Catastrophic Injuries in Pole Vaulters: Response

Dear Editor: This letter is written in response to the article ‘‘Catastrophic Injuries in Pole Vaulters: A Prospective 9-Year Follow-up Study’’ by Boden et al. The authors should be commended for their work in improving pole vault safety. However, I have some concerns. Based on a conclusion in the study that ‘‘the average annual rate of catastrophic injuries from pole vaulters landing in the vault box has more than tripled over the past decade and remains a major problem,’’ the National Collegiate Athletic Association on December 1, 2013 implemented a rule making it mandatory to use a certain Safety Max Box Collar (retail, $600; Gill Athletics, Champaign, Illinois, USA) in pole vaulting. The National Federation of State High School Associations is likely soon to follow. The authors of this article claimed no conflict of interest. However, coauthor Jan Johnson, the inventor of the Safety Max Box Collar, had secured a patent in 2009. The title is misleading in that the methods used were not prospective, including retrospective data collection through the Internet. No registry was created to prospectively collect data regarding injuries as they occurred. The article states, ‘‘Data were collected from the NCCSIR [National Center for Catastrophic Sport Injury Research], Internet searches (Google, polevaultpower), and communication with the National Pole Vault Safety Committee and the Pole Vault Safety Certification Board. ’’ Since 2006, there has been no USA Track & Field (USATF)–supported National Pole Vault Safety Committee. Jan Johnson has appointed himself as the chairperson of his own committee since 2006. The Pole Vault Safety Certification Board is also Jan Johnson’s creation and is an online educational program teaching safety and pole vault instruction, which supplies a certificate after completion of the course for a fee. In their original study in 2001, Boden et al obtained catastrophic data from 1982-1998 exclusively from the NCCSIR, using the NCCSIR definitions for direct catastrophic injuries. Thirty-two catastrophic cases, including 31 catastrophic head injuries and 1 thoracic spine fracture with paraplegia, were documented in the original study. No cases of serious injuries, as defined by the NCCSIR, were included. In the most recent study, data acquisition came from more sources, and the definition of direct catastrophic injuries was expanded to include injuries that would have fallen into the category of serious injuries as defined by the NCCSIR. Therefore, because different methods of data acquisition were used and different definitions of direct catastrophic injuries were used between their 2 studies, a direct comparison of rates of injuries cannot be made. A comparison could be made if only the data obtained from the NCCSIR were analyzed. The authors did mention this limitation with the following statement: ‘‘Alternatively, because of the lower number of injuries in this report identified by the NCCSIR and the higher number located through Internet searches and other avenues, it is possible that the new report has more injuries that were ‘less catastrophic. ’’’ It is hard to imagine that no serious injuries occurred from 1982-1998. Had the same methods been used in the original study, the numbers of catastrophic cases would have likely been significantly higher. I requested information from Dr Boden and Mr Johnson, and the authors have not been forthcoming with regard to information regarding their cases obtained from the NCCSIR and those obtained by other avenues. However, they have provided me with a spreadsheet documenting the 19 cases in question (Table 1). The NCCSIR now has a policy of not providing data unless a formal request is made for the purpose of research. However, I have been able to deduce, based on tables provided by the NCCSIR on their website, that at most, only 8 cases of direct catastrophic track and field cases were recorded from 2003-2011. Because the Boden et al study indicated that 2 deaths occurred during this time period, the third death reported by the NCCSIR must have involved a non–pole vaulter. This suggests that at most, the NCCSIR reported only 7 direct catastrophic injuries, which is in stark contrast to the 19 reported by Boden et al. One of the authors, Rebecca Peter, directed me to her website at www.polevaultpower. com, where she had listed 9 catastrophic cases during this time period of 2003-2011. Reviewing these 9 cases, only 2 cases involved landing in the vault box area. All met the NCCSIR definition of a direct catastrophic injury. Both fatalities were noted. Interestingly, 1 of the deaths, by account of the athlete’s coach, was not the result of landing in the vault box area as suggested by Boden et al. The athlete landed on the runway or other surface in front of the pit. Therefore, no deaths occurred during this time period by landing in the box. In addition, cross-referencing an 18-year-old high school female athlete’s injury demonstrated that her injury occurred by hitting her head on the asphalt runway and not in the vault box area as noted by Boden et al. If both vault box landing injuries listed on the Pole Vault Power website (www.polevaultpower.com) were included in the NCCSIR data, then only 2 of 7 direct catastrophic injuries were the result of landing in the box or 28.6% (compared with 74% as reported by Boden et al). This is comparable with the 25% noted in the original study. According to Boden et al’s first study, the overall rate of direct catastrophic pole vault injuries was 2.0 per year, and the rate of fatalities was 1.0 per year. By my calculations, from 2003-2011, the rate of direct catastrophic injuries would be 7 cases in 9 years, or 0.78 per year (or 39% of