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

Background: Baseball is one of the most popular sports among high school- and college-aged men and carries significant injury risk; however, contemporary data comparing injury epidemiology between these competition levels are limited. Purpose: To compare the population-adjusted incidence, anatomic location, and diagnoses of baseball-related injuries presenting to US emergency departments (EDs) between high school and college-aged male athletes. Study Design: Descriptive epidemiological study. Methods: The National Electronic Injury Surveillance System (NEISS) was queried for baseball-related injuries from 2015 to 2024 in male patients aged 14 to 23 years. Patients aged 14 to 18 years were classified as high school-aged and those aged 19 to 23 years as college-aged. Incidence, anatomic location, diagnoses, and ED disposition were analyzed. Weighted national estimates were calculated using NEISS sample weights, and National Federation of State High School Associations and National Collegiate Athletic Association (NCAA) participation data were used to derive incidence rates (IRs) per 100 at-risk players and IR ratios (IRRs) with 95% CIs. Results: A total of 8335 baseball-related injuries were identified in the NEISS sample, corresponding to a weighted national estimate of 297,921 male athletes aged 14 to 23 years evaluated in US EDs for baseball-related injuries between 2015 and 2024. College-aged athletes had a higher injury incidence and were nearly 3 times as likely to be evaluated as their high school-aged counterparts (14.00 vs 5.23 per 100 at-risk players; IRR, 2.68; 95% CI, 2.65-2.70). Both groups exhibited a sharp decline in injury incidence in 2020, corresponding with the onset of the COVID-19 pandemic. The most frequently injured body parts in both groups included the face, head, ankle, and knee, and fractures were the most common diagnosis. IRRs for nearly all injuries were higher among college-aged athletes, particularly for shoulder injuries (IRR, 4.20; 95% CI, 3.44-5.14) and dislocations (IRR, 5.98; 95% CI, 4.62-7.74). Conclusion: This study showed that between 2015 and 2024, college-aged baseball players had significantly higher IRs of ED-treated injuries than their high school-aged peers across most body regions and diagnoses. College-aged athletes face elevated risks for more severe injuries requiring emergency care, including fractures, dislocations, and concussions, highlighting the need for preventive strategies tailored to the specific demands of higher competition levels.