Epidemiology of Softball Injuries Comparison of Softball-Related Injuries at US Emergency Departments Between High School and Collegiate Athletes: A 10-Year NEISS Analysis, 2015-2024

Background: Softball is among the most widely played sports for women in the United States (US). However, contemporary comparisons of injury epidemiology between high school- and college-aged athletes are limited. Purpose: To provide an updated, comparative assessment of the epidemiology of softball-related injuries among female high school- and college-aged athletes and to characterize the burden of these injuries on emergency departments (EDs) across the United States. Study Design: Descriptive epidemiological study. Methods: The National Electronic Injury Surveillance System (NEISS) was queried for softball-related injuries in female athletes aged 14 to 23 years from 2015 to 2024. Patients aged 14 to 18 years were categorized as high school-aged, and those aged 19 to 23 years as college-aged. Weighted national estimates were calculated using NEISS sampling weights. Participation data from the National Federation of State High School Associations and the National Collegiate Athletic Association were used to derive population-based incidence per 100 at-risk participants. Incidence rate ratios (IRRs) with 95% CIs compared high school- and college-aged athletes for incidence, injury patterns, and disposition. Results: A total of 3385 NEISS cases corresponded to a weighted national estimate of 376,295 softball-related injuries in female athletes aged 14 to 23 years treated in US EDs between 2015 and 2024. College-aged athletes had a higher overall injury incidence than high school-aged athletes (22.44 vs 9.35 per 100 at-risk persons; IRR, 2.40 95% CI, 2.38-2.42). Both groups exhibited a sharp decline in injury incidence in 2020, corresponding with the onset of the coronavirus disease 2019 pandemic. The head, ankle, knee, and face were the most frequently injured body regions. When expressed per 100 at-risk persons, college-aged athletes had significantly higher injury rates to the upper leg, ear, eye, foot, and mouth, as well as higher rates of nearly all diagnosis categories, including avulsions, dental injuries, and lacerations. Most injuries were treated and discharged, but college-aged athletes had higher rates of admission/transfer, observation, and leaving against medical advice. Conclusion: Our study showed that from 2015 to 2024, college-aged female softball athletes were more than twice as likely as high school-aged athletes to present to the ED with a softball-related injury, with higher incidence across most body regions, diagnoses, and ED dispositions. These findings highlight a substantial, level-specific injury burden and support targeted preventive strategies.