Pediatric Softball Injuries and Mechanisms of Injury

Background: This study sought to characterize the mechanisms of injury responsible for common softball-related injuries in recent years.

Methods: The National Electronic Injury Surveillance System (NEISS) database was queried for all pediatric softball-related injuries presenting to participating US Emergency Departments from 2010 to 2019. Patients were classified by age as children (7–12 years), adolescents (13–18 years), or young adults (19–21 years). The case narrative of each injury was used to categorize the responsible gameplay mechanisms: hit by bat, hit by ball, sliding into base, collision with another player, catching, running, and throwing. Statistical weights provided by the Consumer Product Safety Commission (CPSC) were used to combine these individual injuries into national injury estimates.

Results: There were an estimated 511,117 pediatric softball injuries presenting to the ED during the study period, with a mean patient age of 14.3 years (95% CI = 14.1–14.4). The head and neck was the most commonly affected body region, affected in 30.2% of cases (95% CI = 28.2–32.2%). Injuries to the head/neck were most often caused by being hit by the ball (78.4%, 95% CI = 76.4–80.3%) and most commonly resulted in a superficial injury (36.9%), internal injury (22.2%), or concussion (16.3%). Foot and ankle injuries were most frequently caused by sliding into base (51.5%, 95% CI = 47.0–55.2%) and typically resulted in a sprain or strain (65.5%). The most frequent causes of shoulder and elbow injuries were being hit by the ball (33.3%, 95% CI = 28.6–38.3%) and throwing the ball (27.6%, 95% CI = 22.8–32.9%). These resulted most frequently in a sprain or strain (39.5%), followed by a superficial injury (28.2%). The proportion of softball injuries affecting the shoulder or elbow and the lower extremities increased with athlete age, while the proportion of injuries affecting the remainder of the upper extremities decreased with athlete age.

Conclusion: Being hit by the ball was the most common mechanism of injury amongst youth softball players, especially to the head/neck region. Coaches and leagues should consider mandating helmets for infielders, who traditionally do not wear protective headgear, and using only the more visible yellow softball in gameplay and practice. Foot and ankle injuries can be reduced using breakaway bases, and runner’s bases to reduce collisions at the bases. Finally, pitch counts should be instituted to prevent the rise of elbow and shoulder injuries among older adolescent athletes.