Injury incidence and risk factors in youth American football versus soccer: a national emergency department analysis.

Abstract

Objective: To compare the incidence, characteristics, and risk factors of injuries among youth athletes participating in American football and soccer in the United States, with a focus on injuries presenting to emergency departments (EDs) and factors associated with hospitalization.

Methods: A retrospective analysis of the National Electronic Injury Surveillance System (NEISS) database from 2014 to 2023 was conducted. Youth athletes aged 5-10 years (childhood), 11-13 years (early adolescence) and 14-18 years (adolescence) presenting to EDs with football- or soccer-related injuries were included. NEISS provides nationally representative estimates based on a stratified sample of approximately 100 hospital EDs and includes demographic characteristics, injury diagnoses, body regions affected, and patient disposition. Weighted national estimates, standard errors, and 95% confidence intervals (CIs) were calculated. Multivariable regression analysis was performed to identify risk factors associated with hospitalization.

Results: During the 10-year study period, 110,521 injury cases were identified in the NEISS sample, representing an estimated 3,228,911 injuries nationally (95% CI: 2,431,796-4,027,828). Of these, American football accounted for a significantly greater proportion of injuries than soccer (64.7% vs. 35.3%, p < 0.001). No significant temporal increase in injury incidence was observed for either sport between 2014 and 2023. Compared with soccer, football demonstrated significantly higher injury rates across all body regions, including the head/neck, trunk, and extremities (p < 0.001). Multivariable logistic regression identified several factors associated with increased odds of hospitalization, including adolescents aged 14-18 years (OR 1.13, 95% CI 1.02-1.26), male gender (OR 1.92, 95% CI 1.59-2.33), Hispanic ethnicity (OR 1.07, 95% CI 1.02-1.12), and football-related injuries (OR 1.34, 95% CI 1.20-1.50).

Conclusions: Youth athletes participating in American football experience significantly more injuries and a higher risk of hospitalization compared with those participating in soccer. These findings highlight the need for targeted injury prevention strategies aimed at reducing injury severity in youth football.