P3D319: Marching Band Injuries in Children Presenting to Emergency Departments in the United States, 2012-2021: A Trebling Tale

Background: Marching band is both a sport and a performance art. Organized athletics like American football, soccer and cheerleading all have well established epidemiological trends of injury-related morbidity, including stigmata from head trauma. By comparison, marching band, anecdotally leads to injury. Despite this potential for significant morbidity (e.g. mild traumatic brain injury or heat injury), little evidence exists on the epidemiology of marching band related injuries. Our study seeks to close this knowledge gap by characterizing marching band injuries which led to children being evaluated in Emergency Departments (ED) in the United States (US) from 2012-2021.

Methods: The National Electronic Injury Surveillance System (NEISS) database was queried using the product code 1200 (Sports or recreational activity, not elsewhere classified) to search for ED visits in the US. We applied a natural language processing search to evaluate the frequency of injuries in children 0-25 years of age from 2012-2021 whose narrative encounters included “marching” or “band”. Encounters were grouped based on age (10-13 [middle school], 14-18 [high school], 19-25 [college]), sex, and body part affected. Care patterns were investigated for diagnoses and escalation of care. All reported values are population national estimates generated from actual marching band-related injury encounters and were calculated using the NEISS-supplied weights and variance variables. Rao-Scott Chi-square was used for all categorical comparisons.

Results: From 2012 to 2021 there were 20,335 estimated marching band injuries (MBI) from 579 actual cases (95% Confidence interval (95% CI) 12,892- 27,777) (Table 1). Of the MBI recorded, 84% occurred in those aged 14-18 years [i.e., high school] and 71% occurred in females, P < 0.01 and P < 0.01, respectively. The ankle (18%), knee (18%) and upper trunk (10%) were most injured (Table 1). Fifty percent of injuries occurred in the lower extremity. Major diagnoses in descending order of frequency were soft tissue injuries (10,891 (95% CI 6,666-10,492), mild traumatic brain injury (918 (95% CI 437-1,399), heat injury (875 95% CI 261-1,490), and fracture (763 (95% CI 286-1,241) (Figure 1). Of MBI, 98% did not require escalation of care, P < 0.01.

Conclusion: This is the first nationwide estimate of marching band injuries presenting to an ED. Marching band injuries were most likely to occur in high school aged females and soft tissue injuries of the lower extremity were the most common injury pattern observed. Sixteen percent of MBI were serious and included: mild traumatic brain injury, fractures, dislocations and or heat injury. Based on the injuries catalogued and the low rate of care escalation required, we theorize that a high proportion of these ED visits could likely be prevented. The injury patterns described provide an opportunity for targeted public health intervention by sports medicine teams.