Correction: The impact of tackle football injuries on the American healthcare system with a neurological focus

Abstract

Supporting information Showing 1/2: pone.0201273.s001.pdf RESEA RCH ARTICL E The impact of tackle football injuries on the American healthcare system with a neurological focus Michael J. McGinity 1 , Ramesh Grandhi 1 , Joel E. Michalek 2 , Jesse S. Rodriguez 1 , Aron M. Trevino 2 , Ashley C. McGinity 3 , Ali Seifi 1 * 1 Department of Neurosurg ery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America, 2 Department of Epidem iology and Biostatistics , University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America, 3 Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America * Seifi@uth scsa.edu Abstract Background Recent interest in the study of concussion and other neurological injuries has heightened awareness of the medical implications of American tackle football injuries amongst the public. Objective Using the National Emergency Department Sample (NEDS) and the National Inpatient Sample (NIS), the largest publicly available all-payer emergency department and inpatient healthcare databases in the United States, we sought to describe the impact of tackle foot- ball injuries on the American healthcare system by delineating injuries, specifically neurolog- ical in nature, suffered as a consequen ce of tackle football between 2010 and 2013. While efforts have been made in implementing injury prevention measures, as well as incorporating new rules and safety regulations (e.g., coach/player education, banning helmet-to-helmet tackles, and institution of return to play guidelines), there is still concern of the violent nature of the sport.

Notice of Republication

The original Supporting Information file was published in error. The file was removed in the HTML and PDF versions of this article on July 6, 2018. The article was republished again on July 13, 2018 to update the Data Availability statement for accuracy. Please download this article again to view the correct version. The republished article from July 6, 2018 and the current, republished, corrected article are provided here for reference.

Supporting information

Showing 1/2: pone.0201273.s001.pdf

RESEA

RCH

ARTICL

E

The

impact

of

tackle

football

injuries

on

the

American

healthcare

system

with

a

neurological

focus

Michael

J. McGinity

1

, Ramesh

Grandhi

1

, Joel

E.

Michalek

2

, Jesse

S.

Rodriguez

1

, Aron

M.

Trevino

2

, Ashley

C.

McGinity

3

, Ali

Seifi

1

*

1

Department

of Neurosurg

ery,

University

of Texas

Health

Science

Center

at San

Antonio,

San

Antonio,

Texas,

United

States

of America,

2

Department

of Epidem

iology

and

Biostatistics

, University

of Texas

Health

Science

Center

at San

Antonio,

San

Antonio,

Texas,

United

States

of America,

3

Department

of Surgery,

University

of Texas

Health

Science

Center

at San

Antonio,

San

Antonio,

Texas,

United

States

of America

*

Seifi@uth

scsa.edu

Abstract

Background

Recent

interest

in the

study

of concussion

and

other

neurological

injuries

has

heightened

awareness

of the

medical

implications

of American

tackle

football

injuries

amongst

the

public.

Objective

Using

the

National

Emergency

Department

Sample

(NEDS)

and

the

National

Inpatient

Sample

(NIS),

the

largest

publicly

available

all-payer

emergency

department

and

inpatient

healthcare

databases

in the

United

States,

we

sought

to describe

the

impact

of tackle

foot-

ball

injuries

on

the

American

healthcare

system

by

delineating

injuries,

specifically

neurolog-

ical

in nature,

suffered

as

a consequen

ce

of tackle

football

between

2010

and

2013.

Methods

The

NEDS

and

NIS

databases

were

queried

to collect

data

on

all

patients

presented

to the

emergency

department

(ED)

and/or

were

admitted

to hospitals

with

an

ICD

code

for

injuries

related

to American

tackle

football

between

the

years

2010

and

2013.

Subsequently

those

with

football-related

neurologic

al injuries

were

abstracted

using

ICD

codes

for

concussion,

skull/face

injury,

intracranial

injury,

spine

injury,

and

spinal

cord

injury

(SCI).

Patient

demo-

graphics,

length

of hospital

stay

(LOS),

cost

and

charge

data,

neurosurgical

interventions

,

hospital

type,

and

disposition

were

collected

and

analyzed.

Results

A total

of 819,000

patients

presented

to EDs

for

evaluation

of injuries

secondary

to Ameri-

can

tackle

football

between

2010

and

2013,

with

1.13%

having

injuries

requiring

inpatient

admission

(average

length

of stay

2.4

days).

80.4%

of the

ED

visits

were

from

the

pediatric

population.

Of

note,

a statistically

significant

increase

in the

number

of pediatric

concussions

PLOS

ONE

| https://doi.or

g/10.137

1/journal.po

ne.01958

27

May

7, 2018

1 / 10

a1111111111

a1111111111

a1111111111

a1111111111

a1111111111

OPEN

ACCESS

Citation:

McGinity

MJ, Grandhi

R, Michalek

JE,

Rodriguez

JS, Trevino

AM, McGinity

AC, et al.

(2018)

The impact

of tackle

football

injuries

on the

American

healthcare

system

with a neurological

focus.

PLoS

ONE 13(5):

e0195827.

https://doi.org/

10.1371/

journal.pone.

0195827

Editor:

Faramarz

Dehghani,

Martin

Luther

University

, GERMANY

Received:

September

15, 2017

Accepted:

March

23, 2018

Published:

May 7, 2018

Copyright:

©

2018

McGinity

et al. This is an open

access

article

distributed

under

the terms

of the

Creative

Commons

Attribution

License,

which

permits

unrestricte

d use, distribu

tion, and

reproduction

in any medium,

provided

the original

author

and source

are credited.

Data

Availabilit

y Statement:

All relevant

data are

within

the paper

and its Support

ing Information

files.

Funding:

The authors

received

no specific

funding

for this work.

Competing

interests

:

The authors

have declared

that no competing

interests

exist.

over

time

was

demonstrate

d (OR

= 1.1,

95%

CI

1.1

to 1.2).

Patients

were

more

likely

to be

admitted

to trauma

centers,

teaching

hospitals,

the

south

or west

regions,

or with

private

insurance.

There

were

471

spinal

cord

injuries

and

1,908

total

spine

injuries.

Ten

patients

died

during

the

study

time

period.

The

combined

ED

and

inpatient

charges

were

$1.35

billion.

Conclusion

Injuries

related

to tackle

football

are

a frequent

cause

of emergency

room

visits,

specifically

in the

pediatric

population

, but

severe

acute

trauma

requiring

inpatient

admission

or opera-

tive

interventions

are

rare.

Continued

investigation

in the

long-term

health

impact

of football

related

concussion

and

other

repetitive

lower

impact

trauma

is warranted.

Introduction

According

to

the

results

of

the

most

recent

survey

by

The

Harris

Poll

1

, professional

football

has

remained

America’s

favorite

sport

for

the

past

thirty

years

[1].

Owing

to

a heightened

awareness

of

mild

traumatic

brain

injury

(TBI)

sustained

during

tackle

football,

there

has

recently

been

increased

interest

in

understanding

the

medical

consequences

of

football,

specif-

ically

relating

to

neurologic

injuries.

Concussion

and

spinal

cord

injury

(SCI)

have

garnered

significant

attention

in

illustrating

the

potential

dangers

associated

with

playing

football

[2].

In

addition,

researchers

are

currently

investigating

a possible

connection

between

repetitive

head

trauma

from

American

football

and

chronic

traumatic

encephalopathy

(CTE).

Football

players

have

been

shown

to

be

twice

as

likely

to

sustain

a severe

injury

(i.e.,

any

injury

that

resulted

in

a loss

of

>

21

days

of

sports

participation),

than

those

playing

the

next

most

dangerous

sport,

wrestling

[3].

While

efforts

have

been

made

in

implementing

injury

prevention

measures,

as

well

as

incorporating

new

rules

and

safety

regulations

(e.g.,

coach/player

education,

banning

helmet-to-helmet

tackles,

and

institution

of

return

to

play

guidelines),

there

is still

concern

of

the

violent

nature

of

the

sport.

A survey

through

the

Physical

Activity

Council

13

indicated

a

recent

decline

in

youth

football

participation,

with

these

frequently

discussed

risks

potentially

representing

a key

factor

in

parents

discouraging

their

children

to

play.

The

risk

of

injury

associated

with

playing

American

football

is significant

and

this

risk

increases

as

the

competition

advances

[4].

Past

studies

have

reported

all-cause

injury

rates

as

high

as

8 injuries

per

1000

in

high

school

football,

36

per

1000

in

college

football,

and

65

per

1000

in

the

National

Football

League

(NFL)

[5–7].

Furthermore,

football

has

one

of

the

highest

incidences

of

TBI

of

all

major

sports,

and

concussions

have

been

identified

as

one

of

the

most

frequently

occurring

injuries

across

all

ages

[6,8,9].

With

recent

evidence

demonstrating

an

association

between

repetitive

head

trauma

and

long-term

neuropsychiatric

and

cognitive

out-

comes,

concerns

regarding

the

impact

of

repeated

head

injuries

are

especially

noteworthy

given

that

the

majority

of

organized

football

participants

are

of

the

pediatric

age

[10,11].

The

National

Emergency

Department

Sample

(NEDS)

and

the

National

Inpatient

Sample

(NIS)

represent

the

largest

publicly

available

all-payer

emergency

department

(ED)

and

inpa-

tient

healthcare

databases,

respectively,

yielding

national

estimates

on

ED

visits

and

inpatient

stays.

NEDS

and

NIS

are

components

of

a set

of

databases

and

software

tools

developed

for

the

Healthcare

Cost

and

Utilization

Project

(HCUP)

[12,13].

We

aimed

to

assess

the

demograph-

ics

of

patients

injured

and

specific

neurological

injuries

sustained

by

patients

secondary

to

Football

injuries

in the

USA

PLOS

ONE

| https://doi.or

g/10.137

1/journal.po

ne.01958

27

May

7, 2018

2 /

10

figshare

1 / 2

Download

Republished version from July 6, 2018.

(PDF)

S1 File. Republished version from July 6, 2018.

https://doi.org/10.1371/journal.pone.0201273.s001

(PDF)

S2 File. Re

References

1. McGinity MJ, Grandhi R, Michalek JE, Rodriguez JS, Trevino AM, McGinity AC, et al. (2018) The impact of tackle football injuries on the American healthcare system with a neurological focus. PLoS ONE 13(5): e0195827. https://doi.org/10.1371/journal.pone.0195827 pmid:29734348