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LAS VEGAS -- Annual surveys of high school athletic trainers show that, among nine major sports, boys' football has the highest injury rate and baseball the lowest, researchers reported here.

But when ranked by severity, boys' wrestling was the most dangerous, with 9.6% of injuries sustained in the sport needing surgery, according to a study by medical student Jordan Pizzarro, BS, of George Washington University in Washington, D.C., and colleagues. Girls' basketball was a close second, at 7.6%.

Pizzarro and colleagues reported the findings at the American Academy of Orthopaedic Surgeons' (AAOS) annual meeting.

The group drew on data from the , an offshoot of the National High School Sports-Related Injury Surveillance Study, for 2015-2019. Trainers at 100 nationally representative U.S. high schools submit injury data weekly to RIO, including the sport involved, in what activity the injury occurred (practice vs competition), the type of injury, and how it was treated. To be reportable, an injury must be attended by a medical professional and result in restricted sports participation for at least 1 day.

About 15,500 injuries in nine types of sport were reported to RIO during the study period out of 6.8 million "athletic exposures," which the researchers defined as one athlete participating in one session of practice or competition. That worked out to a rate of 2.29 injuries per 1,000 exposures.

Injury rates per 1,000 exposures for the nine sports analyzed, in decreasing order, were:

• Boys' football: 3.96
• Girls' soccer: 2.65
• Boys' wrestling: 2.36
• Girls' basketball: 2.03
• Boys' soccer: 1.78
• Boys' basketball: 1.54
• Girls' softball: 1.35
• Girls' volleyball: 1.31
• Boys' baseball: 0.89

Rates for all boys' sports were 2.52 per 1,000, and the corresponding figure for girls' sports was 1.86 per 1,000.

had shown an overall injury rate of 2.51 per 1,000 exposures. "The overall injury rate decreased, which you would think is great, but you also have to look at the types of injuries that are happening," said Pizzarro in an .

"We are seeing an increase in head and neck injuries, especially concussions, as well as more severe injuries and those requiring surgery. Many organizations have adopted safety equipment and injury prevention guidelines; it is questionable if they are being applied correctly," Pizzarro added.

For most sports in the new data, injuries to the head and face were the most common (18%-29% of all injuries), but the ankles suffered most in three sports: girls' volleyball and boys' and girls' basketball. Knee injuries were the second or third most commonly injured across sports.

The proportion of head injuries in 2015-2019 was higher than in the 2005-2006 RIO data, prompting the investigators to suggest that preventive measures haven't been as effective as hoped. "Play intensity, physical contact, and collisions" are apparently increasing in high school athletics, Pizzarro and colleagues indicated, "potentially offsetting the use of protective equipment" such as helmets with face guards.

The vast majority of injuries were sustained during games and matches versus practice, at a ratio of 3.39 across all categories. It was highly variable, though: injuries were sixfold more common in boys' football games than in practices, while the ratio in girls' volleyball was just 1.61.

Strains and sprains were the most common type of injury (37% across all sports, range 29%-48%), but concussions were not far behind at 22% of all injuries. Perhaps surprisingly, boys' football wasn't the worst in this regard -- 28% of girls' soccer injuries were concussions, versus 24% for football. The least concussive sport was boys' baseball at 12%.

Fractures were relatively uncommon across all sports. The highest rate was in boys' baseball, in which fractures accounted for 8.4% of all injuries. Girls' sports in general were much less likely to involve fractures (2.0% of all injuries, versus 4.2% for all boys' sports).

In terms of severity (as indicated by the proportion of injuries needing surgical correction), girls' volleyball and softball appeared to be the safest, at rates of 3.17% and 3.71%, respectively. Boys' football injuries needed surgery at a rate of 7.37%.

"Future studies should focus on improving preventative measures, developing adequate approaches to reducing concussion risk, and investigating surgical procedures and their association with return to play," Pizzarro's group concluded.

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