1. SPORT MEDICINE CENTRE 1 st World Congress on Sports Injury Prevention Oslo, Norway, June 23-25, 2005 Willem H. Meeuwisse, MD, PhD Key Components of Collection and Classification of Sports Injuries

2. SPORT MEDICINE CENTRE Outline –Key Components 1.Collection Who is collecting? Completeness / precision Injuries and exposure 2.Use of diagnostic coding systems 3.Classification methods By location By type By diagnosis By severity

3. SPORT MEDICINE CENTRE 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

4. SPORT MEDICINE CENTRE Why Surveillance? to identify injury problems estimate public health impact identify risk/causal factors identify possible preventative measures

5. SPORT MEDICINE CENTRE 1. Collection Who is collecting? Trained medical staff (therapist) Student Lay person (coach, parent, player) Payment / honorarium? Motivation, accountability

6. SPORT MEDICINE CENTRE Collection Validation? how complete is reporting? Are sources of error estimated or unknown? Anticipate how this might this affect analysis plan

7. SPORT MEDICINE CENTRE Injury Rates Numerator Counting injuries Denominator Counting exposure

8. SPORT MEDICINE CENTRE Collection of Denominator Number of sessions vs hours Inconsistent across literature Consider purpose of study

9. SPORT MEDICINE CENTRE 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

10. SPORT MEDICINE CENTRE Environmental Factors Environment Facilities, surfaces, equipment Part of the assessment of denominator and risk

11. SPORT MEDICINE CENTRE Exposure in Sport Injury Importance for assessing risk and evaluating prevention a combination of: possessing a risk factor participating in sport with that factor

12. SPORT MEDICINE CENTRE 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

13. Orchard Sport Injury Classification System www.injuryupdate.com.au/research/OSICS.htm

14. University of Calgary Diagnostic Coding System

15. SPORT MEDICINE CENTRE Diagnostic Coding Diagnostic coding systems can affect how data are grouped, analyses, displayed and interpreted

16. SPORT MEDICINE CENTRE 3. Classification Methods By location Body region By type Tissue type, injury type By diagnosis Specific or unique diagnoses By severity

17. Rodeo Injuries

18. SPORT MEDICINE CENTRE Injury Severity “grading” (1 st, 2 nd, 3 rd degree) By time loss Continuous variable Days vs sessions Categorical 1, 2-7, >7 ???? Time loss may be most “objective”

19. SPORT MEDICINE CENTRE Time Loss Same session? Next session? Next day?

20. SPORT MEDICINE CENTRE Return to Play “clearance” affects measurement of time loss Return to full training Return to play Medically cleared? Actual return (e.g., coaching decision)?

21. SPORT MEDICINE CENTRE 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

22. SPORT MEDICINE CENTRE Summary Statements 1.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 used 5.Assumptions and limitations should be stated 6.Be comprehensive in data collection and flexible in the analysis

23. SPORT MEDICINE CENTRE 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

24. SPORT MEDICINE CENTRE Thank You! Willem H. Meeuwisse, MD, PhD Key Components of Collection and Classification of Sports Injuries