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American football is one of the most popular sports in the United States (US) among youth and high school athletes; however, participation is decreasing due to concerns about safety. This has led to many new safety initiatives over the last decade, but few studies have sought to evaluate if these interventions have made football safer. The purpose of this study is to investigate national-level data on football-related injuries to compare the injury characteristics and specific injury risks of high school and youth athletes over the last decade. This cross-sectional, retrospective study queried the National Electronic Injury Surveillance System (NEISS) database from 2010–2019 to compare national weighted estimates and injury characteristics of youth (ages 6–12) and high school (ages 14–18) athletes presenting to US emergency departments (EDs) with football-associated injuries. The overall injury risk of football-related injuries presenting to US EDs for high school athletes was 16.17 (C.I. 13.85–18.38) per 1,000 participants/year compared to 11.97 (C.I. 10.34–13.41) per 1,000 participants/year in youth athletes. From 2010 to 2019, the overall injury risk for youth athletes participating in football significantly (p &lt; 0.0001) decreased from 13.31 (C.I. 11.23–15.38) per 1,000 participants to 9.93 (C.I. 7.24–12.62) per 1,000 participants. Additionally, the overall injury risk for high school athletes participating in football significantly (p &lt; 0.0001) decreased from 2010 (N = 18.63 [C.I. 16.05–21.21] per 1,000 participants) to 2018 (N = 13.19 [C.I. 9.94–16.44] per 1,000 participants). High school athletes were almost twice as likely and 2.37 times more likely to present with knee and shoulder injuries compared to youth athletes per 1,000 participants/year. Our study provides evidence that the overall injury risk for both youth and high school football players has significantly decreased since 2010. Furthermore, our study demonstrates that these athletes sustain unique injury characteristics.

Epidemiology of youth and high school American football-related injuries presenting to United States emergency departments: 2010-2019