Epidemiology of sports and active recreation injury in the Latrobe Valley
Monash University Accident Research Centre Report #151 - 1999
Authors: C. Finch, E. Cassell & V. Stathakis
This epidemiological study of sports and active recreation injuries in the Latrobe Valley region aimed to determine the complete sports and active recreation injury experience, including participation, within a well-defined regional population.
Australian Bureau of Statistics census data were obtained to determine the size of the Latrobe Valley population. Data on all recorded hospital discharges, emergency department presentations and general practice consultations for sport and active recreation injury were obtained for a 12-month period from November 7, 1994 to November 6, 1995. In addition, a randomised household telephone survey of participation in sport and active recreation and associated injuries was undertaken.
The ratio of general practice and emergency department presentations to hospital discharges for sports injury was 1 (hospital admission) : 10 (emergency department presentations) : 12 (general practice consultations). From the household survey of 1,084 residents, it was determined that 648 (60%) participated in sports and active recreation activities in the previous two weeks. Thirty-four (5%) of the sports participants sustained a sports injury in the previous two weeks in one of 20 activities. Nine cases (or 27% of all injured people) required treatment for their injury.
The rank order of rates of population participation per 10,000 persons over 4 years of age were: walking 2,315/10,000; swimming 746; bicycling 710; basketball 712; Australian football 477. The rank order of medically treated injury frequency by sport, however, was Australian football, basketball, bicycling, netball, cricket and soccer. Based on self reported data from the community survey the sport and active recreation activities with the highest rates of injury per 1,000 participants were: cricket (242/1,000), horse riding (122/1,000), soccer (107/1,000), netball (51/1,000) and Australian football (37/1,000). These data included inconsequential injuries. Almost one-half (47%) of self-reported injuries in the community survey were inconsequential in that they did not require treatment or affect participation in sports and active recreation or activities of daily living.
These results confirm that sport and active recreation injuries are a public health problem and that a significant proportion require treatment from the health care sector. In the main, sport and active recreation injuries are mild to moderately severe.
The specific aims of the Latrobe Valley sport and active recreation injury study were to:
- describe the epidemiology of sport and active recreation injuries, including risk assessment, within a geographically defined population;
- supplement existing Latrobe Valley health sector data describing sport and active recreation injuries with data on injuries of lesser severity or receiving specialist treatment to provide a full description of sport and active recreation injuries in this community;
- trial a survey methodology for collecting information about sport and active recreation injuries and associated participation levels in sport and active recreation in one community, that could be transferred to other community settings;
- collect sport and active recreation participation data amongst Latrobe Valley residents; and
- analyse injury and participation data to determine injury risk ranked by sport and active recreation activity.
The Latrobe Valley region of Victoria was chosen as the geographical base for this survey because it is the only area in Australia for which all medically-treated and catastrophic injury data (i.e. deaths, hospital admissions, hospital emergency department presentations, general practice consultations) are available for a known population for a given period of time.
The methodology used to describe the broad sport and active recreation injury profile in the defined geographic region had four major components:
1. Analysis of existing databases
- hospital admissions data (Victorian Inpatient Minimum Database - VIMD)
- hospital emergency department presentations (Victorian Injury Surveillance System VISS)
- general practice presentations (Extended Latrobe Valley Injury Surveillance - ELVIS)
2. A community-based survey of sports participation and associated injuries
- randomised household telephone survey
- calculation of injury rates for specific sports within the sample
3. Calculation of overall sport and active recreation injury rates for the Latrobe Valley
- extrapolation of survey results to the whole population
- development of a sports and active recreation injury pyramid for medically-treated injury
4. A survey of local sports and active recreation clubs and schools to gather data on participation, associated injuries and time-at-risk
- postal survey of local sports and active recreation clubs and organisations
- postal survey to all schools within the geographic region
The analysis of sport and active recreation injury data from the three available databases (VINM, VISS and ELVIS) found that there were 112 hospital admissions, 1,177 hospital emergency department presentations and 1,003 general practitioner presentations in the twelve-month period November 7 1994 to November 6 1995 in the defined Latrobe Valley region. When emergency department and general practitioners' data were compared, the same six sport and active recreation activities ranked highly in terms of injury frequency. Australian football accounted for the highest number of injury cases presenting to emergency departments and general practitioners (29% and 22% respectively). Basketball, bicycling, netball, cricket and soccer also contributed significant and similar proportions of injury in both treatment settings.
Because it is known that hospital and general practitioner injury data are not comprehensive, additional information on sport and active recreation injury data were collected from a community telephone survey conducted quarterly over a twelve-month period. This survey also collected data on participation so that injury rates could be compared across activities. A randomised telephone survey of 402 households in the Latrobe Valley was undertaken. Information was collected about participation in sport and recreation activities in the two weeks prior to the survey in 1,084 household residents aged over 4 years. Overall, 652 household members (60% of all household members covered by the survey) participated in some form of sport and active recreation in the two weeks prior to the survey.
The sport and active recreation activity with the highest level of participation per head of population (active and inactive) in the Latrobe Valley was walking (2315 participants/10,000 persons). Other popular individual activities were swimming and bike riding (746 participants/10,000 persons and 710 participants/10,000 persons, respectively). Team sports such as basketball (712 participants/10,000 persons) and Australian football (477 participants/10,000 residents) were also popular.
The survey also collected information about any injuries that occurred during participation in sport and active recreation activities. Of the 652 residents who participated in some form of sport and active recreation, 34 or 5% sustained an injury during the 2 weeks prior to the survey. To compare injury risk across sports, only the active population (participants) was included in the denominator for the calculation of injury rates. Cricket was the sport with the highest rate of injuries per 1,000 participants (242 injuries/1,000 participants) followed by horse-riding (122 injuries/1,000 participants), soccer (107 injuries/1,000 participants) and netball (51 injuries /1,000 participants).
Of the 34 injuries reported (5% of all participants), 27% received some form of treatment, but only 6% of all injury cases received treatment from a doctor. Thirty-six percent of the injured participants had their performance/participation affected and 35% had a disruption to their daily routine as a result of their injury. Conversely, of the 34 injuries reported, 47% were inconsequential in that they did not require treatment, and/or did not disrupt participation in sport and active recreation or activities of daily living. Some injuries affected all aspects (i.e. they required treatment, affected performance or participation in sports and recreation and interfered with the performance of activities of daily living) but others affected only one or two of these aspects. For example, seven of the eleven people with injuries that affected their performance or participation in sport did not receive treatment for those injuries. Soccer recorded the highest rate of injuries requiring treatment (51 treated injuries per 1000 participants) followed by cricket (41 treated injuries per 1000 participants) and netball (24 treated injuries per 1000 participants).
The injury data from the hospital and general practitioner databases were then collated with the injury data from the household survey to construct a sport and active recreation injury pyramid for the Latrobe Valley. Per 1,000 head of population in the Latrobe Valley, over a 12 month period, it is estimated that two people will be admitted to hospital for treatment of a sports injury, 17 will present at an emergency department and 19 people will receive treatment from a GP. Using the additional data from the telephone survey it was estimated that for every sports injury case admitted to hospital there are 22 cases that receive medical attention in another setting (hospital emergency department or from a GP), forty-one cases that receive treatment for their injury from other than a medical practitioner and 145 non-treated injuries.
In addition, a mail-out survey of sport and active recreation clubs and schools in the Latrobe Valley was conducted to ascertain injury, participation and exposure (time at risk) data in these settings. Unfortunately, this aspect of the project yielded very poor data, largely due to poor response rates and incomplete data. Obviously, more assistance and support to schools and clubs were required to enable them to complete the survey form.
This study has confirmed that injuries associated with participation in sport and active recreation activities are a significant public health issue. A community telephone survey of sports participation and associated injuries is a useful way to collect data on injury risk and to compare risk across activities. This kind of survey provides better data about sports injuries than mail surveys of schools or sporting clubs.
On the basis of this study, it is concluded that a population-based telephone survey is a useful methodology for collecting data about community level sports injuries and participation in sport and active recreation, necessary to calculate injury rates. There appears to be little value in trying to identify sports injuries and exposure data through mail surveys of schools and sporting clubs, due to poor response rates and a lack of relevant or detailed information.
Comparison of the survey results with data from available health sector sources, indicates that the available injury databases describe less than 30% of all sports injury cases. Health sector data (sports injury cases) and participation-adjusted figures give different rankings of the risk of injury in sport and active recreation activities indicating the importance of specific exposure data in the estimation of risk. However, health sector data are essential for quantifying and describing injuries that are severe enough to require medical treatment to identify the high risk sports for these injuries.
In summary, this project has shown that injuries during sport and physical activity are not rare events. They have a significant public health impact with consequences for injury treatment, quality of life and future participation in activity. The extent to which these findings can be extrapolated to other populations is not known but should be investigated in future studies.
Nevertheless, these findings suggest that prevention activities should be aimed at the following sports and active recreation activities and groups:
- Bicyclists, because of high frequency of medically treated injury and the severity of their injuries.
- Australian football and basketball because of high frequency of medically-treated injury.
- Other team ball sports (cricket, soccer and netball) because of comparatively high rates of injuries per 1,000 participants.
- Horse riders because of the comparatively high rate of injuries per 1,000 participants and frequency of hospital admissions.
- Children aged 4-15 years because of the comparative severity of their injuries.
- Adults 15-39 years because of the comparative frequency of injuries in this age group.
Sponsoring organisations: Victorian Health Promotion Foundation, Commonwealth Department of Health and Aged Care and the Australian Sports Commission (Australian Injury Prevention Taskforce).