1st World Congress on Sports Injury Prevention

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Key Components of Collection and Classification
of Sports Injuries

• 1st World Congress on Sports Injury Prevention
• Oslo, Norway, June 23-25, 2005

Willem H. Meeuwisse, MD, PhD
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Outline Key Components

• Collection
• Who is collecting?
• Completeness / precision
• Injuries and exposure
• Use of diagnostic coding systems
• Classification methods
• By location
• By type
• By diagnosis
• By severity

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Steps in Developing Injury Prevention

• 1. Identify the problem
• 2. seek to understand "cause" of injury
• 3. attempt to reduce injury
• develop an intervention
• introduce the intervention
• evaluate the intervention

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Why Surveillance?

• to identify injury problems
• estimate public health impact
• identify risk/causal factors
• identify possible preventative measures

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1. Collection

• Who is collecting?
• Trained medical staff (therapist)
• Student
• Lay person (coach, parent, player)
• Payment / honorarium?
• Motivation, accountability

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Collection

• Validation?
• how complete is reporting?
• Are sources of error estimated or unknown?
• Anticipate how this might this affect analysis
  plan

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Injury Rates

• Numerator
• Counting injuries
• Denominator
• Counting exposure

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Collection of Denominator

• Number of sessions vs hours
• Inconsistent across literature
• Consider purpose of study

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Estimating Exposure

• exposure estimation (group index)
• no. of athletes X no. sessions no. athlete
  exposures
• exposure measurement (individual index)
• count each exposure (or partial exposure) for
  each athlete

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Environmental Factors

• Environment
• Facilities, surfaces, equipment
• Part of the assessment of denominator and risk

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Exposure in Sport Injury

• Importance for assessing risk and evaluating
  prevention
• a combination of
• possessing a risk factor
• participating in sport with that factor

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2. Diagnostic Coding Systems

• Open source coding systems best
• Limitations with universal systems
• ICD-9 or ICD-10
• Sport-specific open systems best
• Orchard codes
• University of Calgary System

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Orchard Sport Injury Classification System

• www.injuryupdate.com.au/research/OSICS.htm

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University of Calgary Diagnostic Coding System
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Diagnostic Coding

• Diagnostic coding systems can affect how data are
  grouped, analyses, displayed and interpreted

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3. Classification Methods

• By location
• Body region
• By type
• Tissue type, injury type
• By diagnosis
• Specific or unique diagnoses
• By severity

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Rodeo Injuries
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Injury Severity

• grading (1st, 2nd, 3rd degree)
• By time loss
• Continuous variable
• Days vs sessions
• Categorical
• 1, 2-7, gt7 ????
• Time loss may be most objective

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Time Loss

• Same session?
• Next session?
• Next day?

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Return to Play

• clearance affects measurement of time loss
• Return to full training
• Return to play
• Medically cleared?
• Actual return (e.g., coaching decision)?

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Classification Pitfalls

• Multiple diagnoses?
• Knee triad ACL, MCL, meniscal tear
• Multiple injuries
• Concussion and AC separation
• Bias for acute vs overuse?
• In research, assumptions and limitations must be
  clearly stated

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Summary Statements

• Collection should be done by trained personnel,
  with incentives (pitfalls with volunteers)
• Whenever possible, exposure should be measured
  (individual), not estimated (group)
• Error should be measured (or estimated)
• Sport diagnostic coding systems that are public
  should be used
• Assumptions and limitations should be stated
• Be comprehensive in data collection and flexible
  in the analysis

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Issues

• Need consistency in denominator
• Athlete exposures (sessions) vs hours
• Need consistency in measures / categories of
  severity
• Time loss
• How do we handle multiple regions / diagnoses?
• Accurate capture of overuse injuries

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Key Components of Collection and Classification
of Sports Injuries

• Thank You!

Willem H. Meeuwisse, MD, PhD