How many Little League players are injured each year?
Little League Inc. provides exact figures for their players’ injuries each year.
Yet youth baseball injuries by nature are incalculable. Here’s why:
Only one third of all sports injuries treated in hospital emergency rooms are identifiable as sports injuries due to current ICD-9 coding (medical coding) limitations. It is estimated that 3 million children are seen in hospital emergency rooms each year for sports-related injuries. Twenty-five percent to 30% of youth sports injuries occur in organized sports.[1]
There is also no method to count the number of doctor’s office visits or visits to sports medicine clinics for sports-related injuries, which are estimated to total another 5 million annually.[2]
Even Steve Barr, Director of Media Relations at Little League, has said that Little League documents injuries requiring professional medical attention but admits, "With over 7,000 leagues, it’s difficult to track every single injury." [3]
Despite this, Little League Inc. provides figures-which are most often the number of insurance claims submitted to and paid for by Little League group accident insurance - as the actual number of injuries.
Little League insurance is a secondary carrier, which means that all primary insurance coverage must be exhausted first in order for Little League insurance to even consider a payment.[4]
Steve Kallas, Director of the Center for Sports Parenting elaborates on this point: “Little League only counts a child's injury when a family files a secondary insurance claim through Little League insurance. Because most families prefer their own insurance, many injuries are not recorded. An example of this was the Baggs v. Little League International Inc. case where a boy was struck in the eye from a ball hit off a metal bat. According to the defendant's attorney, the Little League only became aware of this incident because the boy's parents filed a claim with Little League insurance, to help pay the medical bills required to treat their severely injured child.” [5]
Authors of multi-year injury studies with Little League players recognize the limitations of using insurance figures in place of true numbers of injuries. In a medical study published in 2003 in the Journal of the American Medical Association, researchers Dr. Frederick Mueller, Chairman of USA Baseball’s Medical/Safety Advisory Committee, Daniel Kirby, Risk Manager Director of Little League Inc. and others said:
“Another limitation of this study is the use of insurance records to identify injuries.
It is possible that some Little League injuries during the study period did not result in compensated claims and therefore were not included in this study. Legitimate injuries that were registered with Little League may not have been compensated (undercompensation bias). In addition, some injuries may not even have been registered with Little League (underregistration bias.)” [6]
In a 2001 study by Dr. Stephen Marshall, along with Mueller and Kirby, said this:
“Another limitation of this study is the use of insurance records to identify injuries. It is possible that some Little League injuries during the study period did not result in compensated claims and therefore were not included in this study. Legitimate injuries that were registered with Little
League may not have been compensated (undercompensation bias).
In addition, some injuries may not even have been registered with Little League underregistration bias).” [7]
Dr. Ronald Danis, a Professor at the University of Wisconsin School of Medicine & Public Health’s Department of Ophthalmology & Visual Sciences, agrees. He believes that the actual number of injuries that faceguards prevent is much more than what is reported using insurance claims as total number of injuries.
“I believe that Marshall et al underestimated this incidence by basing their estimates of injury rates on compensated claims submitted to Little League insurance carriers. Many serious injuries will not be captured by this mechanism, because families may prefer to go through their own health insurance organization or they may not be aware of league-provided insurance. A serious injury might also elude detection because of delayed recognition,” Danis said.[8]
“The incidence rate might be more closely approximated by using the claims made, rather than the claims compensated. If a claim has been made, then the injury must have incurred some medical expense. If the incidence was calculated based on claims made, it would nearly double, according to data from the 1999 season,” he said.[9]
The United States Consumer Product Safety Commission (CPSC) has confirmed this as well. In 2002, a letter from Todd Stevenson, Secretary of the CPSC said, in part, “The Little League does not keep track of injuries as such, but rather of secondary medical insurance claims. This information may or may not reflect actual injuries.”[10]
So we know that Little League injuries by nature can’t be calculated and we know some of the drawbacks of the practice of using compensated injury claims in place of actual injuries in studies.
But what explains the alarming discrepancy in the number of high severity injuries in Little League between medical studies’ results and what is reported from Little League National Headquarters?
Two medical studies used data spanning a total of eleven years of Little League play and used compensated insurance figures to calculate the number of severe injuries during the timeframes of each study.
In the study which covered the years 1987-1996 approximately 25% of the 29,038 injuries were considered severe. “Severe” was defined as fractures, dislocations, and concussions. Thirteen players died during this time. The authors of this study published in 2001 included Dr. Mueller and Mr. Kirby. [11]
In the study published in 2003, the years 1997-1999 were analyzed. There were a total of 4,233 injuries and approximately 38% of them were considered severe. Higher-severity injuries were defined as dismemberments, fractures, and dislocations.[12]
In both of these studies, the average number of severe injuries that received Little League insurance compensation was just over 800 annually.
But the figures provided in Little League’s safety newsletter, As Safe As Possible (ASAP) claim only 5-8% of the medical studies’ totals.
Little League’s numbers[13] are:
1994-1996: An average of 59 severe injuries to players and volunteers per year
2000: 45 players and adults were seriously injured
2001: 28 players and adults were seriously injured
2002: 38 players and adults were seriously injured.
In all serious/severe injury cases, the newsletter states that extensive treatment for injuries was necessary.[14]
The severe injuries Little League lists for 2002 include fractures, a torn ACL, a sprained back, a head injury, a concussion, a broken leg, a broken finger, a broken jaw, a dental injury (specifics not provided), an injured knee (specifics not provided), a torn meniscus and a dislocated knee.
Despite all of this, Little League President Stephen Keener has steadfastly says that Little League’s records are accurate. In a 2008 interview, Keener said,
"Little League will continue its strong commitment to player safety, and we feel our well-documented record of safety in youth baseball speaks for itself.'' [15]
Yet Little League Inc. has presented:
· Understated numbers of injuries
· Compensated insurance claims as total injury figures
· Inaccurate numbers of severe injuries
· Specific injury figures when injury totals are by nature incalculable
To me, what speaks for itself is that Little League cannot prevent injuries or detect trends if they forget about them or remain unaware of them and that their “well-documented record” is an illusion that is shattered with the facts above.
[1] The Prevention of Sports Injuries in Children. Micheli, L.J, Glassman, R. and Klein, M. Clinics in Sports Medicine; 2000; 19;4; 821-834
[2] IBID
[4] What Parents Should Know About Little League Insurance; Littleleague.org
[5] ‘Foul Play’ series aired on the Connecticut Public Broadcasting network; this original web episode aired 08/11/08
[6] Marshall, S.W.; Mueller, F.O. & Kirby, D.P. ; et al. (2003). Evaluation of Safety Baseballs and Faceguards for Prevention of Injuries in Youth Baseball; JAMA , 289(5):568-574
[7] Mueller, F.O., Marshall, S.W. & Kirby, D.P. (2001). Injuries in Little League Baseball From 1987 Through 1996: Implications for Prevention; The Physician and Sportsmedicine, (29)7, p.41-48
[8] Dr. Ronald Danis’ Letter to the Editor, Injuries in Youth Baseball; JAMA. 2003; 290(2):194. doi: 10.1001/jama.290.2.194-a
[9] IBID
[10] Letter from Todd Stevenson, Secretary of the CPSC to J.W. MacKay, Jr. dated April, 5, 2002. The letter is on file at www.CPSC.gov.
[11] Mueller, F.O., Marshall, S.W. & Kirby, D.P. (2001). Injuries in Little League Baseball From 1987 Through 1996: Implications for Prevention; The Physician and Sportsmedicine, (29)7, p.41-48
[12] Marshall, S.W.; Mueller, F.O. & Kirby, D.P. ; et al. (2003). Evaluation of Safety Baseballs and Faceguards for Prevention of Injuries in Youth Baseball; JAMA , 289(5):568-574
[13] Little League safety newsletter, As Safe As Possible (ASAP), Jan-Feb 2004 Volume 11/Number 1
[14] IBID
[15] Associated Press, (2008, May 17), Boy's Baseball Injury Raises Bat Safety Questions, www.Nbcsports.msnbc.com
