The Current State of American Flag Football Injuries Among Female Athletes: A 10-Year Epidemiological Review of National Injury Data.

Background: Flag football, a noncontact variant of American football, has gained significant interest in the United States and globally, which has been attributed to its accessibility, low cost, and perceived safety compared with traditional tackle football. Purpose: To identify the trends, primary mechanisms, and distributions of American flag football injuries among female athletes to better inform prevention and safety measures. Study Design: Descriptive epidemiology study. Methods: Data analyzed in this study were extracted from the National Electronic Injury Surveillance System (NEISS), a public database representing approximately 100 US emergency departments (EDs) that provides national injury estimates. NEISS was queried for all flag football injuries in female patients from January 1, 2014, to December 31, 2023. Descriptive statistics were used to analyze the distribution of injury by age, mechanism, diagnosis, and body region. Linear regression was used to analyze changes in injury rates over time. Results: Across the study period, 605 female patients with flag football injuries were evaluated at US EDs, extrapolating to a national estimate (NE) of 22,666 injuries from 2014 to 2023. The highest frequency of injuries occurred in 2023 (NE = 3531; 15.6%) and the lowest in 2020 (NE = 436; 1.9%). The most common injury diagnosis was found to be strain/sprain (NE = 6835; 30.2%), with adolescents aged 11 to 20 years sustaining the greatest number of injuries across all diagnoses. The most commonly affected body part was the finger (NE = 137; 22.6%). When analyzing the mechanism of injury, the most common cause was fall, including fall on an outstretched hand (NE = 4321; 19.1%). In addition, the majority of patients were treated and released (NE = 22,253; 98.2%). Conclusion: This study demonstrated that from 2014 to 2023, female flag football injuries reported to US EDs remained relatively stable, dropping in 2020 during the COVID-19 pandemic and peaking in 2023. The most common injuries sustained by female athletes playing flag football were strains/sprains and fractures. Given the high prevalence of injuries sustained in the adolescent population, the use of appropriate protective gear should be emphasized to prevent a precipitous rise in injuries as the sport continues to grow in popularity throughout the country.