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Severity (Degree) of Injury

Some reporting systems may require additional severity information beyond the definition of reportable.2,7,8,12-14 Additional classifications of injury severity are based on length of disability and are classified as mild (out of participation for 7 days).2,7 More detailed ISS categorize severity as minor (1 to 7 days of absence), moderate (8 to 28 days of absence), and major (> 28 days of absence).13,29

Severity is often defined by the number of days the athlete is withheld from participation. Some view time lost from sport as the main indicator of the severity of the injury,8,14,20 and that time lost indirectly assesses severity.3 Discrepancies often occur when coaches report injuries, which is typical of youth ISS. Seven days appears to be the most common time frame used in defining mild vs severe injury.7 Usually, the day that an injury occurs is considered day zero and is not counted as time lost. For example, if a player is injured on Monday and returns to full participation the next day, Tuesday, the injury is reported as no time lost. An athlete who is unable to participate on Tuesday and Wednesday would be reported as 2 days of time lost. A career-ending injury is defined as an athlete who is unable to make a full return to sport.8

Location of Injury

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Injuries can be classified by location (head), type (contusion), and body side.2,7,8,12-14 Location of the injury refers to the area of the body that is affected.2,7,8,12,14 There are main groupings by body region (head, upper limb, trunk, and lower limb) that are then divided into specific segments. For example, the main grouping for injury location may be the lower limb, with subcategories that include hip/groin, thigh, knee, lower leg/Achilles tendon, ankle, and foot/toe.8 Body segments may also be combined into broader categories when the frequency of injury at a particular body area is low, such as with hand, wrist, and forearm injures. When using a coding system, such as the Orchard Sports Injury Classification System (OSICS), there are 24 injury locations and options for elaborating on the type of injury that the OSICS may identify, such as fracture, dislocation, etc.17-19,24 Streamlined grouping is efficient for data collection. Issues may develop when users review longitudinal data to see trends for specific injuries because OSICS will denote knee sprain but will not denote knee medial collateral ligament sprain. Therefore, some systems add detail around the location and structure. For example, the 2003-2004 NCAA ISS for women’s volleyball included a subcategory on knee injuries with knee structures identified (medial meniscus, lateral meniscus, ACL, posterior cruciate ligament, etc).9

Injury Classification

The tissue affected, rather than the location, is the main focus of injury diagnosis and care.23 In surveillance systems, injury classification focuses on type of injury (contusion, sprain, strain). Injury type is summarized under a main heading (muscle, tendon, bone, ligament) and can be further defined into subcategories (concussion with or without loss of consciousness).14 These subcategories identify the specific type of injury (dislocations/subluxations vs sprains/ligament injury).8

Clinically, when an injury occurs, a diagnosis is required by a clinician. These classifications can be turned into codes (numbers) for recordkeeping and billing. In general medicine, the International Statistical Classification of Diseases, Version 10 (ICD-10) is the preferred coding system used and is the gold standard. ICD-10 is used for tracking the general injuries and illness; however, the specificity of its codes limits its application for sport ISS.21

Surveillance systems may use a specific sport injury coding system. Examples of these systems include the OSICS,17-19 the National Athletic Injury/Illness Reporting System (NAIRS),20 and the Sports Medicine Diagnostic Coding System (SMDCS).21 Injury classification systems are used in sports medicine for the following 2 main purposes18:

1. To accurately classify diagnoses for injury surveillance

2. To create a database from which cases can be extracted for research on particular injuries.

Orchard Sports Injury Classification System

OSICS is a 4-character, specific sport injury classification system that was developed to examine the incidence of injury in elite level Australian-rules football in 1992. At the time, there was no sports-specific injury classification system available. Provided it is appropriately acknowledged, OSICS is free for researchers and sports medicine professionals to use. It is similar to the ICD-10, and recent revisions have made it easier to use in a sports medicine setting. OSICS-101 was released in 2010 and is currently used by Union of European Football Associations and Federation Internationale de Football Association.8,15-17 For the most accurate version of OSICS, sports injury specialists should refer to the website: www.johnorchard.com/about-osics.html.

National Athletic Injury/Illness Reporting System

Kenneth Clarke and John Powell developed the National Athletic Injury/Illness Reporting System (NAIRS) at Pennsylvania State University in 1975.12,18 NAIRS was originally developed to track football injuries and collected data from 1977 to 1981. All injuries were identified according to the American Medical Association’s Standard Nomenclature of Athletic Injuries.12 The initial system enhanced data collection and incorporated many important features, such as standardized definitions of injury/illness, standardized rates of AEs, and a larger longitudinal sample than previously attempted.20 The NAIRS classifications are the basis of the NCAA ISS and are widely used in the United States. However, because the classifications are now embedded in data collection systems, it is difficult to find literature supporting its reliability.18