Patterns and Factors Associated with Escalated Care Following Sports Injuries in U.S. Emergency Departments: A Secondary Analysis of the 2025 National Electronic Injury Surveillance System

Abstract

Background: Evidence spanning youth and adult sports injuries is needed to prioritize prevention and emergency-care resources.
Objective: To describe sports-injury patterns and identify factors associated with escalated emergency department (ED) care.
Methods: We conducted a cross-sectional analysis of the 2025 National Electronic Injury Surveillance System. We identified sports-related ED visits using prespecified activity codes. The survey design was used to estimate national totals and 95% confidence intervals (CIs). A survey-weighted multivariable logistic model estimated adjusted odds ratios (aORs) for transfer, admission, observation, or death.
Results: Among 73,839 sampled visits, the national burden was 2.66 million (95% CI 2.20–3.12 million). Patients aged 10–17 years accounted for 40.5% of visits, and males for 65.4%. Team and ball sports contributed 48.9%; lower-extremity injuries (30.5%) and other or unspecified diagnoses (37.0%) were most frequent. Escalated care occurred in 5.9% (95% CI 4.5–7.3%) of visits with known disposition. Associations included age 65 years or older (aOR 4.52, 95% CI 3.50–5.84), male sex (1.61, 1.50–1.74), equestrian or climbing sports (3.63, 2.60–5.06), fracture (48.94, 32.99–72.60), and documented alcohol involvement (2.13, 1.37–3.32).
Conclusion: Sports injuries generated substantial ED use, while escalation risk was concentrated in older adults, selected sport categories, and clinically severe injury patterns. Prevention should combine high-volume youth and team-sport measures with severity-focused strategies for older and equestrian or climbing participants.