Emergency Department Visits in a Pediatric Population: An Examination of Sports and Recreation-Related Injuries and Traumatic Brain Injuries among School-Age Children in North Carolina

Sports and recreational activities provide numerous physical and mental health benefits. However, these activities also involve an inherent risk of injury, including traumatic brain injury (TBI). Although the relationship between sports and recreational activities and injury is well documented, there is still much to be described about the characteristics of these injuries, particularly in children. This dissertation included two studies using emergency department (ED) data to describe the burden of sports and recreation-related (SR) injuries among youth. The first study used 2010-2014 North Carolina ED visit data to describe the incidence of SR injuries among school-age youth, 5-18 years of age. The second study utilized data collected as part of a prospective study of youth, 5-17 years of age, with suspected TBIs presenting to a large, metropolitan hospital system during 2013-2014. In our first study, we identified 767,075 unintentional injury-related ED visits among school-age youth from 2010-2014, of which 213,518 (28%) were SR-related. The incidence rate of SR ED visits among school-age youth was 23.7 ED visits per 100,000 person-years (95% confidence interval, 23.6-23.8). In comparison to other injuries among school-age youth, SR ED visits were more likely to have a diagnosis of an injury to the upper extremity, the lower extremity, and a TBI or other head, neck, or facial injury. The leading category of SR-related injury was sports/athletics played as a group or team (e.g. American tackle football). In our second study, we identified 1,526 ED visits among school-age children with suspected TBIs enrolled in the parent study, of which 352 visits were due to SR activities. Children with suspected TBIs due to SR activities were more likely to have a history of TBI, report signs and symptoms of TBI, and require imaging services, as compared to children with injuries related to other causes. Sports and recreation-related injury places a heavy burden on the youth population. While programs and policies exist to minimize the risk of injury due to sports and recreational activities, our finding emphasize that such prevention activities need to consider sex, age, and type of sport/recreational activity, among other factors, when assessing injury risk.Doctor of Philosoph