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Study of Stanford student athletes provides new insights into injury impacts

October 10, 2015

Before most of the more than 12 million student athletes in the United States are allowed to kick, throw or hit a ball, they must fill out several pages of health forms, often called pre-participation evaluations. This is typically done by hand, as are injury updates, making it difficult for doctors or researchers to draw conclusions about the scale and impact of student athlete injuries.

Now, Stanford physicians have produced a three-year medical report of the university's nearly 1,700 student athletes during that period, providing insight into the lasting impact of injuries in greater detail than ever. The findings also support the value of electronic pre-participation evaluations (ePPE), which were used to track the students' medical records.

Led by Gordon Matheson, a professor of orthopaedic surgery (sports medicine) at Stanford Health Care, researchers collaborated with the athletic department to enroll the school's athletes into an ePPE program.

Students and physicians filled out the cloud-based program with multiple layers of branch-chain questions, which allowed for more thorough recordkeeping than standard handwritten forms.

Injuries that caused student athletes to miss time were recorded. These were mostly musculoskeletal injuries, but also included concussions, eating disorders and illnesses such as infectious mononucleosis. In total, students reported 3,126 injuries – 1,473 for women and 1,653 for men – causing each athlete to miss an average of 31.4 days of competition.

Among the findings, 11 percent of the students still suffered symptoms from a previous injury at the time of their next ePPE. Head injuries accounted for 9 percent of all injuries. Although only 3 percent of women reported a diagnosed eating disorder, 15 percent of all women reported a history of stress fractures, which can be associated with low body fat, from either disordered eating or overtraining.

Matheson said that although the data are eye-opening, interpreting the material and deciding what is particularly meaningful may be an even bigger effort.

"We know that student athletes have a lot of injuries from sport participation. But unless we have pooled, aggregate data like this, it's difficult to measure trends and spot areas of concern applied to prevention," Matheson said.

Going forward, Matheson said that he'd like to drill down on specific types of injuries, such as concussions, or investigate why so many students are still symptomatic at the time of follow-up ePPEs. These types of insights, however, will require a significantly larger and more diverse data set.

"I'd love to collaborate with other schools. Several thousand groups of data would really help us see what the trends are in sport injury and what's going on in this population," Matheson said. "For example, lingering symptoms might mean the offseason isn't long enough for full recovery. Or, what are the criteria to use when determining participation status for a student athlete with characteristics of disordered eating? I think there are findings that could make sports safer."

The study was published in the July issue of The American Journal of Sports Medicine and was co-authored by Scott Anderson and Kevin Robell, also of Stanford.