There is a paucity of literature regarding pediatric and adolescent sport-related abdominal injuries. One local study in Australia over a 6 year period between 2001 and 2006 identified 6 % of abdominal injuries in children were related to organized sports, 15 % to skateboards/scooters/bike/roller blades and skates, and 21 % to recreational activity [48]. Most injuries occurred in males, aged 11–12 years, and the majority of injuries resulted from rugby, soccer, and bat/ball games [48]. The most common mechanism was collision in males followed by falls in females [48]. Soft tissue injuries and lacerations were the most common diagnoses and the majority (94 %) were minor injuries managed conservatively [48].

In children and youth aged 10–19 years, more than 40 % of head injuries presenting to Canadian EDs were SRIs [1]. Head injuries include contusions/abrasions, lacerations, and traumatic brain injuries (TBIs), which include skull fractures, hemorrhages and concussions. Head injuries/TBIs occurred most often in males (about 70 %) [28, 49–52] and in children aged 10–14 years participating in most activities [23, 49–52].

In the USA, 6.5 % of all SRIs were TBIs which accounted for approximately 173, 285 ED visits by children annually [28]. Most TBIs were in children and adolescents 10–19 years old (70.5 %) [28]. TBIs were most common in bicycling, football, basketball, and soccer [28, 48]. Admission rates varied from 6.6 to 24 % [28, 49, 51, 52]. Head injuries/TBIs account for varying percentages of injuries in different sports and recreational activities (Fig. 2.3) [14, 18, 20, 23, 28, 46].

The incidence of TBIs has increased in the last 10–15 years. One study found that the incidence of sports-related TBIs increased 62 % from 2001 to 2009 and the estimated rate of injury increased 57 % from 190 per 100,000 population to 298 (likely because of increased awareness and increased ED visits for TBI) [28]. Another study found the incidence of sports-related TBIs increased 92 % over a 10-year period from 2002 to 2011 [48].

Although incidence rates have increased, admission rates for sports-related TBIs have remained stable [52] and injury severity has decreased, as evidenced by decreased mean injury severity score (ISS) from 7.8 in 2002 to 4.8 in 2011 and decreased length of stay (LOS) [52]. In admitted patients, football (24.7 %) and baseball/softball (12.9 %) were the most common sports responsible [49].

Sport-related concussions (SRC) are a significant concern in the pediatric and adolescent population. SRCs accounted for half of concussions in the pediatric age group in the USA [29] and resulted in 3–17 % of all injuries in any specific sport [9, 11]. The number of SRCs has been increasing in the last decade: US ED visits for SRCs in 8–13-year-olds doubled from 1997 to 2007 and increased by >200 % in 14–19-year-olds [29]. Admission rates for concussions were one of the highest for all SRIs (24.2 % in one study) [52].

Most SRCs occurred in males (71.6 %) [52]. Sixty percent of SRCs occurred in adolescents aged 14–19 years and 40 % in children aged 8–13 years [29, 52]. One quarter of SRCs occurred during organized team sports (OTS), most commonly football, basketball, soccer, ice hockey and baseball, although 47 % of SRCs in 14–19-year-olds occurred during OTS [29, 52]. Concussion rates per 10,000 participants were highest for ice hockey (10 in 7–11-year-olds, 29 in 12–17-year-olds) and football (8 in 7–11-year-olds, 27 in 12–17-year-olds) [29].

Most SRCs in Canada occurred in males 10–14 years of age playing ice hockey and accounted for 11.4 % of all injuries in hockey in this age group [9]. However, the highest percentage of SRCs was reported in 5–9 year old females in ringuette; SRCs accounted for 17.1 % of all injuries sustained in ringuette [9]. The lowest percentage of SRCs occurred in volleyball [9]. The most common mechanism resulting in SRCs were falls and contact with another person or object [11, 52].

One local US ED study found that 27 % of cervical spine injuries in children were sports-related; 29 % of these injuries resulted from football [53]. Almost all of these injuries occurred exclusively in boys, with an average age of 13.8 years [53]. The majority of SRIs (75 %) showed spinal cord injury without radiological abnormality (SCIWORA) and 75 % involved the upper spine from C1–C4 (75 %) [53]. The worst injuries occurred with diving [58].

Craniofacial injuries result in significant severity and morbidity. One study found that 45.5 % of patients were admitted, 15 % of those to the ICU, and 31.1 % required surgery [54]. Ten per cent of craniofacial injuries were SRIs and the majority of these injuries occurred in boys (80.8 %) with a peak incidence between 13 and 15 years (40.7 %) [54]. Nasal (35.9 %), orbital (33.5 %), and skull fractures (30.5 %) were the most common diagnoses [54]. Of SRIs, baseball and softball were the most common sports involved (44.3 %) [54]. The most common mechanisms resulting in injury were throwing, catching or hitting a ball (34.1 %) and collision with other players (24.5 %) [54].

SRIs accounted for about 13.8 % of dental injuries, most commonly in baseball (40.2 %), basketball (20.2 %), and football (12.5 %) [30]. The majority of sports-related dental injuries occurred in 13–17-year-olds and 76.6 % of sports-related dental injuries occurred in males [30].

Similar results were found in a local study in Victoria, Australia, which found that 13.5 % of pediatric dental injuries resulted from sports activities, including soccer, cricket, basketball, netball, and hockey [55]. The most common mechanism of sports-related dental injuries resulted from striking or colliding with an object [55].

SRIs accounted for 24 % of pediatric eye injuries [31]. Eye injuries were most common in basketball (18 %), baseball and softball (17 %), and football (16 %) [31]. The majority of injuries occurred in males and in the 10–14 year age group [31]. Injury incidence peaked during May, June, July (36 % of SRIs) and were most likely to be the result of contact with another person [31].

Approximately 36.4 % of pediatric hand injuries were SRIs [32]. Basketball (28.2 %), football (22.7 %), baseball (5.8 %), and soccer (4.0 %) were the most common sports resulting in hand injuries [32]. Patients aged 10–14 years were most likely to be injured in sports (55.6 %) and in sports/recreational facilities (55.1 %) [32]. The most common diagnosis was fracture (35.0 %); more than 70 % of pediatric hand fractures resulted from sports [32].

Heat-related illnesses are a concern with outdoor sports played during warm weather and are on the rise. Heat-related injuries increased 133.5 % over a 10 year period from 1997 to 2006 [33]. The majority of EHIs in pediatric and adolescent patients occurred during sport or exercise, most commonly football and exercise [33, 34]. The majority of heat-related injuries occurred in males and in adolescents aged 15–19 years and 10–14 years [33, 34]. Admission rates for heat-related illnesses was 7–9.6 % [33, 34].

The majority of knee injuries were SRIs and occurred in males [35]. The most common diagnosis was sprains/strains, followed by contusion/abrasions and lacerations/punctures [35]. In patients aged 5–14 years, the most common sports were football, bicycling, and soccer; in patients aged 15–24 years, basketball and football were the most common sports [35].

A violent injury is defined as any injury resulting from physical force by one or more persons with the intent of causing harm, injury or death to another person [3]. In the USA, 0.25 % of SRIs in children and adolescents were violent injuries [3]. The highest incidence rate was for 10–14-year-olds (13.6 per 100,000) and the majority were in males (71.6 %) [3]. Most injuries occurred during basketball (20.8 %), and bicycling (19.3 %) [3]. Most violent injuries occurred during bicycling for 10–14-year-olds (26.7 %), and in basketball for 15–19-year-olds (45.3 %) [3]. Most violent injuries were to the head/neck (52.2 %), of which 24.1 % were TBIs, and 23.6 % to the arm/hand [3]. The most common diagnoses were contusions/abrasions (32.7 %), lacerations/punctures (19.3 %), fracture (18.8 %), and concussion (12.6 %) [3]. The mechanism of injury was most commonly being pushed or hit (65.6 %) and most injuries occurred at a sports/recreation place (27.1 %) or at school (25.8 %) [3]. Most injuries were not severe and only 1.2 % of patients were admitted [3].

Soft tissue injuries (34.3 %) and fractures (18.4 %) were the most common diagnoses in baseball [13]. Face (33.5 %) and upper extremity (32.9 %) injuries were most common [13].

The most common injuries in basketball were sprains/strains followed by fractures/dislocations [9, 14]. Sprains/strains occurred most often in the lower extremity (30.3 %), most commonly the ankle (23.8 %), whereas fractures/dislocations occurred most often in the upper extremities (15.1 %), mostly in the finger (8.4 %) [14]. In a small local US study, however, fractures were found to be the most common injury in basketball [45].

US national data indicated that the most frequent body parts injured in basketball were lower extremities (42.0 %), upper extremities (37.2 %), and head (16.4 %) [14]. The ankle was injured most often (27.3 %), followed by fingers (20.2 %) [14]. A local US study found that ankle and foot injuries (44 %), hand injuries (21 %) and forearm/wrist injuries (13 %) were most common [5]. Canadian data showed that digits (22 %), ankles (16 %), and head (11 %) were the most frequently injured body parts [10].

Contusions/abrasions (30.4 %), lacerations (29.9 %), and fractures (18.8 %) were the most common injuries [15]. The majority of fractures (78 %) were to the upper extremities. There were 1,965 deaths in children and adolescents resulting from bicycling in the USA between 1990 and 2005, mostly from head injuries in the 15–18 year age group [15].

In a local US study, head (14 %) and forearm/wrist injuries (26 %) were most common [5]. Canadian data found that face (15.3 %), head (13.1 %), and forearm (11.5 %) injuries were most common [10]. US national data showed that the most frequently injured body parts were upper extremities (32.7 %), lower extremities (24.1 %), face (21.4 %), and head (12.4 %) [15]. Another US national study indicated that the most frequent body parts injured were the face (decreased with age), upper extremity (fractures), and skin/soft tissue (increased with age) [46].

Lacerations (33.9 %) and soft tissue injuries (24.3 %) were the most common diagnoses [16]. Head/neck injuries (38.2 %) and face injuries (21.7 %) were most common [16].

The most common injuries were sprains/strains (31.3 %), fractures/dislocations (28.4 %), and soft tissue injuries (23.7 %) [17]. A US national study found that the upper extremities (49.1 %), lower extremities (26.2 %), and the head/neck/face (16.0 %) were most commonly injured [17]. The most common injury was upper extremity fracture (21.8 % for boys, 24.8 % for girls) [18]. A local US study found that hand injuries were most common (25 %) [5].

The most common injuries were sprains/strains (44.5 %), fractures/dislocations (30.4 %), and contusions/abrasions (15.6 %) [18]. The most frequently injured body parts were upper extremity (42.3 %), lower extremity (33.8 %), and head/neck (12.9 %) [18].

Two US national studies found similar percentages of injuries attributed to contusions/abrasions (23.6–26.9 %), fractures (17.3–17.5 %), and sprains/strains (16. 9–17.3 %) [19, 20]. TBIs accounted for 14.1 % of ice hockey-related injuries [20] and 9 % of injuries in patients 2–18 years of age were concussions [19].

Studies were inconsistent with respect to the most commonly injured body parts in hockey. Canadian data indicated that head and face injuries were most common [10]. One US study using national data found face (19.1 %), wrist/hand/finger (14.1 %), shoulder/upper arm (13.8 %), and lower leg/ankle/foot (11.1 %) injuries were most common [19]. Another US study found that upper extremity (44 %), head (16.3 %), and lower extremity injuries (16.1 %) were most frequent [20].

In karate, taekwondo and judo, most injuries occurred in karate (79.5 %) [21]. The most common diagnoses in all martial arts were sprains/strains (29.3 %), contusions/abrasions (27.8 %) and fractures (24.6 %) [21], but these varied somewhat within specific types of martial arts. In karate, sprains/strains (30.0 %), contusions/abrasions (28.3 %), and fractures (24.6 %) were most common. In taekwondo, sprains/strains (33.4 %), fractures (28.1 %), and contusions/abrasions (24.3 %) were most common. In judo, fractures (27.3 %), contusions/abrasions (25.4 %), and sprains/strains (24.1 %) were the most frequent injuries [21].

In all disciplines, most injuries occurred to the lower limb/ankle/foot (30.1 %) and hand/wrist (24.5 %) [21]. Anatomic injury sites differed with discipline. In karate and taekwondo, lower leg/ankle/foot (31.0 %/31.8 %), hand/wrist (25.8 %/22 %), and face (9.6 %/10.9 %) injuries were most common [21]. In judo, shoulder/upper arm (19.1 %), lower leg/ankle/foot (16.0 %), and elbow/lower arm (14.9 %) were the most frequently injured body parts [21]. Participants in judo suffered more upper limb/shoulder and neck injuries than in karate and taekwondo [21].

Sprains/strains were the most common injuries (51.5 %) [22]. Lower extremity injuries were the most common (64.4 %), most often the ankle (31.4 %) [22].

The most common injuries were soft tissue injuries (49.0 %/40.5 %), fractures (26.3 %/35.7 %), and TBIs (7.2 %/8.3 %) [23]. The most frequently injured body parts were the knee (22.7 %), head/face (15.7 %), and shoulder (15.6 %) in skiing, and the wrist (17.9 %), arm (16.6 %), and head/face (16.6 %) in snowboarding [23].

Sprains/strains (36.7–38 %), fractures/dislocations (23.1–31 %) and contusions/superficial injuries (20.9–23 %) were the most common SRIs [11, 24]. Fractures were most common in the youngest age group, whereas sprains/strains were more common in older age groups [24]. The most common injuries were to the lower extremity, usually ankles and knees, followed by upper extremity and head/face/neck [5, 10, 11, 24]. Females sustained more lower limb injuries whereas males sustained more hand and head injuries [10]. Body parts injured varied depending on age: wrist (12.7 %) and finger (12.4 %) injuries were most common for children 5–9 years of age; ankle (15.7 %) and wrist (13.6 %) injuries for children aged 10–14 years; ankle (21.9 %) and knee (17.6 %) injuries for the 15–18 year age group [24].

Sprains/strains (31.3 %) and soft tissue injuries (27.0 %) were the most common diagnoses in softball [25]. Hand/wrist injuries were fractures/dislocations (40.2 %), strains/sprains (26.5 %) and soft tissue injuries (24.6 %), whereas face injuries were mainly lacerations (38.5 %), soft tissue injuries (32.8 %), and fractures/dislocations (22.2 %) [25]. Hand/wrist injuries (22.2 %), of which fingers accounted for 12.6 %, and face injuries (19.3 %) were most common [25].

The most frequent injuries were soft tissue injuries (54.7 %), sprains/strains (16.4 %), fractures/dislocations (11.3 %), and submersion (4.9 %) [26]. Children <7 years of age were most likely to be injured by submersion [26]. The most frequently injured body parts were the head/neck (37.0 %) (face most common 43.9 %), and lower extremity (33.3 %) (foot most common 45.5 %) [26].

Sprains/strains represented the majority of injuries (54 %) [27]. Upper extremity (48 %) and lower extremity (39 %) injuries were most common [27]. Of upper extremity injuries, finger injuries were most common (48 %); of lower extremity injuries, ankle injuries were most common (65 %) [27].

Being hit by the baseball (46.0 %), hit by bat (24.9 %), and sliding (9.6 %) were the most common mechanisms of injury [13]. Sliding was more likely to result in fracture and admission [13].

Collision with board/platform (43.9 %) was the main mechanism of injury [16].

Handsprings/flips (42.3 %) and cartwheels/roundoffs (30.7 %) were the most common mechanisms [18].

The most common mechanism were falls (16.5 %), contact with boards (13.6 %) and contact with stick (13.0 %) [19].