Competition and training-based surf sport-related injury in Australia

Transcription

1 Competition and training-based surf sport-related injury in Australia January 2012 A TARS Research report for Surf Life Saving Australia Rebecca Mitchell TRANSPORT AND ROAD SAFETY (TARS) RESEARCH TARS Research Report i

2 Table of Contents List of Tables... iii Acknowledgements... iv Abbreviations... v Executive Summary... vi 1. Introduction Method Literature review SurfGuard Incident Reporting Database Data management and analysis Results Surf sport-related injuries literature review Surf sport-related injuries in the SurfGuard Incident Reporting Database Discussion, conclusion and recommendations References TARS Research Report ii

3 List of Tables Table 3.1 Peer-review journal articles involving injuries to surf life savers and/or surf sport-related injuries... 4 Table 3.2 Peer-review journal articles involving medical problems and/or injuries during water sports by topic... 5 Table 3.3 Gender, age group and incident type of surf sport-related injuries in Australia by competition or training event, Table 3.4 Type of activity and contributing factors of surf sport-related injuries in Australia by competition or training event, Table 3.5 Nature of injury and initial treatment of surf sport-related injuries in Australia by competition or training event, TARS Research Report iii

4 Acknowledgements The author wishes to thank Surf Life Saving Australia for providing access to the SurfGuard Incident Reporting Database and for conducting the data extraction. This research was funded by the Surf Life Saving Australia. The support and the assistance of Shauna Sherker, Barbara Brighton, Dave Thompson, Rick Wright OAM and Norm Farmer ESM is appreciated. The research conclusions are those of the authors and any views expressed are not necessarily those of the funding agency. TARS Research Report iv

5 Abbreviations CPR RICE SLSA TARS UNSW Cardio-pulmonary Respiration Rest-Ice-Compression-Elevation Surf Life Saving Australia Transport and Road Safety Research University of New South Wales TARS Research Report v

6 Executive Summary Having information that describes the incidence, circumstances and patterns of injury experienced during sporting activities provides a starting point to examine the burden of sport-related injury and to identify where preventive strategies should be focused. In Australia, surf sport-related injuries have not been examined in detail. The aim of this research is to identify from the peerreview literature injuries involving surf life savers and/or surf sport-related injuries and to describe the epidemiology of competition and training-based surf sport-related injury in Australia. To review the literature, a broad literature search was conducted using a variety of combinations of the key words related to surf injury. The literature search resulted in 73 references, only 8 (11.0%) of which referred to injuries involving surf life savers and/or surf sport-related injuries. To describe the epidemiology of competition and training-based surf sport-related injury in Australia, a retrospective epidemiological review was conducted of surf sport-related injuries in Surf Life Saving Australia s SurfGuard Incident Reporting Database during 1 January 2003 to 20 August There were 2,645 surf sport-related competition or training-related incidents. Males and females experienced similar proportions of injury by activity type, with older individuals experiencing a higher proportion of injuries during training than younger individuals. Minor first aid was required for 54.5% of the competition and 43.7% of the training-related incidents, with major first aid required in just over 10% of both incident types. Overall, inflatable rescue boats, beach flags, and surf boats were the most common activities performed at the time of the incident, with returning to shore and negotiating the break the most common contributing factors to surf boat incidents. Bruises/contusions, strains, inflammation/swelling, and sprains were the most common types of injuries that occurred during both competition and training. RICE Rest- Ice-Compression-Elevation was the most common form of initial treatment for the injury during both competition and training. Participation in surf sports is not without risk of injury. Information from this research will inform injury prevention efforts for surf sport and act as a guide for future research in this area, in particular, and towards improved injury surveillance for surf sport-related injuries. TARS Research Report vi

7 1. Introduction The pattern of injuries that occur during sport and recreational activities are often examined to identify the number, circumstances and causal factors associated with injurious events so as to quantify the injury burden and to identify potential injury prevention strategies [1]. In Australia, the injury epidemiology of one sport in particular has not been previously described in detail, surf sport. Surf Life Saving Australia (SLSA) is the major organiser of surf sport events in Australia [2]. SLSA has a total of 310 affiliated surf life saving clubs and over 158,000 members nationwide [3]. Surf sport carnivals are held at club, regional, state, national and international levels and surf lifesavers compete at these events to maintain their fitness and skills. Surf sport carnivals are held throughout the year and surf sport disciplines include events such as beach flags, beach sprints, swimming, craft paddling (i.e. surf ski or board), surf boat racing, inflatable rescue boat (IRB) racing, or other events, such as ironman or ironwoman championships, where multiple surf sport disciplines are undertaken [4]. In combination with surf sport carnivals, SLSA has a number of development programs for its members where training and practice for surf sport-related events can be undertaken. These programs begin with the junior Nippers surf awareness, surf safe and surf smart programs for those aged 5 to 14 years, to the surf rescue certificate for those aged 13 to 15 years, to the bronze medallion for individuals aged 15 and over, a minimum award required to become a patrolling surf lifesaver [3]. The number and type of injuries associated with surf sport-related events in Australia have not previously been described. In particular, there is no information on the type of injuries that are sustained during surf sport competition, nor while training for surf sport events. The aim of this research is to identify from the peer-review literature injuries involving surf life savers and/or surf sport-related injuries and to the describe the epidemiology of competition and training-based surf sport-related injury in Australia. TARS Research Report 1

8 2. Method This section describes the research that was conducted. Section 2.1 describes the conduct of the literature review and Section 2.2 outlines the analysis of the SLSA SurfGuard Incident Reporting Database. Ethics approval for the research was received from the University of New South Wales (UNSW) Human Research Ethics Panel (Social/Health Research) (HREA ref 9_11_017) on 30 August 2011 and this was ratified by the UNSW Human Research Ethics Committee (HREC ref 11360) on 2 September Literature review A broad literature search has been conducted by searching the following databases Medline, PsychINFO, Embase, Web of Science, Health and Safety Science Abstracts, Scopus, Google Scholar, and SPORTDiscus using a variety of combinations of the key words including: surf sport, injury, swimming, open water, surf ski, kayaking, board paddling, surf boat, surf rescue, surf carnival, ironman, inflatable surf rescue boats, IRB, triathlon, and triathlete. All searches were restricted to English language articles. The database literature search resulted in 73 references. To access the grey literature, an was prepared by UNSW and sent by SLSA to contact allied organisations, such as fellow members of the International Life Saving Federation, to see if their organisation had conducted any research on surf sport injuries or if they were aware of any research being conducted in the area, or if they had any information on the number of surf sport injuries that have occurred in their local area or country. Three replies were received and no members indicated that they had conducted any research on surf sport injuries. 2.2 SurfGuard Incident Reporting Database A retrospective review of injury information was conducted using information recorded in SLSA s SurfGuard Incident Reporting Database during 1 January 2003 to 20 August SLSA s SurfGuard database includes information recorded by SLSA staff and volunteers on incidents that involve: (i) major first aid (i.e. an incident where a person has been treated and will need further follow up medical treatment); (ii) minor first aid; (iii) major rescue (i.e. a rescue where a person who required assistance was returned to shore, or place of safety, and who, without assistance TARS Research Report 2

9 would have drowned or become injured); (iv) search and rescue; (v) drowning; and (vi) any injuries that have occurred during a surf club competition, a surf patrol, training for competition, carnivals, or during other SLSA endorsed activities. Information recorded includes basic demographics of the person injured or rescued, the incident type, the contributing factors to the incident, and the nature of any injuries received. Potential surf sport-related injury records were identified in the SLSA SurfGuard database by searching for the following incident types: carnival incident OR occurring during the following activity type: training for ; carnival official doing ; competition in ; competition IRB driver ; competition IRB crew ; OR competition IRB patient. This method identified n=779 records. SLSA s Surfguard database was also searched for the following activity types: training for ; carnival official doing ; competition in ; competition IRB driver ; competition IRB crew ; OR competition IRB patient. This method identified n=2,764 records. 2.3 Data management and analysis Data analysis was performed using SAS version 9.1 [5]. There was some duplication of records identified based on either the incident type or the activity performed. Duplicate records were removed using a unique identifier, leaving 3,006 records potentially relating to surf sport injury. Incident types were grouped into: (i) major first aid, including drowning and major stings, (ii) minor first aid, including minor stings, (iii) carnival incidents, and (iv) other incidents, such as employee injuries or complaints. To examine the association between sex, age group and activity type, a chisquare test of independence was used [6]. 3. Results The results are presented in two Sections. Section 3.1 describes the outcomes of the literature review and Section 3.2 describes the analysis of the SurfGuard Incident Reporting Database. TARS Research Report 3

10 3.1. Surf sport-related injuries literature review Of the 73 references identified, only eight (11.0%) articles referred to injuries involving surf life savers and/or surf sport-related injuries (Table 3.1). The remaining articles most commonly related to injuries of triathletes and/or triathlons (30.8%), while kayaking, white water rafting and/or canoeing (15.4%) or while partaking in general aquatic sports activities, such as rafting, sailing, surfing, wind surfing (15.4%)(Table 3.2) Table 3.1 Peer-review journal articles involving injuries to surf life savers and/or surf sportrelated injuries Peer-review journal articles Ashton, L. and Grujic, L., Foot and ankle injuries occurring during inflatable rescue boats (IRB) during surf lifesaving activities. Journal of Orthopaedic Surgery, (1): p Bigby, K., McClure, R., and Green, A., The incidence of inflatable rescue boat injuries in Queensland surf lifesavers. Medical Journal of Australia, (15 May): p Draper, J., Pyne, D., Thompson, K., and Fricker, P., Injury occurrence in surfboard and surf ski paddlers. Australian Journal of Science and Medicine in Sport, (1): p Erby, R., Heard, R., and O'Loughlin, K., Trial of an injury reporting system for surf lifesavers in Australia. Work, : p Fell, J. and Gaffney, P., Physiological profiles of Australian surf boat rowers. Journal of Science & Medicine in Sport, (2): p Ludcke, J., Pearcy, M., Evans, J., and Barker, T., Impact data for the investigation of injuries in inflatable rescue boats (IRBs). Australasian Physical and Engineering Sciences in Medicine, (2): p Pen, L., Barrett, R., Neal, R., and Steele, J., An injury profile of elite ironman competitors. Australian Journal of Science and Medicine in Sport, (1): p Yorkstein, E., Arthur, C., Barker, T., Purdie, D., and McClure, R., Inflatable rescue boat-related injuries in Queensland surf lifesavers: the epidemiology - biomechanics interface. International Journal of Injury Control and Safety Promotion, (1): p TARS Research Report 4

11 Table 3.2 Peer-review journal articles involving medical problems and/or injuries during water sports by topic Topic n % Triathletes/ Triathlons Kayaking, white water rafting and/or canoeing General aquatic sports activities e.g. rafting, sailing, surfing, windsurfing Surfing Adventure wilderness racing, including aquatic events, such as flat water boating Swimming Fitness standards for beach lifeguards History of Surf Life Saving Iron men performance (non-injury) Water safety information TOTAL Surf sport-related injuries in the SurfGuard Incident Reporting Database Of the 3,006 records identified, 2,645 (88.0%) were either engaged in surf sport-related competition (48.2%, n=1,448) or training in surf-related activities (39.8%, n=1,197) at the time of the injury, with the remaining individuals engaged in other activities. Of the 2,645 surf sportrelated competition or training-related incidents, there was no significant difference between the proportion of males and females who experienced an injury by activity type (p=0.5), but there was a significant difference for age group (χ²=50.1, df=7, p<0.0001), with individuals 35 years and older experiencing a higher proportion of injuries during training than younger individuals. During competition, minor first aid represented just over half (54.5%) of the incidents, while during training minor first aid accounted for 43.7% of incidents. Major first aid represented just over 10% of incidents during both competition and training, with 14.4% of incidents that occurred TARS Research Report 5

12 during competition identified as occurring during a carnival. Other incident types were more common during training than competition (43.5% versus 17.9%, respectively) (Table 3.3). Table 3.3 Gender, age group and incident type of surf sport-related injuries in Australia by competition or training event, Competition (n=1,448) Training (n=1,197) n % n % Gender Male Female Not specified Age group < 15 years years years years years years years Not specified Type of incident Minor first aid Major first aid Carnival incident Other incident type Including two deaths during competition. Activities involving IRBs were the most common type of activity being performed at the time of the incident for both competition (19.5%) and training (29.9%). Incidents involving beach flags (13.8%) and surf boat racing (11.3%) were common during competition events, while activities related to achieving a Bronze Medallion (15.1%) and the board (12.9%) were common during training activities. There were 1,311 and 1,347 contributing factors identified for incidents occurring during competition and training events, respectively. Returning to shore and TARS Research Report 6

13 negotiating the break were the most common contributing factors to the incident for both type of events (Table 3.4). Bruises/contusions, strains, inflammation/swelling, and sprains were the most common types of injuries that occurred during both competition and training events. Just over half of the competition (54.5%) and training (51.0%)-related surf sport injuries were initially treated with Rest-Ice-Compression-Elevation (RICE) (Table 3.5). Just less than 40% of individuals who were injured during competition or training were not referred for further treatment (39.6% and 36.1%, respectively). For the remaining individuals that were injured during competition or training, just less than one-quarter were referred to a medical practitioner (22.2% and 26.0%, respectively), with 14.9% and 20.1%, respectively, transported by ambulance to hospital, 5.2% and 4.3%, respectively, referred to a physiotherapist, and the remaining individuals were referred for treatment to other or unknown services (18.0% and 13.5%, respectively). For the three most common types of activities, sprains (16.0%) and strains (15.3%), bruising/contusion (12.4%), inflammation/swelling (12.3%), fractures (10.3%), and dislocations (10.1%) were the most common type of injuries experienced during both competition and training for IRB events. Fractures (19.9%), sprains (16.5%), strains (14.6%), inflammation/swelling (14.2%) and bruising/contusions (13.1%) were the most common type of injuries experienced during competition and training for beach flags. Bruising/contusions (25.3%), open wounds/lacerations/cuts (19.1%) and inflammation/swelling (13.2%) were the most common type of injuries experienced during training and competition for surf boats. TARS Research Report 7

14 Table 3.4 Type of activity and contributing factors of surf sport-related injuries in Australia by competition or training event, Competition (n=1,448) Training (n=1,197) Type of activity n % n % Inflatable rescue boat Beach flag Surf boat Board Surf ski Beach sprint Iron man/ Iron woman event Board race Australian titles Swim Board rescue Surf race Bronze Medallion Surf Rescue Certificate Nippers Other Contributing factors 1 Returning to shore Negotiating the break Collision with Lost control of own craft Other person lost control of craft Pot hole Dumped Slip/ trip/ fall Freak wave Shore break Sand bank Other Not known More than one contributing factor could be identified for each incident. TARS Research Report 8

15 Table 3.5 Nature of injury and initial treatment of surf sport-related injuries in Australia by competition or training event, Competition (n=1,448) Training (n=1,197) Nature of injury 1 n % n % Bruise/ contusion Strain Inflammation/ swelling Sprain Open wound/ laceration/ cut Fracture (including suspected) Abrasion/ graze Dislocation/ subluxation Respiratory problem Suspected spinal Heat stroke / heat exhaustion Marine sting Other Initial treatment RICE/ ICE Rest, Ice, Compression, Elevation Dressed (including bandage) Cleaned Oxygen therapy Sling / splint Strapping/ taping only Spinal collar None given Other Not known More than one nature of injury could be identified for each incident. TARS Research Report 9

16 4. Discussion, conclusion and recommendations From the literature review, it does not appear that surf sport-related injuries and/or injuries involving surf lifesavers have been extensively studied and reported in the peer-review literature, with only eight articles being identified. Three articles related to research that had been conducted on IRBs and related injuries, one article each examined injuries in surf board and surf ski paddlers, surf boat rowers, and elite ironman competitors, and one article reviewed a trial of an injury reporting system for surf lifesavers. The examination of data from the SurfGuard Incident Reporting Database has provided the first known epidemiological review of competition and training-based surf sport-related injury in Australia. Males and females experienced a similar proportion of injuries, whether during training or competition. Likewise, competitors at a national surf carnival in Queensland experienced a similar proportion of injuries by gender [7]. The current study found that older individuals experienced a higher proportion of injuries during training than younger individuals, but without information on time exposed, it is difficult to comment on why this may be so, as associations have been found between time spent training and sustaining an injury in triathletes [8], and older individuals could be more susceptible to overuse and strain injuries than younger individuals [9]. Overall, IRBs, beach flags, and surf boats were the most common activities performed at the time of the incident during competition. Similarly, a review of work-related compensated injury claims in New South Wales during found that injuries to surf lifesavers commonly occurred in IRBs and surf boats [7]. Injuries and biomechanical impact on surf lifesavers during IRB operation have been investigated by several authors [10-13] who, upon review of workers compensation claims, found fracture and fracture/dislocations of the lower limbs to be common compensated injuries [13]. The difference to the results of the current study is likely to arise as the more severe injuries, such as fractures, that require medical treatment are more likely to be reported and result in compensation, as oppose to more minor injuries, such as sprains and strains. Injuries requiring minor first aid, such as RICE, were the most common during both competition and training, with returning to shore and negotiating the break, the most common contributing factors of the incident identified. Erby et al [7] also found that superficial injuries, such as TARS Research Report 10

17 bruising/contusions and strains and sprains, were common injuries sustained during a national surf carnival that were treated with RICE. Likewise, Erby et al [7] found negotiating a surf break and returning to shore to be common contributing factors for injury during competition. There are several limitations of the analyses conducted. The categories for recording the incident type and incident location were not mutually exclusive. For example, if an incident required major first aid, it was not possible to also select that this incident occurred at a carnival and vice versa. Similarly, it was not possible to accurately identify which incidents occurred in the water versus on the beach. Data collectors often recorded the type of the event (e.g. Bronze Medallion), rather than the activity being conducted at the time of the incident (e.g. swimming), so specific activity information was absent. Data quality and completeness was variable as many of the data variables required text or multiple responses. No information was available regarding the number of competitors per event or time exposed, which would have enabled the calculation of injury rates per event or time exposed. Lastly, the data validity of the SLSA SurfGuard database has not been assessed, so results from these analyses should be interpreted with care. However, SLSA SurfGuard is the only available surf-related incident database in Australia. Conclusion Taking part in surf sport-related activities is not without risk of injury. This research has shown that particular types of injuries are associated with some surf sports, whether they are conducted during competition or training. This study will inform injury prevention efforts for surf sport and act as a guide for future research in this area, in particular prospective data collection, using a modified data collection form, at competition events regarding injuries sustained is recommended as a first step toward improved injury surveillance. Recommendations Recommendations stemming from this research largely focus on improvements in the injury surveillance capabilities of SLSA. Basic improvements in the SLSA SurfGuard Incident Reporting Database will allow for improved extraction of records for data analysis, better recording of data, and, ultimately, improved information to use for research and injury surveillance purposes. TARS Research Report 11

18 1. Exporting function It is recommended that the export function on the SurfGuard Incident Reporting Database is enhanced, so that the export of an unlimited number of data variables is possible in one query function. The ability to select cases, based on a range of inclusion criteria would also be ideal. This would remove the need to export the data in batches. 2. Data dictionary and data classification It is recommended that a Data Dictionary be developed for the SurfGuard Incident Reporting Database, so information is available on the classification frameworks that are used for each variable within the SurfGuard Incident Reporting Database. Data collectors often recorded the type of the event (e.g. Bronze Medallion), rather than the activity being conducted at the time of the incident (e.g. swimming), so specific activity information is absent. The data dictionary needs to clearly indicate what information should be recorded for each data variable. It is recommended that a standard format be adopted and included in the data dictionary for the classification of other, not relevant, and not known data items. It is common practice for other to be categorised as 97 or 997 or 9997, depending on the number of codes in the classification coding frame. Likewise, not relevant is commonly coded as 98, 998 or 9998 and not known as 99, 999 or The use of symbols, such as ;, should be discouraged from inclusion in the database. 3. Numerical data versus text It is recommended that the data retained and/or exported from the SurfGuard Incident Reporting Database should be in numerical codes, rather then text as numerical codes are easier to analyse in statistical packages. It is possible to have numerical and text information in drop drown menus in database packages, such as Microsoft Access, but have only the numerical codes retained for data export. In a few cases, text variables should be included, such as to describe other options or for text descriptions of the event. 4. Data variables: mutually exclusive It is recommended that for each data variable, only one piece of information should be recorded. For example, if an incident required major first aid, it was not possible to also select that this TARS Research Report 12

19 incident occurred at a carnival and vice versa. Similarly, it was not possible to accurately identify which incidents occurred in the water versus on the beach Each data variable should also contain only one piece of information. This was not the case for the following variables: contributing factors, referred to, other services, treating person, nature of injury, body part, and incident type and it is recommended that additional data variables be added to accommodate the number of data items recorded. For example, up to seven contributing factors are recorded within the one variable. This is not ideal for data analysis. Using the example of contributing factors, this variable should be turned into seven variables to accommodate all the data items listed (e.g. CF1, CF2, CF3 etc). For nature of injury and body part, up to five injuries are recorded in nature of injury and up to four body locations in body part. As is, it is not possible to identify which injury corresponds to which body part. It is recommended that additional data variables be added to enable the identification of each injury and its bodily location e.g. Injury Nature of injury Body part Injury 1 Nature of injury 1 Body part 1 Injury 2 Nature of injury 2 Body part 2 Injury 3 etc 5. CPR/Oxygen Report Form It is recommended that the need for the patient condition information requested on the CPR/Oxygen Report Form be reviewed. During the conduct of the data analysis for this report, almost all of this information was missing (e.g. range between 92.9% to 99.8% missing). 6. Exposure data No information was available regarding the number of competitors per event or time exposed, which would have enabled the calculation of injury rates per event and/or time exposed. It is recommended that the number of competitors at SLSA events be recorded to facilitate the calculation of exposure-based injury incident rates for SLSA competition events. TARS Research Report 13

20 7. Modified data collection form It is recommended that SLSA modify its data collection form for the SurfGuard Incident Reporting Database in line with the recommendations above and pilot test the new form during a SLSA competition event as a first step toward improving SLSA s injury surveillance capabilities. TARS Research Report 14

21 5. References 1. van Mechelen, W., Hlobil, H., and Kemper, H., Incidence, severity, aetiology and prevention of sports injuries. A review of concepts. Sports Medicine, (2): p Brawley, S., 'Surf lifesaving owes no person a living': a third sector case study. Labour history, (Nov): p Surf Life Saving Australia. Surf Life Saving Australia [cited December 2011]; Available from: 4. Surf Life Saving Australia, Australian Surf Sports Manual, No , Surf Life Saving Australia: Sydney. 5. SAS Institute, SAS: statistical software, version , SAS Institute: Cary, North Carolina. 6. Armitage, P., Berry, G., and Matthews, J., Statistical Methods in Medical Research. Fourth Edition ed. 2002, Cornwell: Blackwell Science. 7. Erby, R., Heard, R., and O'Loughlin, K., Trial of an injury reporting system for surf lifesavers in Australia. Work, : p Shaw, T., Howat, P., Trainor, M., and Maycock, B., Training patterns and sport injuries in triathletes. Journal of Science & Medicine in Sport, (4): p O'Toole, M., Hiller, W., Smith, R., and Sisk, D., Overuse injuries in ultraendurance triathletes. The American Journal of Sports Medicine, (4): p Yorkstein, E., Arthur, C., Barker, T., Purdie, D., and McClure, R., Inflatable rescue boatrelated injuries in Queensland surf lifesavers: the epidemiology - biomechanics interface. International Journal of Injury Control and Safety Promotion, (1): p Ashton, L. and Grujic, L., Foot and ankle injuries occurring during inflatable rescue boats (IRB) during surf lifesaving activities. Journal of Orthopaedic Surgery, (1): p Ludcke, J., Pearcy, M., Evans, J., and Barker, T., Impact data for the investigation of injuries in inflatable rescue boats (IRBs). Australasian Physical and Engineering Sciences in Medicine, (2): p Bigby, K., McClure, R., and Green, A., The incidence of inflatable rescue boat injuries in Queensland surf lifesavers. Medical Journal of Australia, (15 May): p TARS Research Report 15