Abstract
Purpose
To examine lower extremity youth soccer injuries presenting to US emergency departments.
Methods
Data from the National Electronic Injury Surveillance System were analyzed for soccer players ≤18 years old sustaining lower extremity injuries from January 2013 to December 2022. Patient data collected included age, sex, mechanism of injury, setting (practice vs game), diagnosis, lower extremity injury, and disposition. Raw data were used to calculate national estimates (NEs) based on the assigned statistical sample weight of each hospital.
Results
A total of 503,169 lower extremity injuries were diagnosed in US emergency departments (57.2% male; 42.8% female). On average, there was a decrease in 3,124 injuries per year from 2013 to 2022 (95% confidence interval, –5,324 to –925; P = .01) and 2,384 per year from 2013 to 2022 excluding 2020 (95% confidence interval, –3,452 to –1,315; P < .01). The ankle (NE = 196,592; 39.1%), knee (NE = 147,364; 29.3%), and foot (NE = 58,999; 11.7%) were the most commonly injured. The most common mechanisms of injury were not specified (NE = 188,653; 37.5%), ankle roll (NE = 71,992; 14.3%), and player-to-ground (NE = 581,90; 11.6%). The three most common diagnoses were strain/sprain (NE = 247,274; 49.1%), other/not stated (NE = 91,355; 18.2%), and contusion/abrasion (NE = 74,552; 14.8%).
Conclusions
Youth lower extremity soccer injuries presenting to US emergency departments decreased from 2013 to 2022. Sex-specific analyses showed that there were significant differences in proportions of injuries between male and female participants for mechanism, diagnoses, and body parts injured.
Clinical Relevance
This study provides insight into the epidemiology of lower extremity youth soccer injuries presenting to US emergency departments over a 10-year period.
Soccer is one of the most popular sports in the United States, with nearly 3 million annual youth participants.1, 2, 3 Due to the growing popularity of the sport, soccer naturally contributes to a large proportion of youth sports injuries.4, 5, 6 The lower extremities (LEs), such as the ankle and knee, are often the most vulnerable areas injured in youth soccer players.5 These injuries are often a result of contact (e.g., collisions) or noncontact (e.g., twisting, falling, hyperextending limb) injuries.7 Depending on intensity (e.g., competition vs practice), there are varying rates of injury among athletes.1,5,8 Fine-tuning of complex motor skills, underdeveloped muscle mass/strength, and adaptation to structural changes to growth spurts are significant contributing factors to the high rates of injury seen in youth.9,10
The awareness of injuries in youth soccer players has led to a greater emphasis on injury prevention. A few examples of these advancements in soccer include guidelines for warm-up to prevent injury, the FIFA 11+,5,11 the advancement of protective gear such as shin guards (reducing fractures or contusions),12 less aggressive soccer cleat models,13 and improvement of strengthening/conditioning programs tailored to soccer fitness.5,14
The purpose of this study was to examine LE youth soccer injuries presenting to US emergency departments (EDs). It was hypothesized that there would be a decreasing numbers of LE injuries presenting to US EDs from 2013 to 2022.
Methods
Data Collection
The National Electronic Injury Surveillance System (NEISS) database, a publicly available national database from the US Consumer Product Safety Commission, was utilized to obtain data. Records from 100 hospital-associated EDs, selected as a representative probability sample of the 5,000 US hospital EDs based on their geographic location, size, and volume, are included in NEISS. Each ED included in the database offers 24-hour services and at least 6 beds. Each hospital is assigned a statistical sample weight, which reliably and reproducibly enables calculation of a national estimate (NE).
All soccer-related injuries (product code 1267: soccer [activity, apparel, or equipment]) involving the LE (product codes 35: knee, 36: lower leg, 37: ankle, 81: upper leg, 83: foot, and 93: toe) were queried. Patients presenting to EDs between January 1, 2013, and December 31, 2022, who were ≤18 years of age were included. All diagnoses and dispositions were included. Injuries sustained outside of organized soccer, as identified during review of injury narratives, were excluded (e.g., settings such as “gym class” or at a “friend’s house”). Injuries that occurred in nonturf, nongrass, or nonoutdoor settings were excluded.
The data set provided date of presentation, age, sex, race, body part, injury diagnosis, disposition, and a brief, provider-documented narrative of the injury. Narratives were utilized to classify mechanisms of injury, setting of injury, and specific knee structures injured. Mechanisms of injury were categorized as ankle roll, player-to-ground, sliding tackle/kicked, twisting/torsion, player-to-player collision, player-to-ball, slide tackle, hyperextension, other, or not specified (i.e., no data were provided on how the patient acquired their injury). Settings of injury included practice, game, or unspecified. Knee structures included in the narratives were medial collateral ligament, lateral collateral ligament, anterior cruciate ligament, and meniscus.
Statistical Analysis
RStudio Software 2023.06.0+421 (Posit, PBC) was used for statistical analyses. The NEISS database provides statistical sample weight and variance for calculating NEs.15 The relationships between year and NE for overall injuries, mechanisms of injury, and injury diagnoses were analyzed via linear regression analysis. Effects of the COVID-19 pandemic were investigated through regression analyses excluding data from 2020 only and from 2020 to 2022. Statistical significance was set at P < .05. NEs were calculated by multiplying each raw data point by the associated statistical weight of the reporting hospital. Categorical variables were compared using the Fisher exact test with post hoc Holm adjustment.
Results
Between January 1, 2013, and December 13, 2022, there were NE = 503,169 youth soccer LE injuries presenting to US EDs; NE = 287,826 (57.2%) were male (Table 1). The mean age at presentation for LE injury was 13.7 ± 7.0 (NE = 13.8 ± 4.9; range, 1-18) years (Table 1).
Table 1.
Study Characteristics and Demographic Data: Lower Extremity Injuries
| Patient Characteristic | Lower Extremity Injuries |
|
|---|---|---|
| Raw Injuries | Weighted National Estimate | |
| Age, mean ± SD [range], y | 13.7 ± 7.0 [1-18] | 13.8 ± 4.9 [1-18] |
| Male patients | 10,817 (60.4) | 287,826 (57.2) |
| Female patients | 7,097 (39.6) | 215,344 (42.8) |
| Total number | 17,914 | 503,169 |
NOTE. Data are presented as number (%) unless otherwise indicated.
The annual incidence of LE injuries peaked in 2014 (Fig 1). On average, LE injuries presenting to US EDs decreased by NE = 3,124 injuries per year (NE coefficient = –3,124; 95% confidence interval [CI], –5,324 to –925; P = .01) (Fig 2A). With the exclusion of the year 2020, LE injuries presenting to US EDs decreased on average by NE = 2,384 injuries per year (NE coefficient = –2,384; 95% CI, –3,452 to –13,15; P < .01) (Fig 2B). With the exclusion of the years 2020 to 2022 (i.e., including 2013-2019), LE injuries presenting to US EDs decreased on average by NE = 1,648 per year (NE coefficient = –1,648; 95% CI, –2790 to –507; P = .01) (Fig 2C).
Fig 1.
National estimates of lower extremity injuries by year.
Fig 2.
Annual lower extremity injuries from 2013 to 2022 (A), with exclusion of 2020 (B) and with exclusion of years 2020 to 2022 (C).
The most common mechanism of ED-diagnosed LE injury was not specified (NE = 188,653; 37.5%), followed by ankle roll (NE = 71,992; 14.3%), player-to-ground (NE = 58,190; 11.6%), and standing tackle/kicked (NE = 58,167; 11.6%) (Table 2). Males, compared to females, had a higher proportion of player-to-ground (NE = 22,867 [11.8%] vs 24,323 [11.3%]; P < .01), other (NE = 16,416 [5.7%] vs 8,967 [4.2%]; P < .01), and slide tackle (NE = 4,918 [1.7%] vs 1,620 [0.8%] P < .01) injuries presenting to US EDs (Table 2). Females, compared to males, had a greater proportion of not specified (NE = 81,885 [38.0%] vs 106,768 [37.1%]; P < .01), ankle roll (NE = 32,934 [15.3%] vs 39,058 [13.6%]; P < .01), player-to-player collision (NE = 15,721 [7.3%] vs 20,185 [7.0%]; P < .01), and hyperextension (NE = 2,245 [1.0%] vs 2,327 [0.8%]; P < .01) injuries (Table 2). Appendix Table 3 references the raw injury data for Table 2, mechanism of injury for the lower extremity.
Table 2.
Mechanism of Injury: Lower Extremity
| Mechanism | National Estimate Total, n (%) | National Estimate Male, n (%) | National Estimate Female, n (%) | P Value |
|---|---|---|---|---|
| Not specified | 188,653 (37.5) | 106,768 (37.1) | 81,885 (38.0)∗ | <.01 |
| Ankle roll | 71,992 (14.3) | 39,058 (13.6) | 32,934 (15.3)∗ | <.01 |
| Player-to-ground | 58,190 (11.6) | 33,867 (11.8)∗ | 24,323 (11.3) | <.01 |
| Standing tackle (kicked) | 58,167 (11.6) | 33,534 (11.7) | 24,633 (11.4) | .06 |
| Twisting/torsion | 39,557 (7.9) | 22,623 (7.9) | 16,934 (7.9) | p=1 |
| Player-to-player collision | 35,905 (7.1) | 20,185 (7.0) | 15,721 (7.3)∗ | <.01 |
| Other | 25,384 (5.0) | 16,416 (5.7)∗ | 8,967 (4.2) | <.01 |
| Player-to-ball | 14,211 (2.8) | 8,130 (2.8) | 6,081 (2.8) | p=1 |
| Slide tackle | 6,537 (1.3) | 4,918 (1.7)∗ | 1,620 (0.8) | <.01 |
| Hyperextension | 4,572 (0.9) | 2,327 (0.8) | 2,245 (1.0)∗ | <.01 |
| Total | 503,169 | 287,825 | 215,344 | Overall Fisher exact test, <.01 |
Indicates statistically significant difference between sex-specific analyses.
Based on linear regression analysis, there were significant decreases in the national estimate of LE injuries for not specified (NE coefficient = –2,135; 95% CI, –3,023 to –1,246; P < .01), standing tackle/kicked (NE coefficient = –418; 95% CI, –726 to –109; P = .01), player-to-player collision (NE coefficient = –205; 95% CI, –390 to –20; P = .03), and other (NE coefficient = –278; 95% CI, –453 to –104; P = .01) mechanisms (Fig 3A). Linear regression with the exclusion of the year 2020 due to COVID-19 showed significant decreases in the same categories for not specified (NE coefficient = –1,851; 95% CI, –2,371 to –1,331; P < .001), standing tackle/kicked (NE coefficient = –338; 95% CI, –593 to –84; P = .02), player-to-player collision (NE coefficient = –157; 95% CI, –308 to –6; P = .04), and other (NE coefficient = –236; 95% CI, –387 to –84; P = .01) mechanisms (Fig 3A). There were no significant changes within the numbers available for this study in twisting/torsion (NE coefficient = 79; 95% CI, –126 to 284; P = .40), slide tackle (NE coefficient = 14; 95% CI, –59 to 88; P = .67), player-to-ball (NE coefficient = –59; 95% CI, –163 to 45; P = .23), player-to-ground (NE coefficient = 11; 95% CI, –331 to 353; P = .94), hyperextension (NE coefficient = 2; 95% CI, –48 to 53; P = .92), and ankle roll (NE coefficient = –136; 95% CI, –511 to 239; P = .43) mechanisms (Fig 3A).
Fig 3.
Overall lower extremity injuries national estimates by mechanism from 2013 to 2022 and overall lower extremity diagnoses national estimates by mechanism from 2013 to 2022.
Based on linear regression analysis, there were significant decreases in the national estimate of LE injuries for the strain/sprain (NE coefficient = –1,968; 95% CI, –2,917 to –1,019; P < .01), contusion/abrasion (NE coefficient = –818; 95% CI, –1,164 to –47; P < .01), fracture (NE coefficient = –349; 95% CI, –653 to –45; P = .03), and avulsion (NE coefficient = –14; 95% CI, –25 to –4; P = .01) categories. Linear regression analysis showed a significant increase in injury for the nerve damage (NE coefficient = 8; 95% CI, 0 to 15; P < .05) diagnosis category (Fig 3B). Linear regression with the exclusion of the year 2020 due to COVID-19 showed significant decreases per year for ED LE diagnoses in the same categories for strain/sprain (NE coefficient = –1,653; 95% CI, 2,144 to –1,161; P < .01), contusion/abrasion (NE coefficient = –727; 95% CI, –1,008 to –447; P < .001), fracture (NE coefficient = –258; 95% CI, –464 to –52; P = .02), and avulsion (NE coefficient = –15; 95% CI, –26 to –3; P = .02). There was also a significant increase per year in nerve damage (coefficient = 9; 95% CI, 2 to 16; P = .02) diagnosis with the exclusion of 2020 (Fig 3B).
There were no significant changes in crushing (NE coefficient = –7; 95% CI, 21 to 7; P = .27), dislocation (NE coefficient = –18; 95% CI, –110 to 74; P = .67), foreign body (NE coefficient = –2; 95% CI, –6 to 2; P = .33), hematoma (NE coefficient = 6; 95% CI, –23 to 35; P = .64), laceration (NE coefficient = –30; 95% CI, –82 to 22; P = .22), puncture (NE coefficient = –4; 95% CI, –13 to 5; P = .37), other/not stated (NE coefficient = 65; 95% CI, –619 to 74; P = .83), and dermatitis/conjunctivitis (coefficient = 7; 95% CI, –6 20; P = .24) diagnoses (Fig 3B).
Proportions of diagnoses by sex are shown in Figure 4, and LE soccer injury diagnoses presenting to US EDs are represented in Appendix Table 1 (available at www.arthroscopyjournal.org). Male participants had a higher proportion of LE injury diagnoses in comparison to female participants in the following categories: fracture (P < .01), laceration (P < .01), avulsion (P < .01), dermatitis/conjunctivitis (P = .04), and puncture wounds (P < .01) (Fig 4 and Appendix Table 1, available at www.arthroscopyjournal.org). Female participants had a higher proportion of LE injury diagnoses in comparison to male participants in the following categories: strain/sprain (P < .01), contusion/abrasion (P < .01), dislocation (P < .01), crushing (P < .01), nerve damage (P < .01), and foreign body (P < .01) (Fig 4 and Appendix Table 1, available at www.arthroscopyjournal.org).
Fig 4.
Proportions of diagnoses by sex.
Proportions of injuries affecting various body parts by sex are shown in Figure 5, and additional data on soccer LE body parts injured are represented in Appendix Table 2 (available at www.arthroscopyjournal.org). The most common body parts injured presenting to US EDs were the ankle (NE = 196,592; 39.0%), knee (NE = 147,364; 29.0%), and foot (NE = 58,999; 12.0%) (Appendix 2, available at www.arthroscopyjournal.org). Female players had a higher proportion of injuries in comparison to male players for the ankle (P < .01) and knee (P < .01) categories presenting to US EDs (Fig 5 and Appendix 2, available at www.arthroscopyjournal.org). Male players had a greater proportion of injuries in comparison to female players for the foot (P < .01), lower leg (P < .01), toe (P < .01), and upper leg (P < .01) categories presenting to US EDs (Fig 5 and Appendix 2, available at www.arthroscopyjournal.org).
Fig 5.
Proportions of injuries affecting various body parts by sex.
There was a total of NE = 65,807 (13.1%) of fractures. The most common body parts fractured were the lower leg (NE = 21,218; 32.0%), ankle (NE = 17,993; 27.0%), and toe (NE = 10,615; 16.0%). LE injuries were reported in NE = 503,169 cases in different settings, including not specified, game, and practice. For the cases that reported LE injuries, NE = 451,092 (89.7%) cases were not specified, NE = 35,941 (7.1%) cases occurred in games, and NE = 16,136 (3.2%) cases occurred in practice. LE fractures showed NE = 60,157 (91.4%) cases that were not specified, NE = 4,188 (6.4%) cases in game, and NE = 1,463 (2.2%) cases in practice.
There were NE = 5,894 ankle rolls resulting in ankle fracture, accounting for 33% of all ankle injuries. The player-to-ground mechanism resulted in fracture 17% of the time, with the lower leg (37%) and ankle (28%) being the most commonly fractured body parts. The standing tackle mechanism resulted in fracture 16% of the time, with the lower leg (44%) and toe (24%) being the most commonly fractured body parts. The slide tackle mechanism resulted in fracture in 27% of cases, with 58% of fractures affecting the lower leg and 35% affecting the ankle. The slide tackle mechanism resulted in strain/sprain in 40% of cases, with 71% of strains/sprains affecting the ankle. The twisting/torsion mechanism resulted in strain/sprain in 54% of cases, with 78% of strains affecting the knee.
Most patients were treated/examined and released without treatment (NE = 492,042; 97.8%). The minority of patients were treated and admitted for hospitalization within same facility (NE = 6,572; 1.3%), left without being seen (NE = 3,070; <1.0%), were treated and transferred to another hospital (NE = 1,229; <0.0%), or were held for observation (NE = 256; <0.0%).
Discussion
The current study found a decreasing number of LE injuries presenting to US EDs by NE = 3,124 injuries per year from 2013 to 2022. Exclusion of the year 2020 (COVID-19) also showed significant decreases in LE injuries presenting to US EDs by NE = 2,384 injuries per year from 2013 to 2022. The average age of ED-diagnosed LE injuries was 13.8 ± 4.9 years, with male athletes (57.2%) sustaining a higher proportion of injuries. The 3 most common mechanisms of injury were not specified (37.0%), ankle roll (14.0%), and player-to-ground (12.0%). The present study found that LE ED-diagnosed injuries for the standing tackle, player-to-player collision, not specified, and other mechanisms decreased over the 10-year period analyzed. Potential factors contributing to the reduction in ED-diagnosed LE injuries include better equipment (e.g., shin guards, shoes, etc.), rule changes (e.g., more severe consequences for dangerous plays or tackles), improved warm-up/training techniques (e.g., FIFA 11+ reduces injury by 39.0%-44.0%), and sports science advancements (e.g., injury prevention techniques).5,11,14,16 Alternatively, one consideration of the interpretation of results is that over the years, patients and families may avoid the ED for the same condition but rather wait and get either an orthopaedic or sports medicine appointment.17, 18, 19 Overall injuries may not be decreasing at the same proportion as ED visits are decreasing. In addition, other sports, such as in youth wrestling and soccer players ages 0 to 69 years in previous studies, have pointed to a decreasing trend in overall injuries, similar to this study.20,21
Despite the decreasing trend of ED-diagnosed LE injuries, some mechanisms of injury did not change: twisting/torsion, slide tackles, player-to-ball, falls, hyperextension, and ankle roll mechanisms (Fig 3). One potential explanation for this is that soccer involves rapid changes in direction, speed, aerial duels, and other forms of physical contact, ultimately predisposing players to certain mechanisms of injury regardless of protective measures.22,23 Youth athletes may be at a greater risk of injury due to biomechanical factors such as joint laxity, muscle imbalances or weakness, and a complex development of motor skills that could potentially explain the unchanged trends for certain types on injury, such as ankle rolls and hyperextension mechanisms.9,24,25 Environmental factors could also play a role as field surfaces can contribute to injuries such as slips, falls, and ankle rolls.5,26,27 Previous studies have also showed that synthetic turf can result in up to a 16.0% increase in LE injuries as turf surfaces do not release cleats as readily, which could also be contributing to increased injury risk in certain mechanisms such as twisting and torsion.28
The most common injured body parts diagnosed in US EDs during this study were the ankle (39.0%), knee (29.0%), and foot (12.0%). Among ED diagnoses for injury, the most common were sprain/strains (49.0%), other/not stated (18.0%), and contusion/abrasion (15.0%). The ankle and knee joints play crucial roles in supporting the body during dynamic movements, explaining the susceptibility to injury for these body parts.28 In addition, slide tackles accounted for a relatively small proportion of injury compared to other mechanisms. However, among slide tackle injuries, fractures were a common diagnosis, likely related to the force generated, the uncontrollable nature of maneuvers, and the vulnerability of the ankle joint.29,30
Sex-specific analyses showed significant differences in proportions of injuries between male and female participants for mechanism, diagnoses, and body parts injured presenting to US EDs. Potential explanations for the differences in proportions of injuries between male and female youth players can be attributed to a combination of biological, physiological, and behavioral differences. Biological differences in males, such as increased muscle mass, could potentially lead to increased physical burden, contact (e.g., slide tackling), and aggression, thus increasing risk of injury among male players for fractures, lacerations, avulsions, and puncture wounds.5,31 In addition, certain anatomic and physiological differences may predispose female players to certain mechanisms and diagnosis of injury. For example, greater flexibility, joint laxity, and anatomic variation (e.g., greater hip anteversion and tibiofemoral angles) may be contributing to higher proportions of injury for ankle rolls, hyperextension, dislocations, and sprains/strains in female soccer players.32, 33, 34 This study also showed that certain joints are predisposed to injury in females as opposed to males, such as the ankle (43.0% vs 36.1%; P < .01) and knee (30.6% vs 28.3%; P < .01). This is also likely attributed to biomechanical differences among female athletes, which predispose players to knee injuries such as the anterior cruciate ligament, which has been reported in previous research to have a 4 times higher risk of injury than male soccer participants.35, 36, 37 It is important to acknowledge that knee injuries may also be less often diagnosed in EDs and more frequently diagnosed later in sports medicine or orthopaedic clinics, leading to a delay in diagnosis and reduced numbers reported in this study, as opposed to what the true values may entail.17, 18, 19 Behavioral influences, such as increased risk-taking behavior in males, also could have influenced certain mechanisms of injuries (e.g., fractures).38,39
Potential explanations for the decrease in sprains/strains (P < .01), contusions/abrasions (P < .01), fractures (P = .03), and avulsions (P = .01) could be due to improved training regimens/coaching and equipment such as shin guards.12,40 Sadigursky et al.11 showed that the FIFA 11+ injury prevention program, for instance, reduced injuries in soccer players by 30.0% (P = .01). Francisco et al.41 suggested that shin guards provide protective means against minor injuries (e.g., contusions/abrasions) and may even reduce the risk of major injuries (e.g., fracture), although the level of protection may vary depending on the guard used (e.g., plastic, fiberglass, Kevlar). Their study found that average shin guards reduced forces by 11.0% to 17.0% and strain by 45.0% to 51.0% compared to the unguarded leg.40,41 Additionally, a lower number of injuries presenting to EDs may be related to an increased emphasis on sportsmanship and fair play in the modern game, ultimately promoting personal and social responsibility between players.42,43 Other diagnoses, such as crushing, dislocation, foreign body, hematoma, laceration, puncture, other/not stated, and dermatitis conjunctivitis, are less likely to be related to external factors, thus remaining unchanged (Fig 3B).
Pfirrmann et al.44 showed that youth athletes experience a lower number of injuries in practice, as opposed to game settings. This study also similarly showed that there was a higher proportion of both LE injuries and fractures in games as opposed to practice that presented to US EDs. The greater prevalence of LE injuries and fractures in game versus practice settings could be attributed to increased aggression, leading to a higher risk of injury.5,45 It is important to note that ∼90% of injuries in this study did not report whether injuries had occurred in practices or games.
This study contributes to the growing literature regarding youth soccer LE injuries while also providing insight into the changing epidemiology of youth soccer injuries presenting to US EDs. Further investigation is required to identify the impact of national protocols on LE injuries in youth soccer. Future studies can also investigate if there have been changes in the relative frequency of injuries in comparison to one another over the years.
Limitations
Limitations of this study are related to the utilization of the NEISS national database. The classification of LE injury mechanisms was limited to information provided from the narrative. As such, the “not specified” mechanisms accounted for a large proportion of the analysis (37.0%). However, including these data provided an accurate representation of LE soccer injury trends in the youth. In addition, the proportion of not specified mechanisms is smaller than that of previously published NEISS studies.46 Certain mechanisms that should be investigated further include overuse injury, as this was not included in the data provided by the NEISS. Another point of discussion is that the data often lacked information on setting of injury (e.g., practice or game) and ligamentous knee injuries that would also have given insightful information into the trends of knee injuries in youth soccer players diagnosed in EDs. This study is also restricted to athletes who presented to the ED and did not include LE injuries diagnosed or treated by onsite personnel such as athletic trainers, other health care professionals, or urgent care clinics, thus limiting the insight into LE injuries outside of the reported data.47 Increased medical training may be contributing to managing these injuries, obviating ED visits. In addition, COVID-19 also had to be accounted for because of a large decrease in youth soccer participation, leading to decreased injuries for those years (e.g., 2020), as seen in the data. This was accounted for by exclusion of those years, which showed similar trends and statistical significance. It is also important to acknowledge the impact of COVID-19 beyond those initial years, as the amount of youth sports participation has struggled to keep athletes engaged since.48,49 Furthermore, the NEISS database does not track the participation/compliance of the facilities recording data, which can affect reported information in the database. An additional issue that one could argue is that there is no accounting for evolving population demographics. However, during this study period, population demographics were relatively steady at around 73.5 million children from 2013 to 2022 (ranging from 73.1 to 74.3 million).50 Lastly, the method of data analysis used prevented the calculation of the true incidence of national injuries due to the nature of the NEISS to stratify data across 100 hospitals.
Conclusions
Youth lower extremity soccer injuries presenting to US EDs decreased from 2013 to 2022. Sex-specific analyses showed that there were significant differences in the proportions of injuries between male and female participants for mechanism, diagnoses, and body parts injured.
Disclosures
All authors (A.G.C., E.M.S., K.K.O., B.G.A., R.L.P., T.S.B., C.S.A., D.P.T.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Appendix
Appendix Table 1.
Soccer Lower Extremity Injury Diagnoses
| Diagnosis | Raw Injuries, n (%) | National Estimate, n (%) | National Estimate Male, n (%) | National Estimate Female, n (%) | P Value |
|---|---|---|---|---|---|
| Strain/sprain | 8,395 (46.9) | 247,274 (49.1) | 132,514 (46.0) | 114,760 (53.3)∗ | <.01 |
| Other/not stated | 3,341 (18.7) | 91,355 (18.2) | 52,416 (18.2) | 38,939 (18.1) | .28 |
| Contusion/abrasion | 2,522 (14.1) | 74,552 (14.8) | 41,996 (14.6) | 32,556 (15.1)∗ | <.01 |
| Fracture | 2,793 (15.6) | 65,807 (13.1) | 46,240 (16.1)∗ | 19,567 (9.1) | <.01 |
| Dislocation | 452 (2.5) | 13,153 (2.6) | 6,949 (2.4) | 6,204 (2.9)∗ | <.01 |
| Laceration | 209 (1.2) | 5,610 (1.1) | 4,512 (1.6)∗ | 1,098 (0.5) | <.01 |
| Hematoma | 124 (0.7) | 2,948 (0.6) | 1,726 (0.6) | 1,222 (0.6) | .28 |
| Avulsion | 29 (0.2) | 1,179 (0.2) | 729 (0.3)∗ | 450 (0.2) | <.01 |
| Crushing | 13 (0.1) | 345 (0.1) | 132 (<0.1) | 212 (0.1)∗ | <.01 |
| Dermatitis/conjunctivitis | 13 (0.1) | 308 (0.1) | 198 (0.1)∗ | 110 (0.1) | .04 |
| Nerve damage | 9 (0.1) | 294 (0.1) | 139 (<0.1) | 154 (0.1)∗ | <.01 |
| Puncture | 9 (0.1) | 277 (0.0) | 260 (0.1)∗ | 17 (<0.1) | <.01 |
| Foreign body | 5 (0.0) | 68 (0.0) | 14 (<0.1) | 54 (<0.1)∗ | <.01 |
| Total | 17,914 | 503,169 | 287,825 | 215,344 | Overall Fisher exact test, <.01 |
Indicates statistically significant difference between sex-specific analyses.
Appendix Table 2.
Lower Extremity Body Part Injured
| Body Part Injured | |||||
|---|---|---|---|---|---|
| Body Part | Raw Injuries, n (%) | National Estimate, n (%) | National Estimate Male, n (%) | National Estimate Female, n (%) | P Value |
| Ankle | 6,697 (37.4) | 196,592 (39.1) | 103,980 (36.1) | 92,611 (43.0)∗ | <.01 |
| Knee | 5,235 (29.2) | 147,364 (29.3) | 81,517 (28.3) | 65,846 (30.6)∗ | <.01 |
| Foot | 2,092 (11.7) | 58,999 (11.7) | 37,326 (13.0)∗ | 21,673 (10.1) | <.01 |
| Lower leg | 2,301 (12.8) | 57,542 (11.4) | 35,817 (12.4)∗ | 21,725 (10.1) | <.01 |
| Toe | 1,058 (5.9) | 28,451 (5.7) | 19,417 (6.7)∗ | 9,033 (4.2) | <.01 |
| Upper leg | 531 (3.0) | 14,222 (2.8) | 9,768 (3.4)∗ | 4,454 (2.1) | <.01 |
| Total | 17,914 | 503,169 | 287,826 | 215,344 | Overall Fisher exact test, <.01 |
Indicates statistically significant difference between sex-specific analyses.
Appendix Table 3.
Raw Injury Data for Table 2—Mechanism of Injury Lower Extremity
| Mechanism | Raw Injuries, n (%) |
|---|---|
| Not specified | 6,584 (36.8) |
| Ankle roll | 2,331 (13.0) |
| Player-to-ground | 2,286 (12.8) |
| Standing tackle (kicked) | 2,029 (11.3) |
| Twisting/torsion | 1,257 (7.0) |
| Player-to-player collision | 1,394 (2.8) |
| Other | 990 (5.5) |
| Player-to-ball | 570 (3.2) |
| Slide Tackle | 286 (1.6) |
| Hyperextension | 187 (1.0) |
| Total | 17,914 |
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