Progress in Cheerleading: An Update on the Epidemiology of Cheerleading-Related Injuries Presenting to Emergency Departments in the U.S. (2010-2019) (105)
Authors: Xu Amy , Suresh Krishna Vangipuram , Lee R 
Published: October 2021

Objectives: Cheerleading attracts over 3 million participants annually and has been dubbed one of the most dangerous sports. It has become increasingly recognized as an official sport as its skills continue to escalate in complexity and difficulty, enhancing underlying susceptibility to injury. Even though its risks have been well-documented, cheerleading receives less attention in the medical literature than other sports. Few studies have assessed national injury profiles, with the most recent including data up to 2012. This study serves to provide an updated description of the epidemiology of cheerleading-related injuries over the past decade. Methods: The U.S. Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS) was analyzed for cheerleading-related injuries presenting to nationally representative emergency departments (EDs) from 2010-2019. Patient age, sex, race, injury time of year, body region injured, diagnosis, location, and disposition were collected. Using the narrative included with each case, we also captured the specific cheerleading skills, setting, and mechanism that led to injury. Specific stunting position and correctness of cheerleading terminology used were also NEISS sample weights were utilized to provide national estimates. Statistical analyses included linear regression, chi-squared tests, and relative risk calculations. Alpha was set to 0.05. Results: An estimated 351,399 (95% confidence interval [CI] = 254,975 – 447,823) athletes 5-25 years old presented to EDs for injuries sustained from cheerleading between 2010 and 2019. A breakdown of overall injury patterns is demonstrated in Table 1. Over the last decade, there was a significant decrease in the annual number of total injuries by 15.4% (m = -733.5, p = 0.048), corresponding to a significant decline of 27.2% (m = -469.2, p = 0.002) in rate of injury per 100,000 cheerleading participants. Specifically, the annual number of injuries sustained from stunting decreased by 24.1% (m = -289.9, p = 0.015) with a significant decline of 35.8% (m = -12.2, p = 0.005) in rate of injury. Despite these decreases, there was a significant 44.3% (m = 245.8, p = 0.025) increase in the incidence of concussions/closed head injuries (CHIs). There was also a significant rise in patients requiring admission after ED evaluation. The annual number rose by 117.7% (m = 69.7, p = 0.006), corresponding to a 9.0% (m = 1.6, p = 0.022) increase in admit rate per 100,000 participants. Comparing 2019 to 2010, other findings of note include an increased proportion of total injuries accounted for by males, head/neck, lower extremity injuries, and tumbling, as well as a higher percentage occurring during practice and in places of sports/recreation instead of schools. Conclusions: For the first time, we report a national decrease in injuries sustained from cheerleading over a period of time. Our findings illustrate a reduction in total acute cheerleading-related injuries presenting to emergency departments during the past decade despite continued development of the athleticism required of the sport. This may be the result of efforts by national governing bodies in heightening regulations and safety resources available as cheerleading becomes increasingly designated as an official sport by state legislatures. However, a continued high incidence of concussions/CHIs remains, demonstrating an area that requires further improvement. Overall, the comprehensive findings of this report provide an updated resource for both cheerleading and medical industries to utilize in order to enhance care for this subset of athletes.