Thursday, March 8, 2012

It's All Fun and Games, Until Someone Loses...

My husband did that to our son.  Before you call CPS, allow me to explain: JJ was hit in the eye by his dad's fly ball.  Fortunately, he didn't suffer a serious injury, and by the next day, he was proudly showing off his shiner at school.

With opening day approaching and JJ now playing AAA ball, I'm getting more nervous than a mole in a Chuck-E-Cheese arcade. (I'm the kind of gal who ducks when a frisbee is thrown at her).  Those balls are being thrown faster and wilder, now that it's 100% kid pitch.  My one consolation is that he's not playing football.  In fact, baseball has one of the lowest rates of injury among youth sports.  The problem is that it has the highest rates of facial injuries, including fractures and eye and dental injuries.

This is what happens to an eyeball when it's struck head-on by a 66-mph ball:

Most kids my son's age can't pitch faster than 50 mph, but 66 mph is well within the range of 13-and 14-year-old pitchers.  While this degree of deformation rarely leads to globe rupture (think of a squished grape), it can cause retinal detachment and vision loss.

There are two ways to reduce the risk of baseball facial injuries: safety balls and faceguards.  Safety balls include the reduced-impact balls, which contain a polyurethane core instead of yarn wrapped around cork.  There haven't been any randomized, controlled trials of this preventive equipment.  In fact, one group of researchers approached a youth league in Indiana about performing an RCT of faceguards, but the league "refused to cooperate," so  they ran a nonrandomized study instead.  The 136 coaches who chose to make faceguards mandatory reported fewer facial impacts or injuries (12.3%) than the 102 who made them voluntary (15.7%).  Most of these injuries were minor, as only 10 children (8 of whom were on the control teams) sought medical treatment.

USA Baseball commissioned a more rigorous observational study looking at the rates of ball--related injuries and the effectiveness of safety balls and faceguards.  The authors used the data on injuries compensated by Little League's insurance for their calculations, so by design, these were more serious injuries. The overall risk of ball-related injury resulting in compensation was extremely low -- 28 per 100,000 players per season.  As expected, the risk of injury increased with the level of competition, while the use of safety balls and faceguards decreased.  After adjustment for level of competition, safety balls were found to decrease the rate of injury by 23%, and faceguards by 35%.

Despite this data, safety balls and faceguards aren't mandated by most youth leagues.  Safety balls just don't bounce like hardballs, and the most common argument against faceguards is the reduction in visibility.  Recommending faceguards won't significantly increase their use; leagues would have to mandate them, to level the playing field.  I would love to see a randomized, controlled trial of faceguards, not for safety reasons, but to see whether they affect one's batting average.  For younger kids, faceguards may have the advantage of reducing their fear of the ball, and possibly increasing their chances of hitting it.  As a team photographer, I have too many shots to count of 6-year-olds swinging with their eyes shut.

The last argument against faceguards is purely from a numbers perspective.  With an injury rate of only 28 per 100,000, and a 35% reduction in risk, you would have to add faceguards to 5,714 helmets to prevent one injury.  It would be helpful to know if leagues that require safety balls and faceguards pay less in insurance premiums than those that don't.  And it sure would be nice if insurance companies would cut them a break for making the safety of their players paramount.

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