sport medicine centre 1 st world congress on sports injury prevention oslo, norway, june 23-25, 2005...

SPORT MEDICINE CENTRE

1st World Congress on Sports Injury PreventionOslo, Norway, June 23-25, 2005

Willem H. Meeuwisse, MD, PhD

Key Components of Collection and Classification of Sports Injuries


Outline –Key Components1. Collection

• Who is collecting?• Completeness / precision• Injuries and exposure

2. Use of diagnostic coding systems3. Classification methods

• By location• By type• By diagnosis• By severity


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


Why Surveillance?

• to identify injury problems• estimate public health

impact• identify risk/causal factors• identify possible

preventative measures


1. Collection

• Who is collecting?• Trained medical staff (therapist)• Student• Lay person (coach, parent, player)• Payment / honorarium?

• Motivation, accountability


Collection

• Validation?• how complete is reporting?• Are sources of error estimated or

unknown?

• Anticipate how this might this affect analysis plan


Injury Rates

• Numerator• Counting injuries

• Denominator• Counting exposure


Collection of Denominator

• Number of sessions vs hours• Inconsistent across literature• Consider purpose of study


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


Environmental Factors• Environment

• Facilities, surfaces, equipment

• Part of the assessment of denominator and risk


Exposure in Sport Injury

• Importance for assessing risk and evaluating prevention

• a combination of:• possessing a risk factor• participating in sport with that factor


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

Orchard Sport Injury Classification System

www.injuryupdate.com.au/research/OSICS.htm

University of Calgary Diagnostic Coding System


Diagnostic Coding

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


3. Classification Methods

• By location• Body region

• By type• Tissue type, injury type

• By diagnosis• Specific or unique

diagnoses• By severity

Rodeo Injuries


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”


Time Loss

• Same session?• Next session?• Next day?


Return to Play

• “clearance” affects measurement of time loss• Return to full training• Return to play

• Medically cleared?• Actual return (e.g., coaching decision)?


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


Summary Statements1. Collection should be done by trained personnel, with

incentives (pitfalls with volunteers)2. Whenever possible, exposure should be measured

(individual), not estimated (group)3. Error should be measured (or estimated)4. Sport diagnostic coding systems that are “public”

should be used5. Assumptions and limitations should be stated6. Be comprehensive in data collection and flexible in

the analysis


Issues

1. Need consistency in denominator• Athlete exposures (sessions) vs hours

2. Need consistency in measures / categories of severity

• Time loss

3. How do we handle multiple regions / diagnoses?

4. Accurate capture of overuse injuries


Thank You!

Willem H. Meeuwisse, MD, PhD

Key Components of Collection and Classification of Sports Injuries

sport medicine centre 1 st world congress on sports injury prevention oslo, norway, june 23-25, 2005...

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