Injury epidemiology in young female American football athletes: a 10-year analysis using NEISS data.

Abstract

American football has traditionally been male-dominated, but female participation in youth football is increasing, especially with the rise of flag football. This study aimed to (1) describe the epidemiology of injured body parts and diagnoses in female youth football athletes, and (2) compare injury patterns between pre-high school (≤14 years) and high school (≥15 years) players. American football-related injury data were obtained from the National Electronic Injury Surveillance System (NEISS) from 2012-2021, representing U.S. emergency department visits. All participants were female and ≤18 years. Injuries were classified by body part and diagnosis, then compared between pre-high school and high school groups. Descriptive statistics summarized injury characteristics. Chi-square tests assessed group differences, with odds ratios (OR), 95% confidence intervals (CI), and p-values for significance. NEISS data lack detail on injury context, which may limit interpretation. A total of 3,348 injuries were identified: 2,342 in pre-high school and 1,006 in high school athletes. The most common injury sites for both groups were the upper extremity (pre-high school: 57.9%; high school: 43.1%), followed by the lower extremity (22.1% vs. 30.6%) and head/trunk (18.7% vs. 25.1%). Pre-high school athletes sustained proportionally more finger injuries (38.8% vs. 27.1%, p=0.001) and fractures (31.8% vs. 20.4%, p=0.001). High school athletes had higher proportions of head (20.5% vs. 14.1%), ankle (12.7% vs. 10.2%), and knee injuries (10.3% vs. 5.3%) (all p<0.05), as well as more sprains/strains (39.3% vs. 33.9%, p=0.003) and concussions (11.1% vs. 7.4%, p=0.001). Injury patterns differ by age among female youth football players. Pre-high school athletes more often sustain finger injuries and fractures, while high school athletes experience more head, ankle, and knee injuries, along with higher rates of sprains/strains and concussions. These differences may reflect variations in physiology and style of play, and findings may inform age-specific injury prevention strategies and guide future research on female football athletes.