Surfing USA: an epidemiological study of surfing injuries presenting to US EDs 2002 to 2013. From the surfing mecca of Rochester, NY comes a thorough epidemiologic study of surfing injuries presenting to emergency departments across the US. While a number of surfing-injury studies have been hospital-based, they all looked at injuries from a single hospital.1,2,3 This is the first population-based epidemiologic study to look at all surfing-related injuries presenting to a large number (100) of emergency departments across the United States.
Klick, et al gathered data from the National Electronic Injury Surveillance System (NEISS) maintained by the Consumer Products Safety Division which monitors a nationally representative sample of hospitals to identify injury trends of consumer products. Coders review approximately 400,000 records annually and provide demographic data as well as a written narrative of injuries sustained using consumer products, including product 1261, “Surfing”.
During the period 2002 – 2013 the authors identified 2,072 surfing injuries, yielding a national estimate of 131,494 injuries over the 12-year period, or approximately 11,000 emergency department visits per year across the US. Only cases in which the patient was stand-up surfing in the ocean were included. Excluded were cases where the patient was boogie boarding, SUP, bodysurfing, kiteboarding, etc., or when there was insufficient narrative to definitively determine activity. More than 75% of all surfing injuries were reported by only 3 of the 100 hospitals in the NEISS database.
The injuries found were similar to those reported in prior studies. Head neck and facial injuries accounted for 46% of all injuries, lower extremities 26%, upper extremities 16%, and trunk 8%. Lacerations accounted for 40.7% of injuries, followed by sprains and strains 14%, contusions 13%, fractures 11% and concussions 2.7%. Shoulder dislocations accounted for 3.5% of all cases. There was one shark attack, one seal attack, and 9 stingray-related punctures.
Ninety-five percent of patients were treated and released, 3.5% were admitted or transferred, and the rest left before treatment. There was one fatal drowning (the only fatality in the study), five non-fatal drownings, and one myocardial infarction. Older patients (>60 years old), those with trunk injuries, closed-head injuries and fractures were most likely to require admission.
What this study adds to our knowledge
Surfing injuries are not uncommon and account for at least ED 11,000 visits annually in the US. That number is likely an underestimate given the strict definitions and exclusion criteria used in the study, and because surfing is more popular now than during the study period. The data-set also demonstrates that the vast majority of injuries present to a small number of hospitals along heavily-surfed coastlines e.g. the southern California coastline. At these hospitals, surfing medicine is particularly relevant.
By and large, the severity of surfing injuries is low, with only 3.5% of injuries requiring hospital admission (~385 admissions annualy). Closed head injuries, internal injuries, and cervical-spine fractures are the most common severe injuries, and submersion injuries are rare. Fatalities in this study were extremely rare.
References
- Hay C, Barton S, Sulkin T. Recreational surfing injuries in Cornwall, United Kingdom. Wilderness Environ Med. 2009;20:335–8.
- Jubbal KT, Chen C, Costantini T, Herrera F, Dobke M, Suliman A. Analysis of Surfing Injuries Presenting in the Acute Trauma Setting. Ann Plast Surg. 2017
- Chang L, McDanal C. Boardsurfing and bodysurfing injuries requiring hospitalization in Honolulu. Hawaii Med. 1980;39:117