The rate of soccer injuries treated at U.S. emergency departments among patients aged 7-17 years rose by 111%, and that of soccer-related concussions and closed-head injuries increased by 1,595%, during the last 25 years, according to a report published online Sept. 12 in Pediatrics.

These increases underscore the need to improve injury prevention in this patient population. In particular, concussion prevention should focus on reducing player-to-player contact, especially during illegal moves. “Education of players, coaches, referees or officials, and parents about the importance of following the rules of the game, and enforcement of those rules, are critical first steps,” said Nicholas A. Smith of the Center for Injury Research and Policy, the Research Institute at Nationwide Children’s Hospital, Columbus, and his associates.

In what they described as the first study to comprehensively examine the epidemiology of U.S. youth soccer-related injuries treated at EDs, the investigators analyzed data from a nationally representative injury surveillance system between 1990 and 2014. Almost 3 million children were treated during that period for concussions/closed-head injuries, fractures, dislocations, sprains or strains, soft-tissue injuries such as abrasions or hematomas, lacerations, nondental avulsions, or punctures sustained during soccer practice or games.

The annual rate of soccer-related injury per 10,000 participants rose by 111%, and the annual number of such injuries rose by 78%. Much of this increase was attributed to a 1,595% rise in the annual rate of concussions/closed-head injuries and a 1,332% rise in the number of concussions/closed-head injuries. Patients with head injuries were twice as likely to be admitted to the hospital as were those with other types of injury, highlighting the severity of head injuries, the investigators noted.

The majority of injuries (73%) occurred in older children aged 12-17 years; their injury rate was more than three times higher than that in younger children, “probably because of the more aggressive play and the higher-energy impacts associated with the older age group,” Mr. Smith and his associates wrote (Pediatrics. 2016 Sep 12. doi: 10.1542/peds.2016-0346).

The increase in soccer-related injuries was much greater among girls than among boys, paralleling the much larger increase in soccer participation among girls than among boys during the study period.

This study underestimates the actual number of soccer-related injuries because it didn’t include patients who were treated in health care settings other than the ED and patients who were not treated at all, the investigators added.