Poster 376: Injury rates in NCAA student-athletes increased after COVID-19 lockdowns: A descriptive epidemiological study

Objectives: The COVID-19 pandemic altered sports at all levels of play and led to frequent schedule changes, abbreviated seasons, and disrupted training. The unprecedented nature of the COVID-19 pandemic meant that there was no evidence-based strategy to guide a safe return to sport after a prolonged suspension of play. During the season immediately following COVID-19 lockdowns, the National Football League, Major League Baseball, and multiple European soccer leagues reported increased injury rates. However, the effect of COVID-19 precautions on National Collegiate Athletic Association (NCAA) student-athletes’ health and safety remain unknown. It is possible that the findings among professional athletes would be magnified among collegiate student-athletes because NCAA student-athletes are less likely to have access to the level of training, quality of equipment, and intensity of coaching necessary to maintain physical fitness and game readiness during a pandemic-induced lockdown compared to professional athletes. The purpose of this retrospective study was to address this gap in the literature by investigating the epidemiology of NCAA injuries during the 2020 season when compared to pre-COVID-19 seasons. It was hypothesized there would be an increase in overall injury rate and an increase in the number of days unavailable during the 2020 season when compared to pre- COVID-19 seasons. Methods: The injury surveillance database at a single NCAA Division I institution was queried for injuries that resulted in time loss for a student-athlete (missed game or practice), or for injuries that persisted longer than 3 days. Injuries were categorized by anatomic area. Days unavailable were recorded as total days that a student-athlete was listed as “out of activity.” Injuries and days unavailable per 1,000 athlete-exposures (AEs) were calculated for the pre-COVID-19 seasons (2017-2020) and the 2020 season. Results: Compared to the 3 pre-COVID-19 seasons, injury incidence per 1,000 AEs increased by 10.5% in the 2020 season (68.4 vs 75.6 per 1,000 AEs; Figure 1A). Total days unavailable decreased by 20.7% in the 2020 season (1,374 vs 1,089 days per 1,000 AEs; Figure 1B). Compared to female teams, male teams had a larger increase in injury incidence (16.4% vs 6.5%; Figure 3A) and a larger decrease in days unavailable (23.7% vs 10.75%; Figure 3B). Among individual sports, football had the highest injury incidence during the pre-COVID-19 seasons and the 2020 season (180.4 vs 251.0 per 1,000 AEs; Figure 2). Volleyball had the highest increase in injury incidence (123% increase), followed by wrestling (102%; Figure 2). The anatomic distribution of injuries individually varied for each team and there was not a collective trend across sports during the 2020 season. Conclusions: Compared to pre-COVID-19 seasons, the incidence of injuries was higher among collegiate student-athletes at a single NCAA Division I school in the season immediately following the COVID-19 lockdown. Although the incidence of injuries increased, the number of days missed due to injury decreased. The decrease in days unavailable suggests that injury severity of the average reported injury event may have decreased in the post-lockdown season. Taken together, these findings suggest that lack of regular access to training facilities, athletic trainers, coaches, and teammates may lead to increased injury risk. Importantly, all student-athletes did not experience the same change in injury rates, with some sports disproportionately affected. To our knowledge, this is the first study to describe the epidemiology of injuries in the post-lockdown season for collegiate student-athletes. Understanding the specific risk factors and reasons for the changes in injury characteristics allows for guided resource allocation and improved focus of prevention measures. We recommend that for the safety of student- athletes, increased caution be taken when returning to play after prolonged restrictions on athletics.