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The sport and leisure industry is one of the fastest growing sectors of the business market. It has been estimated that each year 1–1.5 million people attend accident and emergency (A&E) departments in Britain,1 and 3.7 million people present to emergency departments in the USA,2 with an injury related to sport and exercise. With these levels of presentation A&E departments can provide valuable research into the demographics of sports related injuries.
There are numerous studies regarding the incidence of sports injuries within a community or defined population, however, there is little modern research investigating specifically the nature of sports injuries presenting to an A&E department in Britain.3–6 Other studies have been published from Ireland,7,8 Europe,9–11 Australasia,12,13 Asia,14 and more recently North America.2,15
This observational study aimed to determine the incidence of attendance, types of injuries, nature of the sport involved, and the arrangements for follow up management in patients presenting, with an injury related to sport, to the A&E department of Crosshouse Hospital, Kilmarnock.
The study took place prospectively over a period of three months from February to April 1999 and included people 16 years of age or over. Any patient presenting with an injury attributable to participation in organised sport or recreational activity had their details and A&E number noted by the triage nurse on duty. Only new attendances were included. Relevant A&E cards were analysed retrospectively by hand. Demographic trends for each patient were recorded:
Incidence of attendance
During the study period overall attendance, excluding children, was 10 172. Of these, 273 cases (2.7%) were classified as sports injuries. Men attended more frequently than women by a ratio of about 9:1. There were only 30 female cases.
Ages of both male and female patients were classified into decades. In both sexes attendance peaked in the 16–20 age category followed by a steady decline in progressing years (fig 1)
In total 29 different sports were represented. Football was the most common sport by a substantial margin (table 1).
Types of injuries
Soft tissue injuries (STI) dominated (70%) (fig 2). Injuries to the lower limb accounted for 60% of all injuries. The upper limb, head and neck, and trunk were responsible for 25%, 10%, and 4% respectively (tables 2–4). Ankle sprains were the most common injury (19%).
Most patients were discharged with instructions to attend their general practitioner (GP) if complications occurred (67%). Altogether 25% were referred to hospital based outpatient clinics (fracture, A&E soft tissue, hand, ENT, and ophthalmology). Five per cent were referred directly to physiotherapy and 3% admitted to hospital (fracture manipulation or observation after head injury) (fig 3).
About 50 000 new patients attend Crosshouse Hospital A&E department a year. Sports injuries accounted for 2.7% of attendances. A&E departments manage patients with acute injuries from sport and this value possibly represents the “tip of the iceberg” of sport related injuries. Limiting the study to three months may introduce a seasonal variation. A year long study would reflect the true representation of overall sports injuries attendance.
The incidence of presentation is lower than other studies where values ranged from 3.6%–8.3%. Difficulties exist when comparing the incidence in these dissimilar studies. In some, children were included.5,8 Study periods varied from one week15 to one year.3,7,8,11,13,14 There is also the problem of comparing values between countries where different healthcare mechanisms exist. In all studies most injuries occur in the under 30 years’ age group irrespective of country of origin. More men present with injuries than women. In this study the male: female ratio was 9:1. Other studies from abroad have a far greater female attendance.11,15
Football was the most common sport implicated in injuries (65%). There was little difference in the other sports represented. Football had a high representation in all studies. National sporting variations, for example, hurling (Ireland),7 ice hockey (Finland),9,10 skiing (Norway),11 and rugby union (New Zealand)12 are present. Contact sports will result in a higher chance of injury. Football, a contact sport, will result in injury. The high incidence of injury in football reflects the mass national participation in this sport within this country from a recreational level to organised leagues.
Injuries to the soft tissues are the commonest diagnosis in all studies. Injuries to the lower limb and specifically the ankle are most frequently represented; a fact supported by this study. With lower limb injuries widespread, aspects of injury prevention must be considered. Shin guards are often worn by all level of footballers and injuries to the tibia are uncommon. However, ankle injuries and knee injuries can lead to significant long term morbidity. Currently there are no ankle or knee braces specifically designed to prevent injury and development in this area is required.
Most patients (67%) received no hospital outpatient follow up, either discharged directly from the department or referred to their GP if complications arose. This may suggest that a significant proportion of injuries were of a minor nature and could be managed in the first instance at primary care level or with first aid measures at the scene. Despite the direct availability of the physiotherapy department only 5% of patients were referred. Not all sports injuries require physiotherapy. However, physiotherapy does perform an integral role in the rehabilitation of soft tissue injuries.
A significant proportion (25%) of patients was referred to outpatient clinics, mainly fracture and A&E soft tissue. This figure is comparable to other studies. This is a comparatively large group of patients and the benefits of a separate sports injury clinic to deal with A&E referrals and possibly community based referrals merits consideration. Conversely, on the basis of this study, this equates to less than 30 new patients a month, which would be challenged on the evidence of cost effectiveness.
This study may have some limitations in that only three months of data are included and relied upon inclusion of patients by the triage nurse. Future research involving sports injuries and the A&E interface require a longer study period producing a greater sample size and include the time of presentation after injury, the treatment performed, reviewing the injuries referred to the GP, and any complications after injury.
Sports injuries present only a minor increase in the workload of an A&E department. This may increase in the future with expansion in leisure time and sporting facilities available to the general public. Patients presenting to an A&E department with a sports injury will typically be male and under the age of 30 years. Football is the most common sport implicated in injury. The lower limb is the most frequently injured area and ankle sprains the most common single injury. Most sports injuries presenting seem to be of a minor nature and could possibly be managed with first aid measures by parents, teachers, and coaches at the scene or by attending primary care.