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Pickleball-Related Injuries Treated in Emergency Departments
The Journal of Emergency Medicine, Vol. -, No. -, pp. 1–5, 2019 Ó 2019 Elsevier Inc. All rights reserved. 0736-4679/$ - see front matter
https://doi.org/10.1016/j.jemermed.2019.09.016
Selected Topics: Sports Medicine PICKLEBALL-RELATED INJURIES TREATED IN EMERGENCY DEPARTMENTS Mathias B. Forrester, BS Independent Researcher, Austin, Texas Reprint Address: Mathias B. Forrester, BS, 4600 Monterey Oaks Boulevard, #F2335, Austin, TX 78749
, Keywords—pickleball; racquet sport; injury; emergency department
, Abstract—Background: Pickleball is a paddle sport that combines many of the elements of tennis, badminton, and ping-pong. It is reported to be one of the faster growing sports in the United States and is popular among older adults. There is limited published information on pickleball-related injuries. Objective: The objective of this study was to describe pickleball-related injuries treated in U.S. emergency departments (EDs). Methods: An analysis was performed of pickleball-related injuries using data from the National Electronic Injury Surveillance System (NEISS) of the U.S. Consumer Product Safety Commission during 2001–2017. Results: A total of 300 pickleballrelated injuries were identified, resulting in a national estimate of 19,012 injuries. The annual estimated number of injuries increased during 2013–2017. Patients 50 years or older accounted for 90.9% of the patients; 50.4% were male. The injury occurred at a sports or recreational facility in 74.3% of the cases. The most common injuries were strain or sprain (28.7%) and fracture (27.7%). The affected body part was the lower extremity in 32.0% of the cases and upper extremity in 25.4%. The patient was treated or evaluated and released from the ED in 88.0% of the cases. Conclusions: Based on NEISS data, pickleball-related injuries have been increasing in recent years. Although pickleballrelated injuries have many similarities with those associated with other racquet sports, there were various differences (e.g., increasing trend and older patient age) that may need to be considered for the prevention and management of injuries related to the sport. Ó 2019 Elsevier Inc. All rights reserved.
INTRODUCTION Pickleball, invented in 1965 in Washington State, is a paddle sport that combines many of the elements of tennis, badminton, and ping-pong. It can be played indoors and outdoors on a badminton-sized court with a modified tennis net. Pickleball uses a paddle smaller than a tennis racquet but larger than a ping-pong paddle and a plastic ball with holes like a whiffle ball. It can be played as singles or doubles (two players to a team) (1,2). Pickleball is reported to be one of the faster growing sports in the United States. According to the Sports and Fitness Industry Association’s 2018 Pickleball Participant Report, pickleball had 3.1 million players in the United States, a 12% increase over the previous year. As of January 1, 2019, membership in the United States of America Pickleball Association had increased 650% since 2013, and the number of places to play pickleball more than doubled since 2010 (1). The sport is popular with community centers, physical education classes, YMCA facilities, and retirement communities (1). It is particularly popular among older adults because it is a low-impact sport, easy to learn, fosters positive social interaction, and provides health benefits (3–5). Studies have examined injuries associated with other racquet sports, such as tennis, racquetball/squash, and badminton (6–9). However, there is limited published information on pickleball-related injuries. One published
Data are publically available and de-identified; therefore, the study is exempt from Institutional Review Board approval.
RECEIVED: 1 June 2019; FINAL SUBMISSION RECEIVED: 12 August 2019; ACCEPTED: 13 September 2019 1
2
M. B. Forrester
article mentions anecdotal reports of pickleball-related injuries consisting of strains, sprains, and fractures to the limbs; tendonitis or tendon rupture; plantar fasciitis; rotator-cuff injuries; and blunt trauma to the head (3). The objective of this study was to describe pickleballrelated injuries treated in US emergency departments (EDs). MATERIALS AND METHODS Data were obtained from the National Electronic Injury Surveillance System (NEISS) operated by the US Consumer Product Safety Commission (CPSC). The NEISS collects data on consumer product-related injuries in the United States from the EDs of approximately 100 hospitals as a probabilistic sample of the more than 5000 U.S. hospitals with EDs. The NEISS is a stratified sample based on ED size and geographic location. Information collected includes patient’s age, sex, race, ethnicity, injury diagnosis, body parts affected, and location where the injury occurred, among others (10). NEISS data have previously been used to examine injuries associated with other racquet sports (6–9). NEISS data are publicly available and de-identified; therefore, the study is exempt from Institutional Review Board approval. Cases were pickleball-related injuries in NEISS during 2001–2017. The Narrative_1 and Narrative_2 text fields were searched for any mention of the terms pickle and ball. The resulting records were then reviewed to determine whether the injury appeared to be related to pickleball. The distribution by selected variables was determined for the resulting cases, as well as a weighted estimate calculated by the sum of the numbers in the Weight number field. The CPSC considers an estimate unstable and potentially unreliable when the number of records used is <20 or the estimate is <1200 (10). In other words, when the number of records is <20, or the estimate based on the number of records is <1200, the estimate should be evaluated with caution. In the present study, the total number of records is above this 20-record threshold. However, when this total is divided among the subgroups for the variables analyzed, the number of records in the subgroups might be below the 20-record threshold and, in those instances, should be evaluated with caution. Those subgroups with estimates that are thus considered unstable and potentially unreliable are indicated as such. RESULTS A total of 300 pickleball-related injuries were identified, resulting in a national estimate of 19,012 injuries. The annual estimated number of pickleball-related injuries during 2001–2012 ranged between 0 and 462 and then
increased to 688 in 2013, 1391 in 2014, 4359 in 2015, 4712 in 2016, and 6072 in 2017. The estimated number of injuries in 2017 was 8.8 times the estimated number in 2013. Due to CPSC criteria, the annual estimates for 2000–2013 may be considered unstable and potentially unreliable. Table 1 presents the patient demographics and circumstances of the pickleball-related injuries. The highest proportion of patients was aged 60–69 years, followed by 70–79 years. The mean patient age for the 300 cases was 63 years (range 8–93 years). Roughly equal proportions of patients were male and female. The number of injuries was spread fairly evenly over every day of the week, with the highest proportion treated on Wednesday and Thursday. The majority of the injuries occurred in a sports or recreational facility. Table 2 shows the type of injury and its management. The highest proportion of injuries was a strain or sprain,
Table 1. Demographics and Circumstances of PickleballRelated Injuries Treated in U.S. Emergency Departments, National Electronic Injury Surveillance System, 2001–2017 Number Variable Patient age (years) 6–12† 13–19† 20–29† 30–39† 40–49† 50–59 60–69 70–79 80+† Patient sex Male Female Day of week Sunday Monday Tuesday Wednesday Thursday Friday Saturday Location Sports/recreational facility School† Home† Public property† Street† Unknown Total
Estimate*
n
%
n
%
2 16 2 4 14 27 128 95 12
0.7 5.3 0.7 1.3 4.7 9.0 42.7 31.7 4.0
33 754 110 220 613 1371 8671 6486 756
0.2 4.0 0.6 1.2 3.2 7.2 45.6 34.1 4.0
151 149
50.3 49.7
9582 9430
50.4 49.6
38 36 42 49 48 43 44
12.7 12.0 14.0 16.3 16.0 14.3 14.7
2509 2420 2853 2886 2986 2623 2735
13.2 12.7 15.0 15.2 15.7 13.8 14.4
208 14 7 4 4 63 300
69.3 4.7 2.3 1.3 1.3 21.0 —
14,117 703 437 282 257 3218 19,012
74.3 3.7 2.3 1.5 1.3 16.9 —
* Estimate is the sum of the Weight field. † The U.S. Consumer Product Safety Commission considers an estimate unstable and potentially unreliable when the number of records used is <20 or the estimate is <1200. Therefore, the estimate for this subgroup should be considered unstable and potentially unreliable.
Pickleball-Related Injuries
3
Table 2. Type and Management of Pickleball-Related Injuries Treated in U.S. Emergency Departments, National Electronic Injury Surveillance System, 2001–2017 Number Variable
n
%
Estimate* n
Type of injury Strain, sprain 87 29.0 5460 Fracture 87 29.0 5263 Contusions, abrasions 33 11.0 2258 15 5.0 1118 Laceration† 18 6.0 1058 Internal injury† † 8 2.7 587 Dislocation 3 1.0 206 Concussion† 1 0.3 78 Hematoma† 1 0.3 15 Avulsion† Other 47 15.7 2969 Affected body part Lower extremity 95 31.7 6092 Upper extremity 79 26.3 4825 Trunk 64 21.3 4062 Head/neck 50 16.7 3212 12 4.0 820 All parts of body† Disposition Treated/examined and released 260 86.7 16,737 Treated and admitted/hospitalized 40 13.3 2276 Total 300 — 19,012
% 28.7 27.7 11.9 5.9 5.6 3.1 1.1 0.4 0.1 15.6 32.0 25.4 21.4 16.9 4.3 88.0 12.0 —
* Estimate is the sum of the Weight field. † The U.S. Consumer Product Safety Commission considers an estimate unstable and potentially unreliable when the number of records used is <20 or the estimate is <1200. Therefore, the estimate for this subgroup should be considered unstable and potentially unreliable.
followed by a fracture and contusions or abrasions. The affected body part was most often the lower extremity, followed by the upper extremity. The majority of the patients were treated or evaluated and released from the ED. DISCUSSION This study identified 300 pickleball-related injuries treated in U.S. EDs during a 17-year period, for a national estimate of 19,012 injuries during that time period. These may be considered relatively few cases, particularly when compared to injuries reported from other racquet sports (6–9). A small estimated number of pickleball-related injuries were reported each year during 2001–2012, then the estimated number increased each year during 2013– 2017. The estimated number of injuries in 2017 accounted for 32.1% of the total estimated injuries during 2000–2017 and was almost nine times the estimated number of injuries reported during 2013. In contrast, the number of injuries associated with tennis and squash or racquetball has demonstrated annual declines (6,7,9). The number of U.S. tennis participants increased during 2000–2010, before declining during 2011 and increasing
again during 2012–2017 (11,12). The number of U.S. squash participants increased during 2006–2015 before declining during 2016–2017 (13), while the number of U.S. racquetball participants increased during 2006– 2008, then declined during 2009–2017 (14). The recent increase in pickleball-related injuries may be related to pickleball being one of the fastest growing sports (1,2). The number of pickleball-related injuries in the NEISS database should be monitored in the future to see whether this increasing trend continues. Patients with pickleball-related injuries tended to be older, with a mean age of 63 years, and 87.3% (90.9% of the estimate) are 50 years or older. Patients with injuries related to other racquet sports were younger, with the majority of patients younger than 50 years (6,7,9). This pattern might be expected, considering that pickleball is particularly popular among older individuals because it is low-impact and easy to learn (3–5). However, this might change if pickleball becomes more popular with younger individuals. Patients with pickleball-related injuries were evenly distributed by sex. Patients with injuries related to badminton also were evenly divided between the sexes, while males comprised the majority of patients with tennis-related injuries (56–57% male) and those with squash or racquetball-related injuries (80%) (6,8,9). Most (74.3%) of the estimated pickleball-related injuries occurred at a sport or recreational facility. Injuries related to tennis and racquetball also most frequently occurred at sports or recreational facilities, while badminton-related injuries most often occurred at schools or public property, followed by sports or recreational facilities (6,9). The differences in the locations where the injuries occurred between the different racquet sports may be due to the equipment needed to play the sport and the most common age of the players. Because pickleball players tend to be older, they might be less likely to play the sport at schools. Injuries associated with pickleball were most frequently a strain or sprain, followed by a fracture and contusions or abrasions, and the body part injured was most often the lower extremity, followed by the upper extremity. Injuries associated with the other racquet sports demonstrated a similar pattern of injuries (6,8,9). The majority of patients (86.7% of the count, 88.0% of the estimate) with pickleball-related injuries were treated or evaluated in the ED and then released. Patients with injuries associated with tennis, badminton, and squash or racquetball were likewise most likely to be treated and released from the ED, although the percentages were higher (96–98%) (6,9). The slightly lower rate of release from the ED among the patients with pickleball-related injuries might be due to the patients being older. Their injuries might tend to be more serious and more likely to
4
M. B. Forrester
lead to hospital admission. Unfortunately, the NEISS does not contain information on the severity of the injury.
may need to be considered for the prevention and management of injuries related to the sport.
Limitations This study is subject to limitations. Cases were identified by searching for pickle and ball in the electronic medical record narrative. Pickleball-related injuries where these terms were not documented in the narrative would not have been included in this investigation. Only those injuries treated at an ED were included. The number of pickleball-related injuries not seen at an ED is unknown. When the location where the injury occurred was examined, the location was unknown in 21.0% of the records (16.9% of the estimate). However, because 69.3% of the cases (74.3% of the estimated injuries) occurred at a sports or recreational facility, the number of injuries with an unknown location may not have serious impact on the analysis of injury location. In addition, there were relatively few cases, particularly when divided among the subgroups during analyses of specific variables. The CPSC considers an estimate unstable and potentially unreliable when the number of records used is <20 or the estimate is <1200 (10). Thus, for a particular subgroup in this study, if the number of records was <20 or the estimate was <1200, the estimate should be considered unstable and potentially unreliable. CONCLUSIONS This study found that pickleball-related injuries have been increasing in recent years, in contrast to that observed for other racquet sports. Patients with pickleball-related injuries tended to be older, but were evenly divided by sex. Their injuries were most frequently a strain or sprain and affected the lower extremity. The majority of patients were treated or evaluated at an ED and then released. Although pickleballrelated injuries had many similarities with those associated with other racquet sports, there were various differences (e.g., increasing trend and older patient age) that
REFERENCES 1. USA Pickleball Association. Available at: https://www.usapa.org/. Accessed April 25, 2019. 2. Loudin A. Pickleball: the fastest growing sport you’ve never heard of NBC News. 2019. Available at: https://www.nbcnews.com/ better/lifestyle/pickleball-fastest-growing-sport-you-ve-never-heardncna992106. Accessed May 3, 2019. 3. Quail MT. Caring for patients with pickleball injuries. Nursing 2019;49:16–7. 4. Casper JM, Jeon JH. Psychological connection to pickleball: assessing motives and participation in older adults. J Aging Phys Act 2018;1–6. 5. Ryu J, Yang H, Kim ACH, Kim KM, Heo J. Understanding pickleball as a new leisure pursuit among older adults. Educ Gerontol 2018;44:128–38. 6. Nhan DT, Klyce W, Lee RJ. Epidemiological patterns of alternative racquet-sport injuries in the United States, 1997-2016. Orthop J Sports Med 2018;6. 2325967118786237. 7. Chevinsky JD, Newman JM, Shah NV, et al. Trends and epidemiology of tennis-related sprains/strains in the United States, 2010 to 2016. Surg Technol Int 2017;31:333–8. 8. Chevinsky JD, Shah NV, Tretiakov M, et al. Demographics of tennis-related injuries that presented to emergency departments in the United States. Surg Technol Int 2017;31:352–8. 9. Gaw CE, Chounthirath T, Smith GA. Tennis-related injuries treated in United States emergency departments, 1990 to 2011. Clin J Sport Med 2014;24:226–32. 10. U.S. Consumer Product Safety Commission. National Electronic Injury Surveillance System (NEISS). Available at: https://www. cpsc.gov/Safety-Education/Safety-Guides/General-Information/ National-Electronic-Injury-Surveillance-System-NEISS. Accessed April 25, 2019. 11. Tennis Industry Association. Tennis talking points: 2017 TIA research reports. Available at: http://www.tennisindustry.org/pdfs/ Industry_Talking_Points.pdf. Accessed July 28, 2019. 12. Statistica. Number of participants in tennis in the United States from 2006 to 2017 (in millions). Available at: https://www.statista.com/ statistics/191966/participants-in-tennis-in-the-us-since-2006/. Accessed July 28, 2019. 13. Statistica. Number of participants in squash in the United States from 2006 to 2017 (in millions). Available at: https://www. statista.com/statistics/191958/participants-in-squash-in-the-us-since2006/. Accessed July 28, 2019. 14. Statistica. Number of participants in raquetball in the United States from 2006 to 2017 (in millions). Available at: https://www.statista. com/statistics/191922/participants-in-racquetball-in-the-us-since2006/. Accessed July 28, 2019.
Pickleball-Related Injuries
5
ARTICLE SUMMARY 1. Why is this topic important? Pickleball is reported to be one of the faster growing sports in the United States and is popular among older adults; however, there is limited published information on pickleball-related injuries. 2. What does this study attempt to show? This study describes pickleball-related injuries treated in U.S. emergency departments (EDs). 3. What are the key findings? Pickleball-related injuries increased during 2013– 2017. Patients with pickleball-related injuries tended to be older, but evenly divided by sex. Their injuries were most frequently a strain or sprain and affected the lower extremity. The majority of patients were treated or evaluated at an ED and then released. 4. How is patient care impacted? Although pickleball-related injuries had many similarities with those associated with other racquet sports, there were various differences (e.g., increasing trend and older patient age) that may need to be considered for the prevention and management of injuries related to the sport.
https://doi.org/10.1016/j.jemermed.2019.09.016
Selected Topics: Sports Medicine PICKLEBALL-RELATED INJURIES TREATED IN EMERGENCY DEPARTMENTS Mathias B. Forrester, BS Independent Researcher, Austin, Texas Reprint Address: Mathias B. Forrester, BS, 4600 Monterey Oaks Boulevard, #F2335, Austin, TX 78749
, Keywords—pickleball; racquet sport; injury; emergency department
, Abstract—Background: Pickleball is a paddle sport that combines many of the elements of tennis, badminton, and ping-pong. It is reported to be one of the faster growing sports in the United States and is popular among older adults. There is limited published information on pickleball-related injuries. Objective: The objective of this study was to describe pickleball-related injuries treated in U.S. emergency departments (EDs). Methods: An analysis was performed of pickleball-related injuries using data from the National Electronic Injury Surveillance System (NEISS) of the U.S. Consumer Product Safety Commission during 2001–2017. Results: A total of 300 pickleballrelated injuries were identified, resulting in a national estimate of 19,012 injuries. The annual estimated number of injuries increased during 2013–2017. Patients 50 years or older accounted for 90.9% of the patients; 50.4% were male. The injury occurred at a sports or recreational facility in 74.3% of the cases. The most common injuries were strain or sprain (28.7%) and fracture (27.7%). The affected body part was the lower extremity in 32.0% of the cases and upper extremity in 25.4%. The patient was treated or evaluated and released from the ED in 88.0% of the cases. Conclusions: Based on NEISS data, pickleball-related injuries have been increasing in recent years. Although pickleballrelated injuries have many similarities with those associated with other racquet sports, there were various differences (e.g., increasing trend and older patient age) that may need to be considered for the prevention and management of injuries related to the sport. Ó 2019 Elsevier Inc. All rights reserved.
INTRODUCTION Pickleball, invented in 1965 in Washington State, is a paddle sport that combines many of the elements of tennis, badminton, and ping-pong. It can be played indoors and outdoors on a badminton-sized court with a modified tennis net. Pickleball uses a paddle smaller than a tennis racquet but larger than a ping-pong paddle and a plastic ball with holes like a whiffle ball. It can be played as singles or doubles (two players to a team) (1,2). Pickleball is reported to be one of the faster growing sports in the United States. According to the Sports and Fitness Industry Association’s 2018 Pickleball Participant Report, pickleball had 3.1 million players in the United States, a 12% increase over the previous year. As of January 1, 2019, membership in the United States of America Pickleball Association had increased 650% since 2013, and the number of places to play pickleball more than doubled since 2010 (1). The sport is popular with community centers, physical education classes, YMCA facilities, and retirement communities (1). It is particularly popular among older adults because it is a low-impact sport, easy to learn, fosters positive social interaction, and provides health benefits (3–5). Studies have examined injuries associated with other racquet sports, such as tennis, racquetball/squash, and badminton (6–9). However, there is limited published information on pickleball-related injuries. One published
Data are publically available and de-identified; therefore, the study is exempt from Institutional Review Board approval.
RECEIVED: 1 June 2019; FINAL SUBMISSION RECEIVED: 12 August 2019; ACCEPTED: 13 September 2019 1
2
M. B. Forrester
article mentions anecdotal reports of pickleball-related injuries consisting of strains, sprains, and fractures to the limbs; tendonitis or tendon rupture; plantar fasciitis; rotator-cuff injuries; and blunt trauma to the head (3). The objective of this study was to describe pickleballrelated injuries treated in US emergency departments (EDs). MATERIALS AND METHODS Data were obtained from the National Electronic Injury Surveillance System (NEISS) operated by the US Consumer Product Safety Commission (CPSC). The NEISS collects data on consumer product-related injuries in the United States from the EDs of approximately 100 hospitals as a probabilistic sample of the more than 5000 U.S. hospitals with EDs. The NEISS is a stratified sample based on ED size and geographic location. Information collected includes patient’s age, sex, race, ethnicity, injury diagnosis, body parts affected, and location where the injury occurred, among others (10). NEISS data have previously been used to examine injuries associated with other racquet sports (6–9). NEISS data are publicly available and de-identified; therefore, the study is exempt from Institutional Review Board approval. Cases were pickleball-related injuries in NEISS during 2001–2017. The Narrative_1 and Narrative_2 text fields were searched for any mention of the terms pickle and ball. The resulting records were then reviewed to determine whether the injury appeared to be related to pickleball. The distribution by selected variables was determined for the resulting cases, as well as a weighted estimate calculated by the sum of the numbers in the Weight number field. The CPSC considers an estimate unstable and potentially unreliable when the number of records used is <20 or the estimate is <1200 (10). In other words, when the number of records is <20, or the estimate based on the number of records is <1200, the estimate should be evaluated with caution. In the present study, the total number of records is above this 20-record threshold. However, when this total is divided among the subgroups for the variables analyzed, the number of records in the subgroups might be below the 20-record threshold and, in those instances, should be evaluated with caution. Those subgroups with estimates that are thus considered unstable and potentially unreliable are indicated as such. RESULTS A total of 300 pickleball-related injuries were identified, resulting in a national estimate of 19,012 injuries. The annual estimated number of pickleball-related injuries during 2001–2012 ranged between 0 and 462 and then
increased to 688 in 2013, 1391 in 2014, 4359 in 2015, 4712 in 2016, and 6072 in 2017. The estimated number of injuries in 2017 was 8.8 times the estimated number in 2013. Due to CPSC criteria, the annual estimates for 2000–2013 may be considered unstable and potentially unreliable. Table 1 presents the patient demographics and circumstances of the pickleball-related injuries. The highest proportion of patients was aged 60–69 years, followed by 70–79 years. The mean patient age for the 300 cases was 63 years (range 8–93 years). Roughly equal proportions of patients were male and female. The number of injuries was spread fairly evenly over every day of the week, with the highest proportion treated on Wednesday and Thursday. The majority of the injuries occurred in a sports or recreational facility. Table 2 shows the type of injury and its management. The highest proportion of injuries was a strain or sprain,
Table 1. Demographics and Circumstances of PickleballRelated Injuries Treated in U.S. Emergency Departments, National Electronic Injury Surveillance System, 2001–2017 Number Variable Patient age (years) 6–12† 13–19† 20–29† 30–39† 40–49† 50–59 60–69 70–79 80+† Patient sex Male Female Day of week Sunday Monday Tuesday Wednesday Thursday Friday Saturday Location Sports/recreational facility School† Home† Public property† Street† Unknown Total
Estimate*
n
%
n
%
2 16 2 4 14 27 128 95 12
0.7 5.3 0.7 1.3 4.7 9.0 42.7 31.7 4.0
33 754 110 220 613 1371 8671 6486 756
0.2 4.0 0.6 1.2 3.2 7.2 45.6 34.1 4.0
151 149
50.3 49.7
9582 9430
50.4 49.6
38 36 42 49 48 43 44
12.7 12.0 14.0 16.3 16.0 14.3 14.7
2509 2420 2853 2886 2986 2623 2735
13.2 12.7 15.0 15.2 15.7 13.8 14.4
208 14 7 4 4 63 300
69.3 4.7 2.3 1.3 1.3 21.0 —
14,117 703 437 282 257 3218 19,012
74.3 3.7 2.3 1.5 1.3 16.9 —
* Estimate is the sum of the Weight field. † The U.S. Consumer Product Safety Commission considers an estimate unstable and potentially unreliable when the number of records used is <20 or the estimate is <1200. Therefore, the estimate for this subgroup should be considered unstable and potentially unreliable.
Pickleball-Related Injuries
3
Table 2. Type and Management of Pickleball-Related Injuries Treated in U.S. Emergency Departments, National Electronic Injury Surveillance System, 2001–2017 Number Variable
n
%
Estimate* n
Type of injury Strain, sprain 87 29.0 5460 Fracture 87 29.0 5263 Contusions, abrasions 33 11.0 2258 15 5.0 1118 Laceration† 18 6.0 1058 Internal injury† † 8 2.7 587 Dislocation 3 1.0 206 Concussion† 1 0.3 78 Hematoma† 1 0.3 15 Avulsion† Other 47 15.7 2969 Affected body part Lower extremity 95 31.7 6092 Upper extremity 79 26.3 4825 Trunk 64 21.3 4062 Head/neck 50 16.7 3212 12 4.0 820 All parts of body† Disposition Treated/examined and released 260 86.7 16,737 Treated and admitted/hospitalized 40 13.3 2276 Total 300 — 19,012
% 28.7 27.7 11.9 5.9 5.6 3.1 1.1 0.4 0.1 15.6 32.0 25.4 21.4 16.9 4.3 88.0 12.0 —
* Estimate is the sum of the Weight field. † The U.S. Consumer Product Safety Commission considers an estimate unstable and potentially unreliable when the number of records used is <20 or the estimate is <1200. Therefore, the estimate for this subgroup should be considered unstable and potentially unreliable.
followed by a fracture and contusions or abrasions. The affected body part was most often the lower extremity, followed by the upper extremity. The majority of the patients were treated or evaluated and released from the ED. DISCUSSION This study identified 300 pickleball-related injuries treated in U.S. EDs during a 17-year period, for a national estimate of 19,012 injuries during that time period. These may be considered relatively few cases, particularly when compared to injuries reported from other racquet sports (6–9). A small estimated number of pickleball-related injuries were reported each year during 2001–2012, then the estimated number increased each year during 2013– 2017. The estimated number of injuries in 2017 accounted for 32.1% of the total estimated injuries during 2000–2017 and was almost nine times the estimated number of injuries reported during 2013. In contrast, the number of injuries associated with tennis and squash or racquetball has demonstrated annual declines (6,7,9). The number of U.S. tennis participants increased during 2000–2010, before declining during 2011 and increasing
again during 2012–2017 (11,12). The number of U.S. squash participants increased during 2006–2015 before declining during 2016–2017 (13), while the number of U.S. racquetball participants increased during 2006– 2008, then declined during 2009–2017 (14). The recent increase in pickleball-related injuries may be related to pickleball being one of the fastest growing sports (1,2). The number of pickleball-related injuries in the NEISS database should be monitored in the future to see whether this increasing trend continues. Patients with pickleball-related injuries tended to be older, with a mean age of 63 years, and 87.3% (90.9% of the estimate) are 50 years or older. Patients with injuries related to other racquet sports were younger, with the majority of patients younger than 50 years (6,7,9). This pattern might be expected, considering that pickleball is particularly popular among older individuals because it is low-impact and easy to learn (3–5). However, this might change if pickleball becomes more popular with younger individuals. Patients with pickleball-related injuries were evenly distributed by sex. Patients with injuries related to badminton also were evenly divided between the sexes, while males comprised the majority of patients with tennis-related injuries (56–57% male) and those with squash or racquetball-related injuries (80%) (6,8,9). Most (74.3%) of the estimated pickleball-related injuries occurred at a sport or recreational facility. Injuries related to tennis and racquetball also most frequently occurred at sports or recreational facilities, while badminton-related injuries most often occurred at schools or public property, followed by sports or recreational facilities (6,9). The differences in the locations where the injuries occurred between the different racquet sports may be due to the equipment needed to play the sport and the most common age of the players. Because pickleball players tend to be older, they might be less likely to play the sport at schools. Injuries associated with pickleball were most frequently a strain or sprain, followed by a fracture and contusions or abrasions, and the body part injured was most often the lower extremity, followed by the upper extremity. Injuries associated with the other racquet sports demonstrated a similar pattern of injuries (6,8,9). The majority of patients (86.7% of the count, 88.0% of the estimate) with pickleball-related injuries were treated or evaluated in the ED and then released. Patients with injuries associated with tennis, badminton, and squash or racquetball were likewise most likely to be treated and released from the ED, although the percentages were higher (96–98%) (6,9). The slightly lower rate of release from the ED among the patients with pickleball-related injuries might be due to the patients being older. Their injuries might tend to be more serious and more likely to
4
M. B. Forrester
lead to hospital admission. Unfortunately, the NEISS does not contain information on the severity of the injury.
may need to be considered for the prevention and management of injuries related to the sport.
Limitations This study is subject to limitations. Cases were identified by searching for pickle and ball in the electronic medical record narrative. Pickleball-related injuries where these terms were not documented in the narrative would not have been included in this investigation. Only those injuries treated at an ED were included. The number of pickleball-related injuries not seen at an ED is unknown. When the location where the injury occurred was examined, the location was unknown in 21.0% of the records (16.9% of the estimate). However, because 69.3% of the cases (74.3% of the estimated injuries) occurred at a sports or recreational facility, the number of injuries with an unknown location may not have serious impact on the analysis of injury location. In addition, there were relatively few cases, particularly when divided among the subgroups during analyses of specific variables. The CPSC considers an estimate unstable and potentially unreliable when the number of records used is <20 or the estimate is <1200 (10). Thus, for a particular subgroup in this study, if the number of records was <20 or the estimate was <1200, the estimate should be considered unstable and potentially unreliable. CONCLUSIONS This study found that pickleball-related injuries have been increasing in recent years, in contrast to that observed for other racquet sports. Patients with pickleball-related injuries tended to be older, but were evenly divided by sex. Their injuries were most frequently a strain or sprain and affected the lower extremity. The majority of patients were treated or evaluated at an ED and then released. Although pickleballrelated injuries had many similarities with those associated with other racquet sports, there were various differences (e.g., increasing trend and older patient age) that
REFERENCES 1. USA Pickleball Association. Available at: https://www.usapa.org/. Accessed April 25, 2019. 2. Loudin A. Pickleball: the fastest growing sport you’ve never heard of NBC News. 2019. Available at: https://www.nbcnews.com/ better/lifestyle/pickleball-fastest-growing-sport-you-ve-never-heardncna992106. Accessed May 3, 2019. 3. Quail MT. Caring for patients with pickleball injuries. Nursing 2019;49:16–7. 4. Casper JM, Jeon JH. Psychological connection to pickleball: assessing motives and participation in older adults. J Aging Phys Act 2018;1–6. 5. Ryu J, Yang H, Kim ACH, Kim KM, Heo J. Understanding pickleball as a new leisure pursuit among older adults. Educ Gerontol 2018;44:128–38. 6. Nhan DT, Klyce W, Lee RJ. Epidemiological patterns of alternative racquet-sport injuries in the United States, 1997-2016. Orthop J Sports Med 2018;6. 2325967118786237. 7. Chevinsky JD, Newman JM, Shah NV, et al. Trends and epidemiology of tennis-related sprains/strains in the United States, 2010 to 2016. Surg Technol Int 2017;31:333–8. 8. Chevinsky JD, Shah NV, Tretiakov M, et al. Demographics of tennis-related injuries that presented to emergency departments in the United States. Surg Technol Int 2017;31:352–8. 9. Gaw CE, Chounthirath T, Smith GA. Tennis-related injuries treated in United States emergency departments, 1990 to 2011. Clin J Sport Med 2014;24:226–32. 10. U.S. Consumer Product Safety Commission. National Electronic Injury Surveillance System (NEISS). Available at: https://www. cpsc.gov/Safety-Education/Safety-Guides/General-Information/ National-Electronic-Injury-Surveillance-System-NEISS. Accessed April 25, 2019. 11. Tennis Industry Association. Tennis talking points: 2017 TIA research reports. Available at: http://www.tennisindustry.org/pdfs/ Industry_Talking_Points.pdf. Accessed July 28, 2019. 12. Statistica. Number of participants in tennis in the United States from 2006 to 2017 (in millions). Available at: https://www.statista.com/ statistics/191966/participants-in-tennis-in-the-us-since-2006/. Accessed July 28, 2019. 13. Statistica. Number of participants in squash in the United States from 2006 to 2017 (in millions). Available at: https://www. statista.com/statistics/191958/participants-in-squash-in-the-us-since2006/. Accessed July 28, 2019. 14. Statistica. Number of participants in raquetball in the United States from 2006 to 2017 (in millions). Available at: https://www.statista. com/statistics/191922/participants-in-racquetball-in-the-us-since2006/. Accessed July 28, 2019.
Pickleball-Related Injuries
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ARTICLE SUMMARY 1. Why is this topic important? Pickleball is reported to be one of the faster growing sports in the United States and is popular among older adults; however, there is limited published information on pickleball-related injuries. 2. What does this study attempt to show? This study describes pickleball-related injuries treated in U.S. emergency departments (EDs). 3. What are the key findings? Pickleball-related injuries increased during 2013– 2017. Patients with pickleball-related injuries tended to be older, but evenly divided by sex. Their injuries were most frequently a strain or sprain and affected the lower extremity. The majority of patients were treated or evaluated at an ED and then released. 4. How is patient care impacted? Although pickleball-related injuries had many similarities with those associated with other racquet sports, there were various differences (e.g., increasing trend and older patient age) that may need to be considered for the prevention and management of injuries related to the sport.