 |
Recreational Injury Interventions
Equipment Modification
Background
Emergency department treated injuries occurring
in the softball and baseball are captured via the NEISS surveillance system. In
the United States, there were an estimated 321,000 ED visits during 1989 for treatment
of these sports related injuries.28 A large proportion (71%) of softball related injuries
are due to sliding into the bases.29 Typical base sliding injuries include
abrasions, sprains, ligament strains and fractures predominately of the lower limbs.
These injuries may result from poor sliding technique, judgment errors or poor physical
conditioning. Breakaway bases have been suggested as a passive, environmental intervention
to reduce sliding injuries. Breakaway bases release from their anchoring system
when subjected to one-fifth the force needed to dislodge a stationary base. Three
studies which evaluated breakaway bases are reviewed below.
Review of breakaway base
studies:
Author | Sendre et al, 1994 |
Study design and target population | Prospective cohort study.
Population: interscholastic, intercollegiate,
recreational, and intramural softball and baseball teams in the Central Michigan
area over 2 seasons, 1990-91. Ages 15-48 years |
Intervention | Hollywood Impact Base (HIB); a breakaway base developed
in 1989. Teams in league rotated play between fields with HIB and those with
standard bases. |
Outcomes | All injuries resulting from sliding or base-running
contact. Injury defined as an acute event that required first aid and prevented
the participant from returning to play during the same practice or game.
All injuries documented by Central Michigan University
sports medicine personnel or umpires and verified by investigators. |
Results | 1 injury per 33,159 athlete exposures with HIB compared
to 4 injuries per 3,999 exposures with standard bases.
RR=0.03 (0.00-0.23) |
Study quality and conclusions | Negligible injury rate using HIB compared to standard
bases.
Good ascertainment of injury. |
Author | Janda et al., 1993 |
Study design and target population | Prospective cohort study.
Population: 8 college and 11 minor league
baseball teams over 2 seasons, 1990-91. |
Intervention | Breakaway bases used on home fields, standard bases
used at away games. Stationary bases used only in 1991 season. |
Outcomes | All sliding injuries (ankle sprains, knee injuries,
shoulder contusions). |
Results | 486 home games (breakaway bases), 498 away games (standard
bases).
10 sliding injuries over 2 seasons. There were 2 injuries
per 100 home games vs 8 injuries per 100 away games. RR=0.2 (0.05-0.80). |
Study quality and conclusions | Use of breakaway bases reduced sliding injuries by
80%.
Managers and trainers of all teams planned to continue
using breakaway bases. |
Author | Janda et al., 1988 |
Study design and target population | Prospective cohort study.
Population: recreational softball teams in
Ann Arbor, Michigan, 2 seasons. Age range 18-55 years. |
Intervention | Breakaway bases vs. standard bases. Teams assigned
to playing fields on a random and rotating basis. |
Outcomes | All sliding injuries requiring first aid. (sprains,
fractures, ligament injuries, slide abrasions). |
Results | 633 games played on breakaway bases, 627 on standard
bases. 47 injuries, 27 (57%) were ankle sprains and fractures. Only 2 injuries
on break away bases. One injury per 18.9 games on stationary base fields compared
to one injury every 316.5 games on the breakaway-base fields. RR=0.04 (0.01-0.17)
Cost of 1 set of breakaway bases was $145
more than a set of standard bases ($295 vs $150). |
Study quality and conclusions | Breakaway bases associated with 96% reduction in sliding
injuries in recreational softball play. Use in recreational softball leagues
could produce significant cost savings. Ascertainment of injuries good. All
injuries recorded by field supervisor and documented by physicians. |
Summary of breakaway base
interventions
Evidence from three separate studies indicates
that use of breakaway bases reduce sliding injuries in baseball and softball by
80-90%. The studies included players of both sexes, ages ranging from 18 to 55 and
covered a broad range of skill levels, from recreational level to minor league.
Recommendations on breakaway
bases
The research evidence strongly suggests that
breakaway bases should be used for all levels of adult baseball and softball competition.
40 million adults play in organized softball leagues playing approximately 23 million
games per year. There are 712 college and 168 minor league teams competing in organized
baseball.32,33
Recommendations for future
research
Studies are needed to determine whether age-appropriate
breakaway bases prevent injury in organized baseball and softball for children.
2. Protective Equipment
Background
In-line skating (also known as rollerblading)
has increased in popularity in the United States from 6.2 million skaters in 1991
to 22.5 million in 1995.34,35 In-line skates have 4 or 5 wheels mounted one behind
the other on a frame attached to a skating boot. Speeds of 10-17 mph are common
for routine cruising, and speeds of up to 30 mph are not unusual.36 Emergency room visits for in-line-skating injuries increased
from 37,000 in 1993 to 100,000 in 1995. The medical care costs of these visits was
$495 million per year. Children 10-14 years of age account for 60 percent of in-line
skating injuries and seventy-five percent of all injuries occur to those between
5 to 24 years of age.37 Injuries tend to be severe with fractures accounting
for almost half of all injuries. Wrist or forearm injuries comprise almost 40 percent
of all injuries with the elbow and head being other common sites.38 One might expect protective equipment such as wrist
guards, knee and elbow pads and helmets would reduce these injuries. To date there
has only been one study which has evaluated these protective devices.
Review of protective equipment
studies:
Author | Schieber et al., 1996 |
Study design and target population | Case-control study.
Population: Subjects treated for in-line skating
injuries at emergency departments participating in the National Electronic
Injury Surveillance System (NEISS). Time period: 12/92-7/93 (N=161) |
Intervention | Wrist guards, elbow pads, knee pads, helmets |
Outcomes | Wrist, elbow, knee or head injury.
Cases: skaters with injuries to wrists, elbows,
knees, or head.
Controls: skaters with injuries to
other parts of the body. |
Results | Wrist injuries most common, 37% of all skating injuries,
2/3 of wrist injuries are fractures. Use of protective devices low among injured
patients.
Odds ratio for wrist injury comparing those
wearing wrist guards to those without is 0.10 (0.03-0.34) adjusted for age
and sex.
Odds ratio for elbow injury comparing
wearers of protective equipment to those with no protection is 0.11 (0.03-0.38)
adjusted for number of lessons and trick skating. Odds ratio for knee injury
for those wearing knee pads was 0.45 (0.14-1.4) |
Study quality and conclusions | Wrist guards and elbow pads are effective in protecting
in-line skaters against injuries. The effectiveness of helmets could not be
assessed because of the small number of head injuries.
Well-designed case control study.
SUDAAN statistical software used to
account for complex sampling, and logistic regression was used to adjust for
confounding factors. |
Summary of protective
equipment interventions
Wrist guards and elbow pads are extremely
effective in reducing injuries to these portions of the body. The data used in this
well conducted case control study were weighted to represent national estimates
of in-line skate injuries. Analysis by Schieber and colleagues35 indicates a 90 percent protective effect for
these protective devices.
Recommendations on protective
equipment
Community wide campaigns should be initiated
to encourage in-line skaters of all ages to wear wrist guards, knee pads, elbow
pads and helmets. These campaigns should be modeled after successful multi-faceted
community-wide campaigns to increase helmet use.39 Helmets are extremely protective against head injuries
for bicyclists even in motor vehicle-bike collisions. One would expect helmets to
be protective for in-line skaters as well.
Recommendations for future
research
Additional case-control studies
should be carried out to evaluate the protective effect of helmets for in-line skating
head injuries. The number of people participating in in-line skating is increasing
each year as evidenced by the increase in emergency department treated injuries.
With a larger population of injured skaters it will be possible to evaluate the
protective effect of helmets and other protective devices.
|