Prospective Study on Effects of Sports Participation on Brain Injury versus Orthopedic Injury in the Adolescent Brain Cognitive Development Study

Abstract

Youth sports are popular in the United States and provide many physical and social benefits for children. However, sports participation is also a major source of pediatric traumatic injuries, including mild traumatic brain injury (mTBI) and orthopedic injury (OI). Previous studies have identified certain sports associated with higher risks of mTBI and/or OI, but are limited to retrospective data. The aim of this study is to prospectively examine the association between individual sports and the risk of mTBI and OI using longitudinal data from the Adolescent Brain Cognitive Development (ABCD) study. We analyzed longitudinal data from 11,332 children at the 1-, 2-, and 3-year follow-ups (ages 10–13 years) from the ABCD study. Participation in 23 sports and the incidence of mTBI and OI were reported by parents at each visit. Generalized linear mixed-effects models with subject-level random intercepts were used to fit the longitudinal data, adjusting for age, sex, race/ethnicity, parental income, parental education, and children’s behavior problems. The results indicated that most sports showed a decline in participation rate over time. Children who played soccer had higher risks of mTBI, odds ratio (OR) = 1.320 (1.075, 1.621), p = 0.008, and OI, OR = 1.208 (1.057, 1.379), p = 0.005, compared with those who did not (95% confidence interval in parentheses). Children who played American football also had higher risks of mTBI, OR = 1.639 (1.238, 2.171), p < 0.001, and OI, OR = 1.405 (1.159, 1.704), p ≤ 0.001, compared with those who had not. Children who played ice hockey had a significantly higher risk of mTBI than OI, ratio of odds ratio = 2.700 (1.445, 5.043), p = 0.002. Finally, children who played volleyball exhibited lower risks of mTBI, OR = 0.442 (0.234, 0.835), p = 0.012, than those who did not. Sensitivity analyses adjusting for additional behavioral and neurocognitive variables and restricting the analysis sample to children who played at least one sport in the 3-year interval showed consistent findings. The findings suggested that sports-specific differences exist in injury risks, and sport-specific and injury-specific prevention strategies are needed in youth sports.