Injury. 2025 Nov 26;57(2):112914. doi: 10.1016/j.injury.2025.112914. Online ahead of print.
INTRODUCTION: Musculoskeletal soft tissue injuries (MSKIs) impose a significant burden on the United States (US) healthcare system, constituting a large proportion of emergency department (ED) visits. Understanding the epidemiology of these injuries is critical for identifying at-risk populations, improving preventive measures, and optimizing resource allocation. This study aims to identify and describe trends in MSKIs presenting to US EDs from 2003 to 2023, using the National Electronic Injury Surveillance System (NEISS).
PATIENTS AND METHODS: A retrospective cross-sectional analysis of NEISS data from 2003 to 2023 was performed, focusing on low-energy mechanism injuries categorized as «Strain, Sprain» or «Avulsion.» Avulsions were manually evaluated to exclude non-MSKI avulsion injuries. Demographic and injury data, including age, gender, race, injury severity (defined according to disposition), and affected body part, were analyzed using descriptive and inferential statistics as well as survey analysis techniques. Piecewise regression was employed to assess trends in injury incidence rates (IR100k), with significance set at α = 0.05.
RESULTS: The final dataset included n = 941,996 observed injuries, which was extrapolated to an estimated national total of 36,605,488 injuries over 21 years. Annual IR100k declined significantly, with breakpoints in 2010, 2019, and 2020 (for each, P < 0.001), coinciding with important national public health events such as initiation of the Affordable Care Act (ACA) and the COVID-19 pandemic. The IR100k of soft tissue injuries presenting to US EDs did not rebound in the three years following the pandemic (P = 0.388). Severe injuries accounted for 0.68 % of all injuries, with minimal change over time in terms of proportion of injuries. The most common injuries presented in the lower extremities (56.8 %) and occurred in males aged <18-44 years. While demographic distributions showed marginal, yet statistically significant, variation, effect sizes were weak.
CONCLUSION: This 21-year analysis revealed declining trends in soft tissue MSKIs presenting to EDs, potentially influenced by societal events such as the ACA and COVID-19 pandemic. These findings highlight the potential impact of healthcare policy and public health crises on ED utilization patterns. and can potentially inform the aims of preventive and rehabilitative measures.
PubMed:41344102 | DOI:10.1016/j.injury.2025.112914