Study of Stanford student-athletes provides new insights into injury impacts

By tracking athletes' health with electronic medical records, Stanford researchers deliver a more comprehensive picture of the lingering effects of certain injuries.

Injured football player

Stanford physicians have studied injuries among the university’s nearly 1,700 student-athletes over a three-year period, gaining insight into the lasting impact of injuries.

Before any of the more than 12 million student athletes in the United States are allowed to kick, throw or hit a ball, they must fill out several pages of health forms, known as pre-participation evaluations. Most often this is done by hand, including injury updates, and so it requires an incredible effort for doctors to draw conclusions about the scale and impact of student-athlete injuries.

Now, Stanford physicians have produced a three-year medical report of the university’s nearly 1,700 student athletes during that period, providing insight into the lasting impact of injuries in greater detail than ever. The findings also support the value of electronic pre-participation evaluations (ePPE), which were used to track the students’ medical records.

Led by Gordon Matheson, a professor of orthopaedic surgery (sports medicine) at Stanford Health Care, researchers collaborated with the athletic department to enroll the school’s athletes into an ePPE program.

Students and physicians filled out the cloud-based program with multiple layers of branch-chain questions, which allowed for more thorough record-keeping than standard handwritten forms.

They marked down any injury that caused the student-athlete to miss time. These mostly consisted of musculoskeletal injuries, but also included concussions, eating disorders and illnesses such as infectious mononucleosis. In total, students reported 3,126 injuries – 1,473 for women, 1,653 for men – which caused them to miss, on average, 31.4 days of competition each.

Among the findings, 11 percent of the students still suffered symptoms from a previous injury at the time of their next ePPE. Head injuries accounted for 9 percent of all injuries. Although only 3 percent of women reported a diagnosed eating disorder, 15 percent of all women reported a history of stress fractures, which can be associated with low body fat, from either disordered eating or overtraining.

Matheson said that although the data are eye-opening, interpreting the material and deciding what is particularly meaningful may be an even bigger effort.

“We know that student-athletes have a lot of injuries from sport participation. But unless we have pooled, aggregate data like this, it’s difficult to measure trends and spot areas of concern applied to prevention,” Matheson said.

Going forward, Matheson said that he’d like to drill down on specific types of injuries, such as concussions, or investigate why so many students are still symptomatic at the time of follow-up ePPEs. These types of insights, however, will require a significantly larger and more diverse data set.

“I’d love to collaborate with other schools. Several thousand groups of data would really help us see what the trends are in sport injury and what’s going on in this population,” Matheson said. “For example, lingering symptoms might mean the offseason isn’t long enough for full recovery. Or, what are the criteria to use when determining participation status for a student-athlete with characteristics of disordered eating? I think there are findings that could make sports safer.”

The study is published in the current print issue of The American Journal of Sports Medicine and was co-authored by Scott Anderson and Kevin Robell, also of Stanford.