Injury and illness surveillance is nearly as old as written text, and the practice of observing and attempting to understand injury and illness phenomena is probably even older. As early as 400 BC, Sun Tzu identified that there was increased incidence of disease amid his warriors when his army camped in swamps as compared to camping in open, dry fields. Greek and Roman physicians documented and developed measures to prevent injuries suffered by their warriors, athletes and gladiators (as evidenced by the protective equipment they wore). However, it was not until the early 20th century that we began to see the underpinnings of modern athletic injury epidemiology with surveillance serving as a key part in the injury prevention process.
Modern athletic injury surveillance began when the media were the first to report catastrophic injuries in American football. Following a string of reports sensationalizing fatalities in the late 19th century, President Theodore Roosevelt nearly banned the sport. It was these same reports that led to the formation of the Intercollegiate Athletic Association of the United States (IAAUS) in 1906, which was later renamed the National Collegiate Athletic Association (NCAA) in 1910. Since the formation of the NCAA and the onset of surveillance of both catastrophic and non-catastrophic injuries, fatalities and injuries of all severity have decreased over the years. Despite vast improvements in student-athlete safety, however, injuries and fatalities continue to occur and require ongoing injury surveillance.
Athletic injury surveillance is the science of documenting, analyzing and interpreting the nature and frequency of injuries and illnesses in athletic or other physically active populations. The data collected in an athletic injury surveillance program provides policy and decision makers the needed information to plan and implement prevention measures. The key tenants of athletic injury surveillance include consistency, sustainability, confidentiality, and feasible recording expectations. Surveillance is useful only if sustained over time, and if the influence of annual and seasonal variation in injury frequencies is minimized. A surveillance program must be financially and logistically sustainable. To include large samples of the population of interest from multiple data collection sites, injury data must be collected in a de-identified and confidential manner. Lastly, recording expectations for the data collectors must add minimal burden and inhibit their other duties.
The NCAA Injury Surveillance Program (NCAA ISP) has been ongoing in some form for nearly 30 years. When the program started in earnest around 1986, personal computers were not prevalent like they are today. Initial injury surveillance efforts relied on paper-pencil reporting methods. The NCAA ISP has relied on athletic trainers who have demonstrated a steadfast commitment to injury prevention. Because of the burden of documenting injuries for both their medical record keeping purposes and the injury surveillance program, many athletic trainers chose not to participate in early injury surveillance efforts. In 2004, an attempt to modernize and to be more inclusive, the NCAA moved to a free online reporting system. The online injury surveillance system was designed to function similar to an online electronic medical record system and it was thought it would reduce the burden of double data entry. Unfortunately, the system competed with some commercial electronic medical record systems, and thereby limited the choices of athletic trainers.
There were several key decisions made in the early 1980’s when the NCAA ISP was conceptualized. These decisions were guided by the need to make the program sustainable with feasible recording expectations for the athletic trainers. These decisions included limiting documented injuries in athletes to only those that missed one day of participation beyond the day of injury (defined as time-loss injuries); furthermore, injuries were only documented during the pre, regular and post-seasons of play. In addition, when athletic injury surveillance was just becoming standardized in the 1980’s, offseason training was not as prevalent at the collegiate and high school levels as it is today. Moreover, as one season finishes, many athletic trainers move from providing coverage for one sport to another that is either beginning or already in-season. For these reasons, little emphasis or effort was aimed at offseason injury data collection.
In an attempt to remain competitive, many student-athletes are participating in offseason training programs. Because of the efforts of the National Center for Catastrophic Sports Injury Research (NCCSIR) we know that student-athletes are at risk of catastrophic injury during offseason training. However, little remains known about the risk of non-catastrophic injury during the offseason. In fact, the current NCAA Injury Surveillance Program does not include offseason injuries in the annual sport reports. This absence is a function of history and perception more than it is a technical limitation. In fact, the modern NCAA ISP managed by the Datalys Center for Sports Injury Research and Prevention, Inc. is equipped to collect offseason injury data.
The Datalys Center began managing the NCAA ISP in 2009 and maintains the NCAA’s injury surveillance data beginning with the 2004 academic year. The Datalys Center NCAA Injury Surveillance Program uses a Common Data Element (CDE) approach. What this means is that the Datalys Center can capture injury and illness data from not only its own Injury Surveillance Tool, but from any commercial electronic health record system that is certified to comply with the Datalys Center Export Engine CDE standard. Currently there are three certified vendors including Flantech Computer Services (SIMS), Keffer Development (ATS), and Vivature NExTT (IMS-2). There are several other vendors undergoing the certification process, but are not certified at the time of publication.
As healthcare practitioners, athletic trainers should document any patient contact as a best practice and as the standard of care. Therefore, even offseason injuries assessed by athletic trainers should be documented. In practice, however, there continue to be real-world limitations that make offseason injury surveillance challenging. These challenges include limited electronic record keeping and limited athletic trainer support for some sport teams. Despite the availability of internet access through personal computers, tablets and smart phones, some athletic trainers continue to keep records via paper-pencil methods primarily due to cost and fears over patient privacy. In addition, many sports at smaller colleges and universities do not have dedicated athletic trainer support or athletic trainers move from sport to sport as seasons end and begin. Lastly, at some colleges and universities, there are no organized offseason practices making collection of exposure data difficult, thus limiting the ability to calculate injury rates for offseason injuries.
Despite these limitations many universities have sufficient technology, staff, and organization to make offseason injury surveillance practical. These efforts will be challenged by institution size and sport; nonetheless, the Datalys Center and the NCAA Sport Science Institute plan to capture these data as both organizations believe this effort is imperative to better understand student-athlete health and safety during offseason training.
Datalys is always seeking additional participants in the NCAA ISP. The program accepts individual athletic trainers and sports teams from a single institution, or multiple athletic trainers and teams from a single institution. Athletic trainers interested in participating should contact the Datalys Center toll-free at 855-832-4222 or visit www.datalyscenter.org.
Datalys Center Mission
To collect and translate — often in collaboration with others — sports participation, injury and treatment data into more effective programs, policies, rules, and education aimed at preventing, mitigating, and treating sports injuries more effectively.
The Datalys Center team includes experts and scientists whose careers have focused on making sports safer through the prevention of injuries. The prevention of injuries begins with understanding the problem through ongoing and consistent injury documentation. The Datalys Center is committed to providing organizations and policy makers with unbiased data and interpretation that can be used to make data driven policy decisions.Last Updated: Jul 11, 2013