Anne M. Mulholland, Hayley V. MacDonald, Jonathan E. Wingo, FACSM. The University of Alabama, Tuscaloosa, AL.

BACKGROUND: From 2003-2018, the Bureau of Labor Statistics reports 14 deaths of sport officials in the US. However, little is known about risk of injury or death during sport officiating, and the accompanying physiological and environmental factors that contribute to elevated risk. The purpose of this study was to establish a comprehensive database to identify types and causes of illness, injury, and death of sport officials and whether they differ by sport or environment. METHODS: Relevant key words were utilized with a popular search engine to systematically review online media sources from 2000-2019 for mention of a referee, sporting official, umpire, or similar who experienced a work-related illness, injury, or death. Chi-square tests were used to determine if fatality is independent from type of injury, sport, and the event location (indoor, outdoor), and if type of injury is independent from type of sport officiated. RESULTS: 145 events of injury, illness, and death were identified, among 134 persons. Sport officials were predominantly male (n=128; female, n=2; unknown, n=4), ranging in age from 20 to 80 y (mean±SD; 52±13 y) with 2 to 48 years (23±12 y) of officiating experience. Events were primarily musculoskeletal (n=55), cardiovascular (CV) (n=42), or head injury (n=30). Sixteen events (7 fatalities, all during soccer games) were intentional injury by another person; all others were presumed accidental in nature. Events occurred most frequently during baseball (n=30), soccer (n=25), American football (n=22), and ice hockey (n=22) games, primarily at the professional (n=69) and high school (n=26) levels. Fatalities (n=36) occurred more frequently during soccer games (n=13; P<0.001) and almost half of all fatalities were CV events (n=17; P<0.001); no musculoskeletal injuries were fatal. CV events occurred primarily while officiating basketball (n=14) and American football (n=12), while head injuries occurred most often while officiating baseball (n=11; P<0.001). Fatal events occurred at similar rates in indoor (16.7%) and outdoor (18.2%) settings (P=0.83). CONCLUSION: Soccer officials experience the highest frequency of violent injury and death. CV events occur most frequently while officiating American football and basketball; further investigation is warranted to determine if this correlates with health status and the high physiological demand of officiating American football and basketball.

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