Differing Risk for Mild TBI and Orthopedic Injury in Youth Sports

Participation in youth sports is associated with differing risks for mild traumatic brain injury (TBI) and orthopedic injury (OI), but overall is linked to better behavioral and emotional, and neurocognitive outcomes in children. This cross-sectional analysis of the Adolescent Brain Cognitive Development (ABCD) study data was published in Brain Injury.

Researchers analyzed ABCD baseline data to compare the risk for mild TBI vs orthopedic injury (OI) in children across different sports. They also examined the relationship between sports participation and children’s physical, behavioral and emotional, and neurocognitive outcomes using generalized linear mixed-effects models.

The study included 11,055 children aged 9 to 10 years, 80% (n=9423) of whom participated in at least 1 organized sport. History of mild TBI was reported in 4.0% (n=378) of children, and OI in 15% (n=1375). Among sport participants, 47% were girls, and the mean (SD) age was 9.93 (0.62) years. The majority of participants were White (57%). Caregiver-reported Child Behavior Checklist (CBCL) internalizing and externalizing T-scores (SD) averaged 48.34 (10.46) and 45.39 (10.07), respectively.

Sport-specific risks differed. Compared with children who never played the sport, soccer participation was associated with higher adjusted odds of both mild TBI (adjusted odds ratio [aOR], 1.462; 95% CI, 1.179-1.817; P =.004) and OI (aOR, 1.155; 95% CI, 1.026-1.299; P =.045). American football was associated with increased mild TBI risk (aOR, 1.471; 95% CI, 1.102-1.935; P =.038). Baseball and basketball were linked to higher OI risk (baseball aOR, 1.203; 95% CI, 1.066-1.358; P =.013; basketball aOR, 1.204; 95% CI, 1.064-1.361; P =.013). Results were adjusted for age, sex, race and ethnicity, parental income and education, and CBCL scores, with multiple-comparison control.

Only climbing showed a significant sport-by-injury interaction. Children who participated in climbing had a higher risk for mild TBI than OI (OR ratio, 1.881; 95% CI, 1.140-3.103; P = .013).

Beyond injury patterns, the analysis found benefits associated with sports participation. Across groups, children who played sports tended to have more favorable behavior and emotion, and neurocognition composite scores. Notably, among children with a mild TBI history, those who played sports had significantly lower (better) behavior and emotion composite scores than their non-sport peers (mean differences, −0.55; 95% CI, −0.99 to −0.11; P =.014). Physical-health composites did not differ meaningfully by injury or participation.

Study limitations include the cross-sectional design, lack of injury timing relative to sport participation, reliance on caregiver report, and analyses restricted to children with complete covariates.

“Our results implied that sports-related injury prevention among children should emphasize sport-specific strategies according to the distinct risks of [mild TBI] and OI,” the study authors wrote.

Disclosures: This research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.