A catastrophic injury is a severe injury to the spine, spinal cord, or brain. It may also include skull or spinal fractures. This is a subset of the definition for the legal term catastrophic injury, which is based on the definition used by the American Medical Association.
The National Center for Catastrophic Sport Injury Research in the United States classifies catastrophic injuries based on the three outcomes associated with them: fatality, those causing permanent severe functional disability, and those causing severe head or neck trauma with no permanent disability. A fatal injury may be a direct result of trauma sustained during an activity or may occur indirectly. The indirect nonfatal catastrophic injury may occur as a result of systemic failure from exertion during an activity, such as from cardiovascular conditions, heat illness, exertional hyponatremia, or dehydration, or a complication to a nonfatal injury. Indirect fatalities are usually caused by cardiovascular conditions, such as hypertrophic cardiomyopathy and coronary artery disease.
Fatal injury may reveal an unknown "underlying anatomical, or physiological abnormality". Individuals with certain anatomical anomalies should not participate in some activities. For example, contact sports are contraindicated for individuals with an anomalous odontoid process, as any violent impact may result in a catastrophic injury. This is because a malformed odontoid process may lead to instability between the atlas and axis (the C1 and C2 cervical vertebrae). Those with atlanto-occipital fusion should also avoid contact sports.
By activity Participation in any sport or recreational activity may result in a catastrophic sports injury, particularly if unsupervised or if engaged with little or no protection. Direct fatalities in sport are rare, as most sport fatalities are indirect and associated with non-sport cardiovascular problems.
In the United States, American football has the greatest incidence of catastrophic injury per population, whereas cheerleading is associated with the greatest incidence of direct catastrophic injury at both the interscholastic and intercollegiate levels.
Cervical spine trauma is most common in sports and activities involving contact and collision, particularly American football, rugby, ice hockey, gymnastics, skiing, wrestling, and diving. A 2005 report by the National Center for Catastrophic Sport Injury Research in the United States stated that sports requiring attention for potential catastrophic injuries are American football, ice hockey, baseball, wrestling, gymnastics, and track and field.
The incidence of catastrophic injury is four times higher in college than in high school in the United States. Sport accounts for between 5% and 10% of all cervical spine and spinal cord injuries in the United States, and 15% in Australia. The incidence of catastrophic injury for all sports is low, less than 0.5 per 100,000 participants.
A study in the province of Ontario in Canada based on epidemiological data from 1986, 1989, 1992, and 1995 states that the greatest incidence of catastrophic injuries occurred in snowmobiling, cycling, ice hockey, and skiing. Of the 2,154 reported catastrophic injuries, 1,756 were sustained by males and 368 by females. The only activity in the study in which female casualties outnumbered males was equestrianism. The study also stated that field and floor sports had a relatively low incidence of catastrophic injury, and that July had the highest incidence of injury. Drowning was the cause of 357 fatalities, and there were 640 head and 433 spine injuries.
The study found 79.2% of the injuries were preventable; from over 1,500 responses, 346 involved alcohol consumption, and 1,236 were not supervised. Most alcohol-related injuries were sustained in snowmobiling (124), fishing (41), diving (40), boating excluding canoeing (31), swimming (31), riding an all-terrain vehicle (24), and cycling (23). Other studies have concluded that alcohol consumption is a common risk factor "associated with all types of exposure" (that is, activities) for traumatic brain injury.
Classification of sports by contact The American Academy of Pediatrics has classified sports based on the likelihood of collision and contact. It recommends against participation in boxing.
Those classified as contact and collision sports include basketball, boxing, diving, field hockey, football, ice hockey, lacrosse, martial arts, rodeo, rugby, ski jumping, soccer, team handball, water polo, and wrestling.
Those classified as limited contact include baseball, bicycling, cheerleading, whitewater canoeing and kayaking, fencing, floor hockey, flag football, gymnastics, handball, horseback riding, racquetball, skating (ice skating, inline skating, roller skating), skiing (cross-country skiing, downhill skiing, water skiing), skateboarding, snowboarding, softball, squash, ultimate frisbee, volleyball, and windsurfing or surfing, and the track and field events high jump and pole vaulting.
Sports classified as non-contact include archery, badminton, body building, bowling, flatwater canoeing and kayaking, curling, dancing, golf, orienteering, power lifting, race walking, riflery, rope jumping, rowing, running, sailing, scuba diving, swimming, table tennis, tennis, weightlifting and weight training, the track and field events discus, javelin, and shot put and all track events.
American football From 1945 to 2005, there were 497 fatalities, of which 69% were a result of brain injury and 16% from spinal cord injury. Today, the most common catastrophic injury in American football is cervical spinal cord injury, which is also the "second leading cause of death attributable to football". The 84% reduction in head injuries and 74% reduction in fatalities is directly attributable to the implementation of NOCSAE standards for football helmets and rule changes for tackling.
Football has the highest incidence of cervical spinal cord injuries in the United States per population. From 1977 to 2001, the incidence of cervical spinal cord injury amongst high school, college, and professional participants was 0.52, 1.55, and 14 per 100,000 participants, respectively.
From 1982 to 1988, 75% of direct fatalities and 40% of indirect fatalities in college sports were associated with football; for high school athletes, the rates were 75% and 33%, respectively. Indirect fatalities were usually caused by cardiac failure or heat exhaustion. Indirect fatalities in high school and college football have been attributed to heat stroke, heart-related conditions, viral meningitis, and even lightning strikes.
The most common mechanism for catastrophic cervical spinal cord injury in American football is axial loading or compression resultant from spear tackling, in which a player uses the crown of the helmet as the initial point of contact for striking another player. This form of tackling was banned in 1976 for high school and college football, resulting in a significant reduction in catastrophic injuries of this type. For example, incidence of quadriplegia decreased from 2.24 and 10.66 per 100,000 participants in high school and college football in 1976, to 1.30 and 2.66 per 100,000 participants in 1977. Since 1977, about 67% of all catastrophic injuries in football were the result of a player making a tackle.
In the paper Catastrophic Football Injuries: 1977-1998 published in 2000 by the journal Neurosurgery, Robert Cantu and Frederick Mueller recommend that "players should use the shoulder for blocking and tackling" instead of "using the head as a battering ram". The purpose of rules against spearing, ramming, and butting is to protect both the tackler and the opponent from head trauma or catastrophic injury. Mueller also suggests that coaches remove players from a game if they exhibit symptoms of concussion, such as dizziness, headaches, nausea, or sensitivity to light.
Baseball Baseball has a high incidence of catastrophic injury, the most common being cranial injuries usually sustained during a collision between a baserunner diving head first and a fielder, resulting in an axial compression injury to the baserunner. Other causes included collisions, such as between a catcher and baserunner, or being struck by a pitched, thrown, or batted ball.
Canoeing In a 2008 study, all catastrophic injuries recorded for recreational canoeing were fatal, and accounted for 4.3% of all sport and recreation fatalities in the province. Of the 27 cases, 24 fatalities resulted from drowning, and the others from cerebral contusions, cerebral lacerations, and skull fractures. Canoeing drowning fatalities are "often correlated with alcohol consumption", as it increases the probability of submersion and decreases the probability of recovery from submersion. They are often associated with young males inexperienced in canoeing.
Cheerleading
The primary cause of increased incidence of catastrophic injuries to cheerleaders is the "evolution of cheerleading to a gymnastic-like activity". It is the leading cause of catastrophic injuries to females, representing over 65% of the catastrophic injuries occurring in high school and college female athletes in the United States.
High-risk activities include the construction of pyramids, which result in several catastrophic injuries each year, the 'basket toss', and tumbling, all of which are usually performed over hard surfaces. Cheerleader pyramids are banned in Minnesota and North Dakota.
Other causes include inadequate supervision, poorly trained coaches, and the equipment used.
Fishing In the Ontario study, fishing resulted in 126 catastrophic injuries, of which 117 were fatal, 110 from drowning. Of these, 119 events were associated with males, of which 112 were fatalities. Fishing had the highest rate of catastrophic injuries to all injuries for any activity in Ontario, as 2.54% of all fishing injuries were catastrophic.
Catastrophic injuries in fishing may be related to equipment, fish, alcohol, or the environment. Equipment issues generally involve penetrative injuries from the use of hooks and harpoons, but may also be caused by the fishing rod, lure, sinker, or bait. Fish-related injuries result from mishandling, poisoning, and contamination from consumption. Environmental causes may include overexposure to solar radiation, lightning strikes, hypothermia during ice fishing, snakebites, and viral infection spread by mosquitoes.
Gymnastics Gymnastics has a relatively low incidence of catastrophic injury, that is the number of catastrophic injuries with respect to the number of participants. In the United States from 1982 to 2007, nineteen catastrophic injuries were reported from 147 million high school and 8 million college participants.
Club-level injury surveillance data in Australia indicate no catastrophic injury to elite participants from 1983 to 1993. Elite gymnast catastrophic injuries to the spinal cord have been recorded in China, Japan, and the United States, the most notable being to Sang Lan and Julissa Gomez. There is an "absence of research reporting rate data" for catastrophic injury to club-level gymnasts in the United States.
Ice hockey The most common catastrophic injury occurring in ice hockey is cervical spinal cord injury, which most often occur at C5, C6, or C7. The most common cause is checking from behind, resulting in a player falling headfirst into the glass or boards. Such checking was banned from hockey in 1985, which has resulted in a decreased incidence of catastrophic spinal injuries and a reduction of head and neck injuries.