Comparison of Basketball-Related Injuries at US Emergency Departments Between High School-Aged and College-Aged Athletes: A 10-Year NEISS Analysis, 2015-2024
Orthopaedic journal of sports medicine · 2026
High schoolers show 2.7x the ED basketball-injury rate of college athletes, but the study can't separate 'more injured' from 'more likely to end up in an ED.'
Lo studio
Descriptive epidemiological study using the NEISS database, n=61,279 documented ED visits (weighted to ~2,023,859 national estimates), basketball players aged 14-23, 2015-2024.
Cosa hanno trovato
High school-aged athletes (14-18) had 2.72 times the ED injury incidence of college-aged athletes (19-23): 686.67 vs 252.63 per 100,000 person-years (95% CI, 2.67-2.77). The gap was widest for concussion (IRR 6.64, 95% CI 5.81-7.58) and hospital transfer/admission (IRR 7.61, 95% CI 5.26-10.99).
Disegno dello studio
Retrospective descriptive epidemiological study using the National Electronic Injury Surveillance System (NEISS), a probability sample of US emergency departments, analysing an estimated 61,000+ weighted basketball-related ED visits among 14-23 year olds over a 10-year period (2015-2024). This sits low on the evidence hierarchy for causal claims, it is registry surveillance data, not a controlled or exposure-matched cohort study.
Metodologia
NEISS relies on ICD-coded ED presentations weighted up from a sample of hospitals, so case ascertainment depends entirely on coding accuracy and consistent 'basketball-related' flagging across sites, a detection bias that cannot be audited from the abstract. The core limitation is selection and denominator bias: incidence rates use general age-group population counts rather than basketball participants or athlete-exposures, so the comparison conflates true injury risk with differences in participation rates, sideline medical coverage, and referral thresholds between high school and college settings. There is no control for confounders such as game intensity, rule differences, or access to on-site athletic trainers, and no attrition or follow-up issues apply since this is a cross-sectional capture of ED visits rather than a longitudinal cohort. A clinician should treat the IRRs as a measure of ED burden by age group, not injury risk per exposure, until studies pair NEISS or similar data with verified participation or exposure counts.
La valutazione
With over 61,000 raw cases the confidence intervals are tight and the statistical signal is real, but 'higher ED incidence' is not the same as 'higher injury risk per game played.' Because the denominator is general population rather than basketball participants or athlete-exposures, the headline IRRs plausibly reflect a mix of higher participation, less on-site medical coverage, and more conservative ED referral in high school athletes rather than a true biological or mechanical difference in injury susceptibility.
Il limite
An exposure-adjusted denominator, ideally athlete-exposures or verified participation numbers by age group, is needed before any claim about differential injury risk (as opposed to differential ED burden) can be trusted.
Studio di riferimento
This extends a long line of NEISS-based descriptive basketball injury papers and sits alongside participation-based surveillance systems like High School RIO and the NCAA Injury Surveillance Program, which use actual athlete-exposure denominators and are the more valid tools for comparing injury rates across levels of play; this study cannot substitute for that comparison.
Cosa fare da lunedì
Doesn't change individual patient management. It's a reasonable data point for programs and school boards to push for better sideline medical coverage and concussion protocols at the high school level: the higher transfer/admission rate in high-schoolers likely reflects, at least in part, fewer on-site athletic trainers available to triage and manage on the sideline, not proof that high school injuries are inherently more severe than college ones. EDs should expect a heavier, more urgent basketball caseload from high-school-aged players than college-aged players during season.
In practice
This applies to clinicians and S&C staff around high school basketball programmes, especially any without a dedicated athletic trainer courtside. In clinic, when a HS player presents post head-knock or ankle roll, don't treat the raw IRR gap as evidence HS players are biologically more injury-prone than college players; ask what medical coverage was on site at the time of injury, since thin sideline triage capacity plausibly drives both the higher ED presentation rate and the higher transfer/admission rate seen here. For S&C and programme leads, use this paper as advocacy leverage, not a training variable: push for qualified sideline medical staff and a written concussion action plan at HS level, and don't adjust conditioning, load, or return-to-play criteria off the back of it, since NEISS carries no athlete-exposure denominator and can't tell you anything about per-player risk or what training variables might modify it.
I cinque studi che contano — ogni settimana, gratis.
Leggiamo tutta la letteratura di medicina dello sport, riabilitazione e performance e valutiamo gli studi che meritano il tuo tempo.
Ricevi il numero settimanale gratuitoLeggi nella tua lingua: English · Français · Deutsch · Español · Italiano · Nederlands · Dansk · Svenska