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Int J Sports Med 2023; 44(05): 313-319
DOI: 10.1055/a-1983-0040
Review

Why Median Severity and Ordinal Scale Severity Values should not be used for Injury Burden Results: A Critical Review

Colin W Fuller
1   Colin Fuller Consultancy Ltd, Main Street, Sutton Bonington, UK
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Abstract

Injury burden is a composite measure of injury incidence and mean severity; this parameter has been reported as an output measure from injury surveillance studies in rugby for over 20 years. The benefits of reporting injury burden results have, more recently, been recognised in other sports. This wider use of injury burden as an output measure from injury surveillance studies has, however, highlighted misunderstandings about how to calculate, present and interpret injury burden data. The aim of this critical review is to explain why median severity and ordinal severity scales should not be used to calculate and report injury burden results in injury surveillance studies. Equations are presented to show how injury burden results should be calculated, and graphs and tables are presented to explain the errors that are introduced when median severity and ordinal scales of severity are used instead of mean severity. This critical review is intended to highlight the correct procedures for calculating, reporting and interpreting injury burden results in order to avoid incorrect results, conclusions and injury prevention recommendations being published.

Key words

surveillance - risk - prevention


Publication History

Received: 22 September 2022

Accepted: 08 November 2022

Article published online:
20 January 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Fuller CW. Catastrophic injury in rugby union: is the level of risk acceptable?. Sports Med 2008; 38: 975-986
    CrossrefPubMedGoogle Scholar
  • 2 Fernandes GS, Parekh SM, Moses JP. et al. Prevalence of knee pain, radiographic osteoarthritis and arthroplasty in retired professional footballers compared to the general population: A cross-sectional study. Br J Sports Med 2018; 52: 678-683
    CrossrefPubMedGoogle Scholar
  • 3 Fuller CW, Drawer S. The application of risk management in sport. Sports Med 2004; 34: 349-356
    CrossrefPubMedGoogle Scholar
  • 4 Fuller CW, Junge A, Dvorak J. Risk management: FIFA’s approach for protecting the health of football players. Br J Sports Med 2012; 46: 11-17
    CrossrefPubMedGoogle Scholar
  • 5 Fuller CW, Vassie LH. Health and Safety Management: Principles and Best Practice. Harlow: FT Prentice Hall. 2004
    PubMedGoogle Scholar
  • 6 Fuller CW. Assessing the return on investment of injury prevention procedures in professional football. Sports Med 2019; 49: 621-629
    CrossrefPubMedGoogle Scholar
  • 7 Fuller CW. Managing the risk of injury in sport. Clin J Sport Med 2007; 17: 182-187
    CrossrefPubMedGoogle Scholar
  • 8 Drawer S, Fuller CW. Evaluating the level of injury in English professional football using a risk based assessment process. Br J Sports Med 2002; 36: 446-451
    CrossrefPubMedGoogle Scholar
  • 9 Palmer-Green D, Hunter G, Jaques R. et al. Methods for epidemiological study of injury and illness in Great Britain Olympic sport: the injury/illness performance project. Proceedings of the IOC World Conference on Prevention of Injury & Illness in Sport, Monte-Carlo, Monaco, April 2011. Abstract available at: Br J Sports Med 2011; 45: 367
    PubMedGoogle Scholar
  • 10 Palmer-Green D, Fuller CW, Jaques R. et al. The Injury/Illness Performance project (IIPP): A novel epidemiological approach for recording the consequences of sports injuries and illnesses. J Sports Med (Hindawi Publ Corp) 2013; 2013: 523974
    PubMedGoogle Scholar
  • 11 Orchard JW, Newman D, Stretch R. et al. Methods for injury surveillance in international cricket. Br J Sports Med 2005; 39: e22
    CrossrefPubMedGoogle Scholar
  • 12 Fuller CW, Ekstrand J, Junge A. et al. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Clin J Sport Med 2006; 16: 97-106
    Google Scholar
  • 13 Fuller CW, Molloy MG, Bagate C. et al. Consensus statement on injury definitions and data collection procedures for studies of injuries in rugby union. Clin J Sport Med 2007; 17: 177-181
    CrossrefPubMedGoogle Scholar
  • 14 Brooks JHM, Fuller CW, Kemp SPT. et al. Epidemiology of injuries in English professional rugby union: Part 1 – Match injuries. Br J Sports Med 2005; 39: 757-766
    CrossrefPubMedGoogle Scholar
  • 15 Quarrie KL, Hopkins WG. Tackle injuries in professional rugby union. Am J Sports Med 2008; 36: 1705-1716
    CrossrefPubMedGoogle Scholar
  • 16 Fuller CW, Taylor A. Eight season epidemiological study of match injuries in women’s international rugby sevens. J Sports Sci 2021; 39: 865-874
    CrossrefPubMedGoogle Scholar
  • 17 Bahr R, Clarsen B, Derman W. et al. International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sports 2020. Br J Sports Med 2020; 54: 372-389
    CrossrefPubMedGoogle Scholar
  • 18 Fuller CW. Injury risk (burden), risk matrices and risk contours in team sports: a review of principles, practices and problems. Sports Med 2018; 48: 1597-1606
    CrossrefPubMedGoogle Scholar
  • 19 Cohen L, Holliday M. Practical Statistics for Students. London: Paul Chapman Publishing Ltd; 1998
    Google Scholar
  • 20 Materne O, Chamari K, Farooq A. et al. Shedding light on incidence and burden of physeal injuries in a youth elite football academy: a 4-season prospective study. Scand J Med Sci Sports 2022; 32: 165-176
    CrossrefPubMedGoogle Scholar
  • 21 Materne O, Chamari K, Farooq A. et al. Injury incidence and burden in youth elite football academy: a four-season prospective study of 551 players aged from under 9 to under 19 years. Br J Sports Med 2021; 55: 493-500
    CrossrefPubMedGoogle Scholar
  • 22 Wik EH, Lolli L, Chamari K. et al. Injury patterns differ with age in male youth football: a four-season prospective study of 1111 time-loss injuries in an elite national academy. Br J Sports Med 2021; 55: 794-800
    CrossrefPubMedGoogle Scholar
  • 23 Nordstrom A, Bahr R, Talsnes O. et al. Prevalence and burden of health problems in male elite ice hockey players. A prospective study in the Norwegian professional league. Orthop J Sports Med 2020; 8: 2325967120902407 DOI: 10.1177/23259671209007.
    Google Scholar
  • 24 Nordstrom A, Bahr R, Clarsen B. et al. Prevalence and burden of self-reported health problems in male elite ice hockey players: a 44-week prospective cohort study. Am J Sports Med 2021; 49: 3379-3385
    CrossrefPubMedGoogle Scholar
  • 25 Worner T, Thorberg K, Clarsen B. et al. Incidence, prevalence, severity and risk factors for hip and groin problems in Swedish male ice hockey: a one-season prospective cohort study. J Athl Train 2022; 57: 72-78
    CrossrefPubMedGoogle Scholar
  • 26 Mann RH, Clarsen BM, McKay CD. et al. Prevalence and burden of health problems in competitive adolescent distance runners: a 6-month prospective cohort study. J Sports Sci 2021; 39: 1366-1375
    CrossrefPubMedGoogle Scholar
  • 27 Martinez-Silvan D, Wik EH, Alonso JM. et al. Injury characteristics in male youth athletics: a five-season prospective study in a full-time sports academy. Br J Sports Med 2021; 55: 954-960
    CrossrefPubMedGoogle Scholar
  • 28 Gram MCD, Clarsen BM, Bo K. Injuries and illnesses among competitive Norwegian rhythmic gymnasts during preseason: a prospective cohort study of prevalence, incidence and risk factors. Br J Sports Med 2021; 55: 231-236
    CrossrefPubMedGoogle Scholar
  • 29 Clarsen B, Steffen K, Berge HM. et al. R. Methods, challenges and benefits of a health monitoring programme for Norwegian Olympic and Paralympic athletes: the road from London 2012 to Tokyo 2020. Br J Sports Med 2021; 55: 1342-1349
    CrossrefPubMedGoogle Scholar
  • 30 Steffen K, Clarsen B, Gjelsvik H. et al. Illness and injury among Norwegian Para athletes over five consecutive Paralympic Summer and Winter Games cycles: prevailing high illness burden on the road from 2012 to 2020. Br J Sports Med 2022; 56: 204-212
    CrossrefPubMedGoogle Scholar