Emergency Department burden and factors associated with non-routine Emergency Department disposition for sports-related head and neck injuries among people aged 5–24 years in the United States, 2015–2025: a NEISS-based repeated cross-sectional study

Abstract To estimate the national emergency department (ED) burden and annual trends of sports-related head and neck injuries among people aged 5–24 years in the United States from 2015 to 2025, compare pre-pandemic, pandemic, and recovery periods using a temporally consistent case definition, and identify factors associated with non-routine ED disposition among included ED-treated injury records. This retrospective repeated cross-sectional study used National Electronic Injury Surveillance System (NEISS) data from 2015 to 2025. The main analysis used Product_1, primary body part, and primary diagnosis fields available in every year and excluded narratives explicitly describing destination transport, occupational or therapy activity, equipment maintenance or handling, or non-participating spectators. Non-routine ED disposition was defined as transfer, admission, observation, or death. National estimates and multivariable logistic regression accounted for the complex survey design. The primary analysis included 167,278 records, representing an estimated 5,175,954 ED visits (95% CI, 4,852,508-5,499,400). Non-routine ED disposition occurred in 6,282 records and represented 177,061 weighted visits (3.42%; 95% CI, 3.17%-3.69%). Transfer, admission, observation, and death represented 55,969, 109,083, 11,154, and 854 weighted visits, respectively. ED visits reached their lowest estimate in 2020 (283,026) and increased to 516,697 in 2024 and 521,027 in 2025. Team/ball sports produced the largest absolute ED burden, whereas motorized/wheeled and wheeled/rolling activities had higher proportions and adjusted odds of non-routine disposition among ED-treated cases. Results were materially unchanged when observation was excluded. Sports-related head and neck injuries among people aged 5–24 years accounted for a substantial U.S. ED burden. Visit estimates rebounded after 2020 but remained below the highest early-period estimates. Activity categories with the largest numbers of ED visits differed from those with the largest proportions of non-routine disposition among ED-treated cases; these results do not estimate sport-specific incidence or participant-level injury risk.