Epidemiology of exertional heat illnesses in National collegiate athletic Association athletes during the 2009-2010 through 2014-2015 academic years

Abstract

Context: Exertional heat illnesses (EHIs) among football athletes have been widely researched, but data examining all collegiate sports are limited. Objective: To describe the epidemiology of EHI in 25 National Collegiate Athletic Association (NCAA) sports. Design: Descriptive epidemiology study. Setting: The NCAA Injury Surveillance Program during the 2009-2010 through 2014-2015 academic years. Patients or Other Participants: A voluntary sample of 166 NCAA institutions over 2048 team-seasons. Main Outcome Measure(s): Athletic trainers reported EHIs to the NCAA Injury Surveillance Program. Only EHIs sustained during a sanctioned practice or competition were included. The EHI rate, specific diagnoses, and number of emergency transports were measured. Results: Overall, 232 EHI events were reported (0.47/ 10 000 athlete-exposures [AEs]; 95% confidence interval [CI] ¼ 0.41, 0.53). Football comprised 75% of all EHI events and had the largest rate (1.55/10 000 AEs; 95% CI ¼ 1.32, 1.78). The overall EHI rate was higher in preseason practices (1.16/10 000 AEs) than all other time periods (regular and postseason practices and all competitions; 0.23/10 000 AEs, injury rate ratio [IRR] ¼ 4.96; 95% CI ¼ 3.79, 6.50). This result was retained when examining the individual sports of football (3.65/10 000 versus 0.63/10 000 AEs, IRR ¼ 5.82; 95% CI ¼ 4.18, 8.10), men's soccer (1.11/10 000 versus 0.07/10 000 AEs, IRR ¼ 16.819; 95% CI ¼ 1.89, 138.55), and women's soccer (1.10/ 10 000 versus 0.05/10 000 AEs, IRR ¼ 22.52; 95% CI ¼ 2.77, 183.05). The EHI rates were highest in states with elevated annual temperatures (1.05/10 000 AEs). Heat cramps (39%), heat exhaustion (27%), and dehydration (29%) were the most common types of EHI. Nineteen athletes with EHI (8%) required emergency transport. Conclusions: Football players continue to experience the most EHIs; however, EHIs can potentially occur in all NCAA sports. Continued emphasis on preseason EHI policies and institution-specific environmental guidelines is needed to address EHI rates.