school sports: a review of the 1995–1997 seasons. J Athl Train. 1999;34 (3):277 –284[Web of Science][Medline]
34. Rutherford GW, Miles RB, Brown VR, McDonald B. Overview of Sports-Related Injuries to Persons 5–14 Years of Age. Washington, DC: US Consumer Product Safety Commission; 1981
35. Kyle SB, ed. Youth Baseball Protective Equipment Project: Final Report. Washington, DC: US Consumer Product Safety Commission; 1996
36. US Consumer Product Safety Commission. National Injury Information Clearinghouse. Washington, DC: US Consumer Product Safety Commission;1994 –1996
37. Larrison WI, Hersh PS, Kunzweiler T, Shingleton BJ. Sports-related ocular trauma. Ophthalmology. 1990;97 (10):1265 –1269[Web of Science][Medline]
38. Crow RW. Diagnosis and management of sports-related injuries to the face. Dent Clin North Am. 1991;35 (4):719 –732[Medline]
39. Tanaka N, Hayashi S, Amagasa T, Kohama G. Maxillofacial fractures sustained during sports. J Oral Maxillofac Surg. 1996;54 (6):715 –719[CrossRef][Web of Science][Medline]
40. McLain LG, Reynolds S. Sports injuries in high school.
Pediatrics. 1989;84
(3):446
–450
41. DuRant RH, Pendergrast RA, Seymore C, Gaillard G, Donner J. Findings from the preparticipation athletic examination and athletic injuries.
Am J Dis Child. 1992;146
(1):85
–91
42. Danis RP, Hu K, Bell M. Acceptability of baseball face guards and reduction of oculofacial injury in receptive youth league players.
Inj Prev. 2000;6
(3):232
–234
43. Vinger PF, Duma SM, Crandall J. Baseball hardness as a risk factor for eye injuries.
Arch Ophthalmol. 1999;117
(3):354
–358
44. Fuller CW, Ekstrand J, Junge A, et al. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Clin J Sport Med. 2006;16 (2):97 –106[CrossRef][Web of Science][Medline]
PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  D. M. Swenson, E. E. Yard, S. K. Fields, and R. D. Comstock Patterns of Recurrent Injuries Among US High School Athletes, 2005-2008 Am. J. Sports Med., August 1, 2009; 37(8): 1586 - 1593. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. W. Coen High School Baseball Injuries Pediatrics, December 1, 2008; 122(6): 1418 - 1418. [Full Text] [PDF]
|
|
|
|
|
|
R. D. Comstock and C. L. Collins High School Baseball Injuries: In Reply Pediatrics, November 1, 2008; 122(5): 1160 - 1161. [Full Text] [PDF]
|
|
|
|
|
|
R. W. Coen High School Baseball Injuries Pediatrics, November 1, 2008; 122(5): 1159 - 1160. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
