Baseball: The Safest Sport for High School Athletes?

LAS VEGAS — Annual surveys of high school athletic coaches show that of the nine major sports, boys’ soccer has the highest injury rate and baseball the lowest, researchers here reported.

But ranked by severity, wrestling was the most dangerous for boys, with 9.6% of injuries sustained in the sport requiring surgery, according to a study by medical student Jordan Pizzarro, BS, of George Washington University in Washington, DC, and colleagues. Girls’ basketball was a close second at 7.6%.

Pizzarro and colleagues reported the findings at the American Academy of Orthopedic Surgeons (AAOS) annual meeting.

The group relied on data for 2015-2019 from the High School Reporting Information Online (RIO) program, an offshoot of the National High School Sports-Related Injury Surveillance Study. Coaches at 100 nationally representative US high schools submit injury data to RIO weekly, including the sport involved, what activity the injury occurred in (training vs. competing), the type of injury, and how it was treated. In order to be reportable, an injury must be attended to by healthcare professionals and result in a limitation of exercise for at least 1 day.

Approximately 15,500 injuries across nine sports were reported to RIO during the study period of 6.8 million “sporting exposures,” which the researchers defined as an athlete participating in a training or competitive session. That gave a rate of 2.29 injuries per 1,000 exposures.

The injury rates per 1,000 exposures for the nine sports analyzed were, in descending order:

• Boys soccer: 3.96
• Girls soccer: 2.65
• Boys wrestling: 2.36
• Girls basketball: 2.03
• Boys soccer: 1.78
• Boys Basketball: 1.54
• Softball girls: 1.35
• Girls Volleyball: 1.31
• Boys baseball: .89

The odds for all boys’ sports were 2.52 per 1,000 and the corresponding figures for girls’ sports were 1.86 per 1,000.

RIO data for 2005-2006 had shown an overall injury rate of 2.51 per 1,000 exposures. “The overall injury rate has gone down, which you would think is great, but you also have to look at the types of injuries that are occurring,” Pizzarro said in an AAOS press release.

“We are seeing an increase in head and neck injuries, particularly concussions, as well as more serious injuries and those requiring surgery. Many organizations have adopted guidelines for safety equipment and injury prevention; it is questionable whether they are applied correctly,” added Pizzarro.

In most sports in the new data, head and facial injuries were the most common (18% to 29% of all injuries), but ankles suffered the most in three sports: girls’ volleyball and boys’ and girls’ basketball. Knee injuries were the second or third most common injuries in all sports.

The proportion of head injuries in 2015-2019 was higher than in the 2005-2006 RIO data, leading investigators to believe preventive measures were not as effective as hoped. “Play intensity, physical contact and collisions” appear to be increasing in high school athletics, Pizzarro and colleagues indicated, “which may offset the use of protective gear” such as helmets with face shields.

The vast majority of injuries occurred during games and fights versus training, with a ratio of 3.39 across all categories. However, it varied widely: injuries were six times more common in boys’ soccer games than in training, while in girls’ volleyball the ratio was just 1.61.

Strains and sprains were the most common type of injury (37% across all sports, range 29% to 48%), but concussions were not far behind at 22% of all injuries. Perhaps surprisingly, boys’ football was not the worst in this respect – 28% of girls’ football injuries were concussions, versus 24% in football. The sport with the fewest shakes was boys’ baseball at 12%.

Fractures were relatively rare in all sports. The highest rate was in boys’ baseball, where fractures accounted for 8.4% of all injuries. Girls’ sports were generally much less likely to have fractures (2.0% of all injuries versus 4.2% for all boys’ sports).

In terms of severity (as indicated by the proportion of injuries requiring surgical correction), volleyball and softball appeared to be the safest for girls, with rates of 3.17% and 3.71%, respectively. Boys’ soccer injuries required surgery at a rate of 7.37%.

“Future studies should focus on improving preventative measures, developing appropriate approaches to reduce concussion risk, and examining surgical procedures and their association with return to play,” concluded Pizzarro’s group.