Decreasing Incidence of Youth Wrestling Injuries: A 10-Year Analysis of National Injury Data

Background: Wrestling is among the most common youth sports in the United States, with about 260,000 high school participants annually. There is a lack of literature investigating wrestling injury profiles and mechanisms of injuries. In the past 15 years, urgent care utilization has increased, and National Federation of State High School Associations (NFHS) concussion protocols have been developed and implemented.

Purpose/hypothesis: The purpose of this study was to analyze causes, diagnoses, body parts, and trends associated with wrestling injuries presenting to US emergency departments. It was hypothesized that there would be (1) decreased overall injuries presenting to emergency departments because of increased urgent care utilization and (2) decreased concussions because of the NFHS rule implementation and revision.

Study design: Descriptive epidemiology study; Level of evidence, 3.

Methods: Youth wrestling injuries presenting to US emergency departments between January 1, 2013, and December 31, 2022, were queried from the National Electronic Injury Surveillance System database. The data included date of presentation, age, sex, race, body part, injury diagnosis, disposition, and a brief injury narrative. National estimates (NE) were calculated using the associated statistical weight of the reporting hospital. Linear regressions were performed to investigate the relationship between year and NE for overall injuries, diagnoses, body parts, mechanisms of injury, and other subanalyses. Statistical significance was set at P < .05.

Results: A total of 8628 (NE = 296,502) wrestling injuries met the inclusion criteria for this study. The mean age at presentation was 14.3 ± 2.6 years (range, 3 to 18 years). The shoulder (NE = 43,207 [14.6%]), head (NE = 40,875 [13.8%]), and knee (NE = 30,218 [10.2%]) were the most injured body parts. The most common diagnoses were strain/sprain (NE = 91,924 [31%]), other/not stated (NE = 53,736 [18.1%]), and fracture (NE = 52,261 [17.6%]). Common mechanisms of injury included not specified (NE = 148,169 [50%]), impact with mat (NE = 61,557 [20.8%]), and abnormal rotation/strain (NE = 37,449 [12.6%]). Overall injuries (P = .01) (coefficient: -1763 [95% CI, -2963 to -563]) and concussions (P = .01) (coefficient: -178 [95% CI, -302 to -55]) statistically significantly decreased.

Conclusions: Our study showed a trend in the decrease in overall injuries and concussions in high school wrestlers. Strains/sprains were the most common diagnoses with the shoulder being the most common site. Youth wrestlers would benefit from future research analyzing risks associated with these injuries as well as advances in protective gear.