Discussion
The 11-day Cali Games had an incidence of 3.1% and 1% athletes suffering from at least one injury or illness, respectively. This is an overall rate of 31.2 injuries and 10.3 illnesses per 1000 athletes. The highest rates of injuries were recorded in jiu-jitsu, karate and roller inline hockey, while speed skating, softball and flying disc had the highest rates of ill athletes.
There are no reports of injuries or illnesses in previous World Games, a fact precluding comparisons with our results or evaluation of trends. This registry allows future comparisons with the next World Games. However, a comparison with previous Olympic Games is possible. In the London Olympic Games 2012, the overall rates were 128.8 injuries per 1000 athletes and 71.7 illnesses per 1000 athletes, from a total of 10 568 athletes.4 This represents a risk 4.12 times higher of having an injury and 6.96 times higher of having an illness, compared to the Cali Games. With 2824 athletes, the Cali Games had 3.74 times less athletes than the London Olympic Games. Our results can be due to the under-reporting of injuries and episodes of ill health, which were measured for the first time for the World Games. For multiple injuries in the same athlete, only the most severe injury was recorded, which certainly can generate an underestimation of the real incidence. Data from athletes with team physicians as part of their national delegation could have been missed because they never were treated by the Cali Games physicians, were not attended to at the local hospitals, and were probably not reported, since the reporting of injuries or illnesses was not mandatory. This can be improved for future World Games competitions by making the reporting of injuries or episodes of ill-health episodes mandatory.
In the Cali Games, we found that while 86% of the injuries produced an estimated time loss between 0 and 7 days, only 11 athletes (12.5%) had a time loss greater than 30 days, usually related to severe trauma such as fractures. Most of the injuries in the London Olympic Games (65%) had no absence from competition or training, 35% had an estimated time loss of at least 1 day from training or competition, while 13% had an estimated time-loss greater than 7 days. This estimated time loss related to injuries is similar between the Cali Games and the London Olympic Games.
In the Cali Games, hands were the most common site of injury, followed by the head and knees, whereas in the Beijing Olympic Games 2008 the most commonly affected sites were the thighs and the knees.5
The most common types of injuries were contusions (30.7%), followed by overuse injuries (19.3%), wounds (15.9%) and fractures (11.3%). In the London Olympic Games, the mechanisms most frequently reported were overuse injury (25%), non-contact trauma (20%), contusion with another athlete (14%) and contusion with a stationary object (12%).4
According to different registries of sports illnesses and injuries, there are differences in the incidence of pathologies for each sport. This shows the natural fluctuation and variability of athletes’ exposure to risk, which further emphasises the usefulness of this type of descriptive and ongoing surveillance studies to monitor trends over time. Maintaining and improving World Games registries is fundamental to achieving this.
Both in the Cali World Games and the London Olympic games, there were more illnesses affecting women than men. In the Cali Games, women had 15.0 episodes of ill health per 1000 athletes compared to 6.8/1000 athletes for men. In the London Olympic games, the incidence was 86.0/1000 for women and 53.3 illnesses per 1000 athletes for men. Men had a higher incidence of injuries in the Cali Games, 35.0 injuries per 1000 athletes, compared to women with 25 injuries per 1000 athletes. This is similar to what occurred in the Beijing Olympic Games (54.2% injuries in men) but different to that in London, where women had a higher incidence of injuries than men, 132.8 vs 121.0 injuries per 1000 athletes. Once again, the higher numbers observed in the London and Beijing Olympic games may be due to under-registration in the Cali Games.
Incidence usually considers the time exposed to risk as the denominator; however, in our study, the incidence of injuries or illnesses was expressed as the number of new cases per 1000 athletes. This is the recommendation of the International Olympic Committee for multisport events like the World Games. These types of surveillance studies are essential to identify and subsequently reduce the incidence of injuries and illnesses in sport competitions, which can also reduce the direct and indirect costs associated. Continuous monitoring in time can determine the true effect of the preventive measures implemented on the incidence of injuries and illnesses. This is the first study of its kind for a World Games competition and it represents a baseline for future events. There are some challenges such as the limited data-collection window, the monitoring of a large number of records in scarce time, the large amount of people involved in the event data-recording process, and the possibility of under-registration, which can all affect the quality of the information.
Under-reporting might be the principal limitation of this study. From the total 117 injury/illness episodes, 35 were from the medical institutions in the city (30%). The remaining 82 injury/illness episodes (70%) were evaluated by the medical staff at the World Games locations. The response rate for these data is thought to be 100%. Nevertheless, it was not measured. There are two main possible sources for under-reporting: first, athletes with minor injuries or illnesses that did not looked for medical attention; but this is a problem that may be present in every surveillance study conducted for a multisport event. The other reason are athletes that did not searched fot medical attention from the organisation but were only treated by the doctor in their national delegation. This was not previously contemplated by the study design and may be the principal cause for under-reporting. Though, this group must include mainly minor injuries or illnesses that did not required any X-rays, laboratories, additional specialised treatment nor caused absence from training or competition. For future World Games events, response rates should be measured and national delegations asked to provide their data about injuries and ill-health episodes.
The International World Games Association should develop an electronic health recording system that could improve data collection with all the variables of interest and that may help to monitor those athletes who are injured or have fallen ill. This record should be mandatory for every national delegation, regardless of whether the athlete is treated by the official physicians of the event or by the physicians of the delegation. This can improve both the quality and completeness of the data collected.
