O3286: Unnecessary Roughness: Recent Trends and Epidemiology of Flag Football Injuries Over a 15-Year Period

Background: Flag football has become a popular alternative to tackle football within the United States. Likely driven by concern for concussion, youth participation in tackle football has declined by 29% from 2016-2021, while flag football participation increased 15% within the same time period. Despite the notable increase in flag football popularity, limited research has been conducted regarding the epidemiology of flag football injuries.

Methods: The National Electronic Injury Surveillance System (NEISS) database was queried to identify all cases of flag football injuries in children aged 0-18 years from 2008 through 2022. All injuries attributed to football, miscellaneous or “other” ball sports, and generalized sports or recreational activity were identified and filtered to include only those related to flag football. NEISS weights were applied to gather national estimates. Descriptive statistics summarized injury type and trends. The Mann-Kendall test was used to determine the trend of injury estimates over time (statistics from 2020 were excluded from this test).

Results: After applying NEISS weights, the national estimate for flag football injuries from 2008-2022 was 69,045 injuries, or 4603 injuries annually. Patients aged 12 years and younger, classified as children, suffered 42% of injuries while patients aged 13-18 years, labeled as adolescents, accounted for 58% of injuries. Injuries were most commonly sustained to the head, neck, and face (31% of cases), however concussions accounted for only 10% of overall injures. The majority of injuries, 98.5%, were labeled as not severe. Fractures and dislocations made up 31% of all injuries and sprains and strains accounted for 24% of cases. The most common fractures were those of the wrist, lower arm, finger, or hand. Sprains and strains were most commonly sustained to the lower extremities. Mann-Kendall testing revealed there was not a significant upward trend in overall injuries during the 15-year period (p=0.07), fractures and dislocations (p=0.5112), or sprains and strains (p=0.6614). There was, however, a significant upward trend in concussions sustained (p=0.0118).

Conclusion: National emergency department data reveals the increase in flag football’s popularity over the last 15 years has not been accompanied by a significant increase in overall injury totals. Although concussions and severe injuries account for a low proportion of overall injuries, there has been a significant increase in injury severity and concussion incidence. The increase in popularity and participation rates without a significant increase in overall injury totals provides evidence that flag football may be a safe alternative to tackle football, although continued surveillance of concussion rates is warranted as continued increase in incidence may merit changes to equipment or gameplay. This information can be used in decision making regarding sports participation, sport rules and regulations, and safety equipment to maintain safety during flag football.