Boxing injuries treated in United States emergency departments, 2000–2023

OBJECTIVES: The objective of this study is to investigate the characteristics and trends of boxing injuries treated in United States (US) emergency departments. METHODS: Using a retrospective cohort study design, data from the National Electronic Injury Surveillance System for 2000-2023 were analyzed, including estimated national boxing injury frequencies and annual population-based rates. RESULTS: An estimated 362,869 boxing injuries were seen in US emergency departments from 2000 to 2023 with a 46.6% nonlinear increase in the boxing injury rate per one million US population from 4.38 in 2000 to 6.42 in 2023. Injuries were most common among males (87.5%) and individuals 18-24 years old (34.7%). Fractures were the most frequent diagnosis (24.6%), followed by soft tissue injuries (21.2%), and sprains/strains (20.9%). Concussions/closed head injuries accounted for 6.9% of injuries and were more likely to be admitted to the hospital (risk ratio [RR]: 4.37, 95% confidence interval [CI]: 2.54-7.51) than other diagnoses. Concussions/closed head injuries were also comparatively more common among younger age groups, accounting for 11.7% of injuries among children 6-11 years old. Most (86.6%) injuries occurred during practice or training. Competition-related injuries were more likely to involve the head/neck region (RR: 2.66, 95% CI: 2.25-3.15), be diagnosed as concussion/closed head injury (RR: 3.30, 95% CI: 2.58-4.22), or be admitted to the hospital (RR: 2.40, 95% CI: 1.43-4.03) than injuries occurring during practice or training. The most frequent injury mechanisms were 'struck opponent or object' (55.8%) and 'struck by opponent' (14.6%), while 'fall' was the mechanism associated with the highest proportion of hospital admissions (4.6%). CONCLUSIONS: Treatment of boxing injuries in US emergency departments is increasing, and concussions/closed head injuries disproportionately affect the vulnerable pediatric age group. The findings of this study improve our understanding of the epidemiology of boxing injuries, which will help inform targeted injury prevention efforts.