UCLA

Soccer-related injuries are a health and healthcare concern in the United States (U.S.), and while interest dates to 1994, injuries continue to be a health concern with increased participation. Consequently, to describe baseline characteristics for future comparisons, it is important to describe the breadth and scope of health and healthcare outcomes that are attributed to soccer (injuries) among visiting U.S. EDs, including hospitalization, cost, and length of stay, with special interest in patient-level and hospital-level features, as well as geographic region, population density, mechanism of injury, and place of injury effects on outcomes. Our aim was to determine features of soccer-related injuries amenable to injury prevention strategies to reduce cost and healthcare utilization across the US ED’s. We evaluated a weighted sample of 480,580 for child, adolescent and adult soccer-related injuries in U.S. EDs to address the following aims:

Aim 1 (First publication): Describe soccer-related concussions, intracranial injuries (ICI), and all-other soccer injuries. We also aimed to describe healthcare utilization, cost and length of hospital stay of soccer-related injuries. A third aim was to determine independent predictors (e.g. age, gender, and other individual and well as hospital-level) of concussions, ICI, and all-other soccer injuries leading to ED visits. Study methods and findings are presented and discussed in “Soccer-related injuries utilization of U.S. emergency departments for concussions, intracranial injuries, and other-injuries in a national representative probability sample: Nationwide Emergency Department Sample, 2010 to 2013” submitted for peer review on March 2, 2021.

Findings Summary for Aim 1: Generally, 98% of soccer-related ED visits resulted in routine (treat-and-release) visits. However, the odds of transfer to a short-term hospital following ED evaluation and treatment was more than 37-fold higher for soccer-injured youth and adults diagnosed with ICI when compared to all-other soccer injuries; additionally, these patients showed 28-fold higher odds of being admitted for inpatient care at the ED-affiliated hospital. For concussion, soccer-injured patients with concussion showed nearly 1.5-fold higher odds of being transferred to a short-term hospital than did those with any other soccer injury. Soccer-related ED visits cost more than 700 million in U.S. dollars from 2010 to 2013.

Aim 2 (Second publication): Describe soccer-related injuries evaluated in U.S. ED’s by age. We also analyzed ED disposition and total healthcare charges for ED visits and inpatient care and resources, by age category. Study methods and findings are presented and discussed in “Soccer-related injuries in U.S. emergency departments across the age spectrum: Nationwide Emergency Department Sample, 2010 to 2013” submitted for peer review on March 28, 2021Findings Summary for Aim 2: Males accounted for the majority of the ED visits across the age spectrum, from youth to older age, but the difference narrowed among 12 to 17 years of age. Private insurance payers significantly comprised >50% of payers for soccer-related injury ED care across all age groups; and the patients in the highest income brackets had significantly higher proportional distribution of ED visits in each age group, ranging from 29.6% in 25 to 34 years of age to 67.4% in those 45+ years of age. Of the $700 million dollars charged, youth players 12 to 17 year olds account for nearly half of all soccer related ED visits and total charges, with most of the charges (83%) from the ED (rather than inpatient charges, 17%). In older players 45+ years of age, inpatient charges (rather than ED charges) account for approximately half of all charges. To conclude, socioeconomic indicators, such as income and access to private insurance, may drive decisions to attend to the ED in U.S. soccer players after an injury. Players 12 to 17 years of age account for the greatest impact of ED utilization and cost, while cost for those 45+ years of age may be costly given the disproportional inpatient charges.

Aim 3 (Third publication): Describe and establish independent predictors of soccer-related injury ED visits resulting in hospitalization (vs not) across individual cofactors, treatment centers characteristics, geographic regions and population density, as well as mechanism of injury and place of injury. We also aimed to describe ED charges, inpatient charges, and hospital length of stay in soccer injuries. Study methods and findings are presented and discussed in “Soccer-related injuries disposition in U.S. emergency departments: Nationwide Emergency Department Sample, 2010 to 2013” pending submission for peer review.

Findings Summary for Aim 3: Males were nearly 2-fold more likely to be hospitalized compared to females. Soccer players with other form of payment where 68% more likely to be hospitalized compared to those with private insurance; once models were adjusted, differences were not noted between public insurance and uninsured compared to private insurance. Injury diagnoses more likely to be hospitalized compared to not having that diagnosis were concussions (68%), intracranial injuries (59-fold), fractures (5.74-fold), and internal injuries (86-fold); least likely to be hospitalized were sprains and strains (3.44-fold), wounds (58%), and contusions (2.12-fold). Upper extremities were 3.7-fold less likely to be hospitalized than those without upper extremity injuries. Soccer players that experienced an injury due to a fall, struck by hit or thrown ball with subsequent fall, or in a residential institution were more likely to be hospitalized than those without a fall, not struck by hit or thrown ball with subsequent fall, or not in a residential institution, 2.33-fold, 2.71-fold, and 7.04-fold respectively. From >$700 million, nearly 75% of the cost, over U.S. $521 million in the 4-year period, of soccer-related injuries resulted from treat-and-release ED visits. The mean of total ED charges was highest among hospitalized ED soccer-injured patients, compared to those not hospitalized from 2010 to 2013: ranging from US$2,117-US$2,425 (Hospitalized) and US$1,415-US$1,770 (Not-hospitalized), respectively.

In conclusion, given that soccer-related injuries have become a health, healthcare utilization, and cost concern, the current studies allowed insight into soccer related injuries in meaningful ways, including (Aim 1) concussions, ICI, and all-other injury; (Aim 2) a lifespan analysis, from childhood to older age; and (Aim 3) the differences between those hospitalized (vs not). Generally, the studies looked at descriptors, hospitalization, ED and inpatient charges, and hospital length of stay, across individual-level, hospital-level, and multiple injuries in soccer-related injuries. The finding helped determine multi-level features susceptible to targeted injury prevention intervention to minimize the price on human suffering, healthcare cost, and utilization, within soccer injuries leading to an ED visit.