Key Components of Collection and Classification of Sports Injuries

1. 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

2. 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

3. 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

4. Why Surveillance? • to identify injury problems • estimate public health impact • identify risk/causal factors • identify possible preventative measures

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

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

7. Injury Rates • Numerator • Counting injuries • Denominator • Counting exposure

8. Collection of Denominator • Number of sessions vs hours • Inconsistent across literature • Consider purpose of study

9. 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

10. Environmental Factors • Environment • Facilities, surfaces, equipment • Part of the assessment of denominator and risk

11. Exposure in Sport Injury • Importance for assessing risk and evaluating prevention • a combination of: • possessing a risk factor • participating in sport with that factor

12. 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

13. Orchard Sport Injury Classification System www.injuryupdate.com.au/research/OSICS.htm

14. University of Calgary Diagnostic Coding System

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

16. 3. Classification Methods • By location • Body region • By type • Tissue type, injury type • By diagnosis • Specific or unique diagnoses • By severity

17. Rodeo Injuries

18. Injury Severity • “grading” (1st, 2nd, 3rd degree) • By time loss • Continuous variable • Days vs sessions • Categorical • 1, 2-7, >7 ???? • Time loss may be most “objective”

19. Time Loss • Same session? • Next session? • Next day?

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

21. 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

22. 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

23. 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

24. Key Components of Collection and Classification of Sports Injuries Thank You! Willem H. Meeuwisse, MD, PhD