Abstract
Objectives:
Soccer is the second most played sport in America by participation, with upwards of 12 million players nationally in 2018. A majority of those athletes are adolescents and young adults, with 71% of players falling between the ages of 6 and 24. This study aimed to determine if any injury profile differences exist in the intra- and post-COVID eras between male and female soccer players in both high school and college.
Methods:
Deidentified Emergency Department data for the years 2020-2022 were queried using the Consumer Product Safety Commission's National Electronic Injury Surveillance System (CPSC NEISS). The raw data was further stratified for a high school age range of 13-17 and a college age range of 18-24. Each of these age ranges were filtered for diagnosis codes 52, 55, 57, and 64 correlating with concussions, dislocations, fractures, and sprains/strains, respectively. The location filter was set to code 9 for a location of sports and recreation. Using the narrative filter, the resultant cases were limited to those that mentioned “soccer”. The identified patient data for each year was collated for total case counts. A Test of Equal Proportions with a Yates Continuity Correction was performed to compare the rate of individual and categorized injuries by sex within each age range and within the same sex between age groups.
Results:
There were 693, 1371, and 1524 injuries in 2020, 2021, and 2022 respectively, for a total of 3588 injuries. Using statistical weights, this translated to a national estimate of 88,576 soccer-related injuries over that timeframe. Categorically, in each of the three years, males had a higher proportion of fractures when compared to females in the 13-17 age range (p<0.001), while the high school aged females sustained a significantly higher proportion of concussions and sprains/strains (p<0.001). Per specific injury, males experienced a greater rate of clavicular, isolated radial, wrist, nonspecific forearm, finger, and nonspecific lower leg fractures than females aged 13-17 (p<0.001, p<0.027, p<0.001, p<0.001, p<0.025, p<0.029). Conversely, high school aged females were diagnosed with knee and ankle sprains/strains at a higher rate than their male counterparts (p<0.012, p<0.001). There were no significant injury profile differences between college aged male and female soccer athletes. When comparing high school versus college aged males, those in the 13-17 group experienced a larger rate of fractures and concussions, while those in the 18-24 group experienced a greater proportion of dislocations and sprains/strains (p<0.001, p<0.037, p<0.004, p<0.001). College aged males were diagnosed with higher rates of shoulder dislocations, skull fractures, finger fractures, knee sprains/strains, and ankle sprains/strains when compared to their younger counterparts (p<0.001, p<0.007, p<0.001, p<0.001, p<0.05). On the other hand, high school aged male soccer players proportionally sustained more isolated radial, nonspecific forearm, wrist, and pelvic fractures (p<0.001, p<0.001, p<0.002, p<0.002). The only significant difference between high school and college aged females were higher rates of concussions in the 13-17 age group, whereas 18-24 year olds experienced a larger proportion of skull fractures (p<0.01, p<0.01).
Conclusions:
Since 2020, high school aged males experienced a significantly higher rate of fractures, whereas their female counterparts sustained a larger proportion of concussions and sprains/strains. Within males across all age ranges, higher rates of concussions and fractures were found in adolescents, whereas college males were more often diagnosed with dislocations and sprains/strains. Within females across all ages, high school soccer players experienced a larger proportion of concussions, while college players were diagnosed with a higher rate of skull fractures. Injury profiles between males and females soccer players in college showed no significant differences. Current literature surrounding age and skill-level based soccer injury profiling is limited, with most data reflective of the previous two decades. Our findings allow for insight on the intra- and post-COVID athlete, highlighting potential areas for injury prevention based on sex and age, while underscoring injuries of high clinical suspicion commonly seen in soccer players presenting to US emergency departments.